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.


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


  • 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
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