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

• Caused by 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

• 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 most of the time due to improper handling of food
• Pets and the use of household items such as plates and toys cannot transmit the disease or bacteria

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

• 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