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
Pearl Toh, 6 days ago
A study finds no evidence that using pharmaceutical aids alone for smoking cessation helps improve the chances of successful quitting despite promising results in previous randomized trials and routine prescription of such drugs to help quit smoking.
Audrey Abella, 22 May 2017
Fixed-dose combinations of long-acting β2-agonist (LABA) and muscarinic antagonist (LAMA) offered superior efficacy and comparable safety to LAMA or LABA/inhaled corticosteroid (ICS), the two most commonly prescribed first-line treatments for stable moderate-to-very-severe chronic obstructive pulmonary disease (COPD), according to a meta-analysis.
Stephen Padilla, 09 Jan 2018
Very elderly adults have the highest rate of invasive pneumococcal diseases, according to a recent study, suggesting that age influences manifestations of this illness.
27 Dec 2017
The prevalence of allergic diseases in the Asia-Pacific region is expected to rise over the next 20 years, driven by rapid economic development and urbanization. Allergic diseases have high socioeconomic impact by impairing productivity and quality of life, and the impact may be greater in Asia-Pacific than in Europe due to the presence and predominance of perennial allergens.