- Synonym(s): sore throat; tonsillitis; “strep throat”
- 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.
- ~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% of cases)
- 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 a serious sequela, but is rare in the United States (<1 case 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.
- Affects all age groups; some etiologies and sequelae occur more frequently in 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 (associated with lower grade fever)
- Rhinovirus; adenovirus (associated with conjunctivitis); parainfluenza virus; coxsackievirus (hand-foot-mouth disease); coronavirus; echovirus
- Herpes simplex virus (HSV) (vesicular lesions); Epstein-Barr virus (EBV/mononucleosis); cytomegalovirus (CMV)
- Acute, bacterial (associated with 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)
- Chronic, 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 (rheumatic fever possible, especially in children/adolescents 5 to 15 years)
- 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).
There's more to see -- the rest of this topic is available only to subscribers.