Diagnosis

Pharyngitis

Inflammation of the mucous membranes of the oropharynx.

Etiology

Causes: [srp][9nm][yof][gzz][soq]

  1. Environmental factors: cold air, irritants, postnasal drip, reflux

  2. Infectious agent:

    • Viral (75%):

      • EBV (mononucleosis)

      • Rhinovirus

      • Adenovirus

      • Parainfluenza virus

      • Coxsackievirus

      • Coronavirus

      • Echovirus

      • Cytomegalovirus (CMV)

    • Bacterial (25%):

      • Group A β-hemolytic Streptococcus

      • Arcanobacterium hemolyticum

      • Group C streptococci (uncommon)

      • Group G streptococci (uncommon)

      • Neisseria gonorrhoeae (uncommon)

      • Mycoplasma pneumoniae

      • Chlamydia pneumoniae

      • Chlamydia trachomatis

      • Treponema pallidum

      • Fusobacterium necrophorum

      • Corynebacterium diphtheriae (rare)

      • Francisella tularensis

      • Yersinia pestis

  3. Chronic inflammation due to recurrent irritation of the mucous membrane:

    • Smoking, postnasal drip, gastroesophageal reflux disease

    • Kawasaki disease, Behçet syndrome, chemotherapy, ACE-inhibitors

    • Peritonsillar abscess, retropharyngeal abscess, epiglottitis

Pathophysiology [gzz]

  1. Direct invasion of the pharyngeal mucosa

  2. Excess secretion and edema

  3. Clinical manifestations:

    • Fever

    • Tonsillar exudates

    • Painful cervical adenopathy

    • Pharyngeal erythema

    • Ear pain

    • Viral etiology: coughing, rhinorrhea, conjunctivitis, headache, and a rash

Complications [gzz]

Epidemiology

Incidence per 100.000 [srp][chg][nzc][w4o][iiz][hnd]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Asthenia, Conjunctivitis, Cough, Diarrhea, Fever, Headache, Hoarseness, Lymphadenopathy, Mucus, Myalgia, Nausea, Neck stiffness, Odynophagia, Otalgia, Rhinorrhea, Sore throat, Vomiting

Clinical findings

None listed.

Anamneses

None listed.

Localized findings

Pain
Radiates
Cavum oris (inside mouth)Throat (pharynx and larynx)
Onset
Subacute (hours)
Pattern
Constant
Provoked by
Swallowing
Severity
Mild (1-3)Moderate (4-7)
Rash
Radiates
Cavum oris (inside mouth)
Lesion type
Erythema
Color
Red
Swelling
Radiates
Cavum oris (inside mouth)Tonsil
Onset
Gradual (days)
Pattern
Constant

Approach

Treatment

  1. Viral pharyngitis --> symptomatic treatment:

    • Paracetamol

    • Dexamethasone is debatable

  2. Antibiotic treatment of group A β-hemolytic Streptococcus to prevent acute rheumatic fever: [skd]

    • 1st line: Penicillin V 300-600mg x 3 for 10 days or Amoxicillin 50 mg/kg for 10 days

    • If penicillin allergy: Cephalexin 20 mg/kg/dose 2 times per day

    • If penicillin anaphylaxis: Clarithromycin 7.5 mg/kg/dose 2 times per day for 10 days

      Clindamycin 5 to 10 mg/kg/dose 3-4 times per day for 10 days

      Azithromycin 12 mg/kg/day for 5 days

Differential diagnoses

Allergic rhinosinusitis, Croup, Diphtheria, Epiglottitis, Gastroesophageal reflux disease, Hand-Foot-and-Mouth disease, Herpes simplex, Influenza, Laryngopharyngeal reflux disease, Mononucleosis, Mycoplasma infection, Peritonsillar abscess, Pneumonia, Retropharyngeal abscess, Scarlet fever

References

[1] Pellegrino R, Timitilli E, Verga MC, Guarino A, Iacono ID, Scotese I, Tezza G, Dinardo G, Riccio S, Pellizzari S, Iavarone S, Lorenzetti G, Simeone G, Bergamini M, Donà D, Pierantoni L, Garazzino S, Esposito S, Venturini E, Gattinara GC, Lo Vecchio A, Marseglia GL, Di Mauro G, Principi N, Galli L, Chiappini E; Other members of the Italian Panel for the Management of Acute Pharyngitis in Children. Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives. Eur J Pediatr. 2023 Dec;182(12):5259-5273.

[2] https://emedicine.medscape.com/article/967384

[3] https://emedicine.medscape.com/article/764304

[4] Wolford RW, Goyal A, Belgam Syed SY, et al. Pharyngitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519550/

[5] Goldin J, Graber M. Bacterial Pharyngitis. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559007/

[6] Pearce S, Bowen AC, Engel ME, de la Lande M, Barth DD. The incidence of sore throat and group A streptococcal pharyngitis in children at high risk of developing acute rheumatic fever: A systematic review and meta-analysis. PLoS One. 2020 Nov 18;15(11):e0242107.

[7] Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, Bloom DE, Cannon JW. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. EClinicalMedicine. 2022 May 20;48:101458.

[8] Danchin MH, Rogers S, Kelpie L, Selvaraj G, Curtis N, Carlin JB, Nolan TM, Carapetis JR. Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia. Pediatrics. 2007 Nov;120(5):950-7.

[9] Oliver J, Malliya Wadu E, Pierse N, Moreland NJ, Williamson DA, Baker MG. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLoS Negl Trop Dis 2018;12(3):e0006335.

[10] Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clini Infect Dis 2012;55(10):e86-102.

[11] Little P, Hobbs FD, Moore M, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: Randomised controlled trial of PRISM (primary care streptococcal management). BMJ 2013;347:f5806.

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