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- Acute or chronic inflammation of the pharyngeal mucosa and underlying structures of the throat
- Group A Streptococcus (GAS) pharyngitis is notable for preventable suppurative (e.g., retropharyngeal or peritonsillar abscess) and nonsuppurative (e.g., rheumatic sequelae) complications.
- Synonym(s): sore throat; tonsillitis; “strep throat”
- ~15 million cases are diagnosed yearly.
- Accounts for 1–2% of all outpatient visits and 6% of all pediatric visits to primary care physicians
- Most commonly viral (40–60%)
- GAS is the most common bacterial cause of acute pharyngitis, accounting for 15–30% of pediatric and 5–15% of adult cases. The incubation period ranges from 24 to 72 hours.
- Rheumatic fever is rare in the United States (<1 per 100,000). Early antibiotic use has diminished occurrence.
- 3,000 to 4,000 patients with group A β-hemolytic streptococcal infection must be treated to prevent one case of acute rheumatic fever.
- All age groups, some etiologies more common with certain age groups
The highest incidence of rheumatic fever is in children 5 to 18 years as a rare sequela of streptococcal pharyngitis.
Etiology and Pathophysiology
- Acute, viral (lower grade fever)
- Adenovirus (associated with conjunctivitis)
- Parainfluenza virus
- Coxsackievirus (hand-foot-mouth disease)
- Herpes simplex virus (vesicular lesions)
- Epstein-Barr virus (EBV/mononucleosis)
- Cytomegalovirus (CMV)
- Acute, bacterial (higher fevers)
- Group A β-hemolytic streptococcus
- Neisseria gonorrhoeae
- Corynebacterium diphtheriae (diphtheria)
- Haemophilus influenzae
- Moraxella catarrhalis
- Chlamydia pneumonia
- Fusobacterium necrophorum (20% young adult cases)
- Group C or G streptococcus
- Arcanobacterium haemolyticum
- Mycoplasma pneumoniae
- Francisella tularensis (tularemia)
- Acute, noninfectious
- Various caustic, mechanical, or trauma-related (including endotracheal intubation)
- More likely noninfectious
- Chemical irritation (GERD)
- Radiation changes
Patients with a family history of rheumatic fever have a higher risk of rheumatic sequelae following an untreated group A β-hemolytic streptococcal infection.
- Epidemics of group A β-hemolytic streptococcal disease
- Cold and flu season (late fall through early spring)
- Age (especially children/adolescents 5 to 15 years)
- Family history of rheumatic fever
- Close contact with infected individuals (home, daycare, military barracks)
- Smoking/secondhand smoke exposure
- Acid reflux
- Oral sex
- Diabetes mellitus
- Recent illness (secondary postviral bacterial infection)
- Chronic colonization of bacteria in tonsils/adenoids
- Avoid close contact with infectious patients.
- Wash hands frequently.
- Avoid first or secondhand smoke.
- Manage preventable causes (e.g., GERD).