Harvey's Garden

Acute tonsillitis and pharyngitis

2 min read

Epidemiology

Etiology

  • Viral: Most common cause (~70-90%). Adenovirus, Rhinovirus, Coronavirus, EBV (Mononucleosis), CMV, HSV.
  • Bacterial: Group A -hemolytic Streptococcus (GAS/S. pyogenes) is the most important bacterial cause (15-30% in children). t
  • Other Bacterial: Fusobacterium necrophorum (Lemierre syndrome), N. gonorrhoeae, C. diphtheriae (rare/unvaccinated).

Pathophysiology

Clinical features

Acute bacterial tonsillopharyngitis

  • Sudden onset of symptoms: fever, sore throat, dysphagia
  • Significantly inflamed pharynx
    • Pharyngeal and/or tonsillar erythema and edema
    • Pharyngeal and/or tonsillar exudates (rare in children < 3 years of age)
    • Palatal petechiae
  • Cervical lymphadenitis
  • Absence of cough

Acute viral tonsillopharyngitis

Accompanied by symptoms of a common cold (rhinitis and/or pharyngitis)

Diagnostics

Rapid strep test

  • Modality: rapid antigen detection test (RADT) specific for GAS antigens.
  • Indications: first-line test in suspected acute bacterial tonsillopharyngitis
    • All symptomatic children ≥ 3 years of age and adults (unless symptoms are suggestive of acute viral tonsillopharyngitis)
  • Procedure: Swab the patient’s tonsils and the back of the throat.
  • Findings
    • Identifies the presence of GAS (positive RADT).
    • Time to result: 5–10 minutes

Additional laboratory tests

  • Antistreptolysin O (ASO) titer
    • Elevated levels suggest a previous GAS infection; not helpful to diagnose acute pharyngitis
    • Indicated in the workup of nonsuppurative complications of GAS tonsillopharyngitis (e.g., acute rheumatic fever, PSGN).

Treatment

Graph View

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