Pharyngitis - PMC - National Center for Biotechnology Information Because of recent improvements in rapid streptococcal antigen tests, throat culture can be reserved for patients whose symptoms do not improve over time or who do not respond to antibiotics. While most patients with sore throat have an infectious cause (pharyngitis), fewer than 20 percent have a clear indication for antibiotic therapy (i.e., group A beta-hemolytic streptococcal infection). Viral features and testing for streptococcal pharyngitis. Hence, careful diagnosis of pharyngitis is necessary to provide targeted treatment. Gonococcal pharyngitis is diagnosed by a positive culture (Thayer-Martin medium) for Neisseria gonorrhoeae. (PDF) Acute tonsillitis and its complications: an overview John R. Bower, in Netter's Infectious Diseases, 2012 Viral Causes of Pharyngitis. Gieseker KE, Roe MH, MacKenzie T, Todd JK. Tonsillar hypertrophy, erythema, edema, or cobblestoning of the posterior pharynx suggest viral infections.2 Findings like upper-lip edema, splenomegaly, posterior cervical adenopathy, and polymorphic rashes increase suspicion for Epstein-Barr virus (EBV) infections.9,15 Bacterial pathogens might cause anterior cervical lymphadenopathy, sandpaperlike (scarlatiniform) rashes, tonsillar exudates, and palatal petechiae.16 Fungal pharyngitis presents with angular cheilitis and painful white curdlike plaques or smooth red patches within the oropharynx.14, Key physical findings in the oropharynx in viral, bacterial, and fungal pharyngitis, Patients can present with some or none of these signs and symptoms. [ 1] The most common and important bacterial cause of pharyngitis is Streptococcus pyogenes (group A Streptococcus [GAS]). Maintaining adequate hydration is critical, regardless of treatment strategy. She denies recent sick contacts and has not traveled in the past 2 months. In determining the underlying cause and thereby deciding if, when, and how to treat the patient with pharyngitis, the physician must integrate information from the history and physical examination. Although a broad variety of differential diagnoses must be considered, ranging from infectious or inflammatory etiology to traumatic or neoplastic processes, the vast majority of these symptoms derive from either a viral or bacterial source. The tongue may be bright red with a white coating (strawberry tongue).4. Infection with Streptococcus pyogenes (group A beta-hemolytic streptococci) is the most common bacterial cause of acute pharyngitis and is responsible for an estimated 5 to 15% of sore throat cases among adults [ 3] and 20 to 30% of cases among children [ 2, 4 ]. (PDF) Pharyngitis: Approach to diagnosis and treatment - ResearchGate group A streptococci. Antibiotic treatment of children with sore throat. Neuner JM, Hamel MB, Phillips RS, et al. The relative importance of each of these agents varies greatly depending on a number of epidemiologic factors, including age of the patient, season of the year, and geographic locale.VirusesMost cases of acute pharyngitis are viral in etiology and involve the pharynx as well as other portions of the respiratory . Therapeutic goals for treating pharyngitis include amelioration of symptoms, decrease in contagion and transmission, prevention of complications, and, to some extent, satisfying the patient's personal goals in the physicianpatient interaction. the contents by NLM or the National Institutes of Health. Bacterial infections also have particular defining characteristics. Some physicians will begin antibiotic therapy presumptively for patients with severe symptoms who meet three or four of the Centor criteria, and may not send a diagnostic test in addition to testing. Pharyngitis is one of the most common conditions encountered by the family physician. The resultant inflammatory process can damage heart muscle and valves (especially, mitral valves), connective tissue, joints, and the central nervous system. Pharyngitis is an inflammation of the pharynx that can lead to a sore throat. Pharyngitis. and transmitted securely. Outbreaks of pharyngitis may occur in households or classrooms, and, infrequently, may be linked to food or animal sources. Modified Centor scoring system: Used to calculate the risk of streptococcal pharyngitis and to decide whether RADT and antimicrobial therapy should be initiated in patients presenting with sore throat. Many bacterial and viral organisms are capable of inducing pharyngitis, either as a single manifestation or as part of a more generalized. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Therefore, the majority of laboratory diagnostics for pharyngitis concentrate on the presence or absence of GABHS. For severe symptoms, viscous lidocaine preparations (e.g., Magic Mouthwash), stronger pain medicines or narcotics, or alternative modalities can be tried. Characteristic signs and symptoms include fever, bilateral nonpurulent conjunctivitis, anterior cervical node enlargement, erythematous oral mucosa, and an inflamed pharynx with a strawberry tongue. Symptoms often manifest after an incubation period ranging from 1 to 5 days, and occur most commonly in the winter or early spring. Dermatologic features of the disease become apparent within three days of the onset of fever14,18 and include cracked red lips, a generalized polymorphous erythematous rash with edema and erythema of the hands and feet, and periungual desquamation followed by peeling of the palms. The majority of cases are of viral origin and do not require antibiotic treatment. Pharyngitis is inflammation of the pharyngeal tissues, and is usually associated with pain. Upper Respiratory Infections - PMC The etiology is usually infectious, with most cases being