Tonsillopharyngitis%20-%20acute Signs and Symptoms
Definition
- 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
Etiology
- 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
Signs and Symptoms
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
Risk Factors
- 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