Tonsillopharyngitis%20-%20acute Signs and Symptoms

• Tonsillopharyngitis is the acute infection of the pharynx, palatine tonsils, or both
• Also called strep throat, acute tonsillitis, pharyngitis or adenotonsillitis
• One of the most common diseases seen in primary care

• Main cause of acute tonsillopharyngitis
• Double-stranded DNA viruses (human adenovirus, Epstein-Barr virus), single-stranded RNA viruses (influenza, para-influenza, rhinovirus, enteroviruses, Coxsackie virus, coronaviruses, respiratory syncytial virus [RSV], human meta-pneumo-virus), and retroviruses (human immunodeficiency virus [HIV]) are among the viral causes

• Responsible for about 5-15% of clinic consultations for acute sore throat in adults 
• Most commonly caused by Gram-positive cocci known as S pyogenes
  • This organism exhibits beta-hemolysis on blood agar plates
  • Belongs to group A Lancefield classification system for beta-hemolytic strep infection
• Other bacterial causes include group C and G Streptococci, Haemophilus influenzae, Nocardia, Corynebacteria and Neisseria gonorrhoeae

• Spreads through person-to-person contact, usually through saliva or nasal secretions from an infected person
  • Primary reservoir of group A Streptococcus are the humans
• Easily transmitted in the schools, day care centers, and 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

Clinical Features Suggestive of a Viral Etiology

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

Clinical Features Suggestive of Group A Beta-Hemolytic Streptococci (GABS) 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 GABS 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 and erythema with or without exudates
• Headache
• Nausea and vomiting (N/V)
• Abdominal pain
• Malodorous breath

Red Flags

• Assess for signs and symptoms of airway obstruction needing urgent management
• Respiratory distress: Chest retractions, cyanosis, moderate-severe dyspnea, increased respiratory rate, shallow breathing, difficulty swallowing, choking, foreign body inhalation, drooling, dysphonia
• Altered mental state, decreased consciousness level, severely lethargic, excessively sleepy, with difficulty to stay awake, unresponsive
• Changes to everyday activity: Refuses to eat, markedly reduced activity
• Signs of dehydration and no urine produced for >12 hours, vomiting
• Meningeal signs: Stiff neck, persistent vomiting, severe headache
• Petechial or purpuric rash

• Commonly infects children aged 5-15 years old and 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