of viral origin and most bacterial. Antibiotic stewardship and the low incidence of streptococcal pharyngitis complications suggest that treatments can be largely supportive. Acute pharyngitis is an inflammatory syndrome of the pharynx and/or tonsils caused by several different groups of microorganisms. Thai TN, Dale AP, Ebell MH. Oral corticosteroids for 1 to 2 days have been shown to reduce odynophagia (number needed to treat of 4) but they have no effect on the clinical course.6,42 Lozenges and benzocaine or lidocaine mouth rinses also provide mild pain relief by numbing the oropharynx.10 Nonsteroidal antiinflammatory drugs such as ibuprofen, along with acetaminophen, can be used to reduce pain and fever in adults and children.43 Acetylsalicylic acid is contraindicated in pediatric patients owing to the risk of Reye syndrome.10 Patients suspected of EBV infections should be advised to refrain from contact sports owing to the increased risk of splenic rupture secondary to EBV. Thomas M, Del Mar C, Glasziou P. How effective are treatments other than antibiotics for acute sore throat? Last, physicians should ensure that patients understand the medical course of their illness, and are satisfied with the assessment and treatment plan. Diagnosis and Management of Group a Streptococcal Pharyngitis in the Group C streptococci also may cause pharyngitis, but would ultimately be distinguished by a RAD test or throat culture. Acute pharyngitis. These frameworks should guide, but not supersede, a physicians clinical judgment. Pathophysiology of Pharyngitis | PDF | Rtt | Immunology - Scribd pharyngitis. Kocoglu E, Karabay O, Yilmaz F, Ekerbicer H. The impact of incubating the throat culture for 72 h on the diagnosis of group A beta-hemolytic streptococci. Editorial commentary: antibiotics for treatment of acute respiratory tract infections: decreasing benefit, increasing risk, and the irrelevance of antimicrobial resistance. Merrill B, Kelsberg G, Jankowski TA, Danis P. What is the most effective diagnostic evaluation of streptococcal pharyngitis? Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. What clinical features are useful in diagnosing strep throat? Whether or not a second RAD or throat culture is to be used as back up to initial testing should depend on the level of clinical suspicion and prevalence of GABHS in the region. Values from McIsaac et al.18. Bethesda, MD 20894, Web Policies The absence of tender anterior cervical adenopathy, tonsillar enlargement, and tonsillar or pharyngeal exudate was most useful in ruling out GABHS. Campagna JD, Bond MC, Schabelman E, Hayes BD. In most cases, it is caused by an infection, either bacterial or viral. The specimen is inoculated onto a 5 percent sheep-blood agar plate, and a bacitracin disk is applied. As discussed above in the pathophysiology section, the most common bacterial cause of pharyngitis is GABHS, occurring in 5 to 30% of cases. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. It is one of the most common reasons for visits to family physicians. A single intramuscular dose of benzathine penicillin G can alternatively be used if adherence is in question.3,27 The number needed to prevent 1 sore throat at 1 week using antibiotics in patients with a positive throat swab is 21. Acute influenza and HIV are the only viruses for which treatments with antiviral agents may improve symptoms. Acute pharyngitis - Etiology | BMJ Best Practice US Pharyngitis is a common concern seen in primary care, caused by viral, bacterial, and fungal agents. A sore throat caused by a virus resolves on its own. Second, based on the above assessment, the physician must determine which laboratory tests, if any, should be carried out to ensure the proper diagnosis. Moesker FM, van Kampen JJA, Aron G, Schutten M, van de Vijver DA, Koopmans MP, et al. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Adapted from the National Institute for Health and Care Excellence.38, Traditionally, there has been a low threshold for treating pharyngitis owing to the risks of bacterial complications. Assistant Professor and Research Director in the Department of Otolaryngology at Queens University and Adjunct Scientist with ICES Queens. Scores below 2 to 3 have up to a 40% chance of streptococcal infection, and risk increases to up to 65% with a score of 4.19 This approach might be equivalent if not superior to the modified Centor score for reducing the need for diagnostic testing and antibiotics without negatively affecting patient outcomes.19. IDSA updates guideline for managing group A streptococcal pharyngitis. Viral causes are often self-limiting, while bacterial and fungal infections typically require antimicrobial therapy. For GABHS pharyngitis, if antibacterial therapy is begun within 3 days of symptom onset, the duration of fever and pain may be shortened by approximately 1 day.4 The primary purpose of using antibiotics in GABHS pharyngitis is to avoid the development of further complications (discussed in the section below). Rapid and simple molecular tests for the detection of respiratory syncytial virus: a review. Streptococcus pyogenesgroup A streptococcus (GAS)infections (strep throat) occur in up to 30% and 15% of sore throats in pediatric and adult populations, respectively.2 Group A streptococcus infections can have life-threatening complications in less than 0.015% of pediatric and 0.05% of adult patients.4,5 These can be separated into nonsuppurative (acute rheumatic fever, glomerulonephritis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) and suppurative (peritonsillar abscess, septic jugular-vein thrombophlebitis, Vincent angina) complications that warrant urgent medical or surgical intervention.2,6.
