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 streptococcus is suspected.

Definition

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

Etiology

  • 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
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 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

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 Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 30 Aug 2019
Infection with hepatitis B virus (HBV) does not appear to independently affect pregnancy outcomes, although it contributes to prolonged infertility, higher odds of secondary infertility, ovulatory disorders and reduced implantation rate, a study has found.
Dr. Joseph Delano Fule Robles, 23 Jan 2019

Scientists from the Department of Microbiology, University of Hong Kong (HKU) recently discovered a compound with broad antiviral activity against viruses causing Middle East Respiratory Syndrome (MERS), avian flu (H7N9), severe acute respiratory syndrome (SARS) and Zika fever.

Pank Jit Sin, 27 Jun 2019

How does it feel to be told one has contracted HIV? How equipped are doctors when breaking the news to a patient that he or she has been diagnosed with HIV? Are we able to provide people living with HIV (PLHIV) the counselling and skills required to take them through this difficult period of life? MIMS Doctor speaks to Dr Julian Hong, a general physician practicing in Singapore, about the challenges faced by both patients and doctors when faced with the difficult topic of HIV.