tonsillopharyngitis%20-%20acute
TONSILLOPHARYNGITIS - ACUTE
Patients with group A beta-hemolytic streptococcal pharyngitis have classic symptoms of tonsillar swelling/exudates, tender anterior cervical lymphadenopathy, with no cough but with fever of >38ºC.
Clinical features suggestive of a viral etiology are conjunctivitis, absence of fever, coryza, cough, diarrhea, anterior stomatitis, hoarseness, discrete ulcerative lesions, rhinorrhea and viral exanthem and/or enanthem.
Antibiotics will not be needed for every patient that presents with sore throat but it should not be withheld if the clinical condition is severe or group A beta-hemolytic streptococca is suspected.

Definition

  • Tonsillopharyngitis is the acute inflammation of the pharynx, tonsils, or both

Etiology

  • Caused by a gram-positive cocci known as S pyogenes
  • This organism exhibits beta-hemolysis on blood agar plates
  • They belong to group A Lancefield classification system for beta-hemolytic strep infection
Mode of Transmission
  • Spreads through person-to-person contact, usually through saliva or nasal secretions from an infected person
  • The primary reservoir of group A streptococcus are the humans
  • The disease is easily transmitted in the following places:
    • Schools
    • Day care centers
    • Military training facilities
  • Transmission via food is rare and if transmission happens, it is due to improper handling of food
  • Pets and the use of household items such as plates and toys cannot transmit the disease or bacteria

Signs and Symptoms

Clinical Features Suggestive of Group A Beta-Hemolytic Streptococci  Pharyngitis

  • The incubation period is approximately 2-7 days

Most classic symptoms:

  • Tonsillar swelling/exudates
  • Tender anterior cervical lymphadenopathy
  • Absence of cough
  • Fever >38°C

Other features of Group A Beta-Hemolytic Streptococci pharyngitis:

  • History of exposure
  • Sudden onset of sore throat
  • Pain on swallowing
  • Petechiae on soft palate (“doughnut” lesions)
  • Scarlet fever rash
  • Beefy red, swollen uvula
  • Tonsillopharyngeal inflammation & erythema with or without exudates
  • Headache
  • Nausea & vomiting (N/V)
  • Abdominal pain
  • Malodorous breath

Clinical features suggestive of a viral etiology:

  • Absence of fever
  • Conjunctivitis
  • Coryza
  • Cough
  • Diarrhea
  • Anterior stomatitis
  • Hoarseness
  • Discrete ulcerative lesions
  • Rhinorrhea
  • Viral exanthem and/or enanthem

Risk Factors

  • Commonly infects children aged 5-15 years old & rare in <3 years old
  • Parents of school-aged children and other adults who are in close contact with the infected individual
  • Crowded places like day care centers, schools and military barracks
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
22 May 2017
Chronic obstructive pulmonary disease (COPD) is currently the 10th commonest cause of death in Singapore, with a disease burden of 5.9 percent according to a 2015 population-based survey (EPIC-Asia survey) in Singapore. Pearl Toh spoke with Dr Augustine Tee, chief and senior consultant of the Department of Respiratory and Critical Care Medicine at Changi General Hospital (CGH) in Singapore, on how COPD is often underdetected in the primary care population as symptoms are not specific and diagnosis requires a combination of clinical risk factors, symptoms and spirometry testing.
15 Aug 2017
New drug applications approved by US FDA as of 1 - 15 August 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.
04 Aug 2017
Chronic obstructive pulmonary disease (COPD) is the fourth cause of global mortality, with experts predicting a potential future rise in the prevalence rates of COPD. 
11 May 2016

In conjunction with World Asthma Day which falls on 3rd May 2016, MIMS Doctor speaks to a renowned respiratory medicine specialist, Dato' Dr. Hj Abdul Razak Abdul Muttalif, regarding the chronic airway disease.