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Questions and Answers
What is the most common cause of pharyngitis in children?
What is the most common cause of pharyngitis in children?
- Rhinovirus
- Epstein-Barr Virus
- Common cold (correct)
- Influenza virus
What is the typical presentation of streptococcal pharyngitis?
What is the typical presentation of streptococcal pharyngitis?
- Cough, nasal congestion, and conjunctivitis
- Acute onset fever and sore throat, with cough and rhinorrhea
- Diarrhea, oropharyngeal lesions, and hoarseness
- Acute onset fever and sore throat, with headache, nausea, and vomiting (correct)
What is the name of the virus that causes mononucleosis?
What is the name of the virus that causes mononucleosis?
- Influenza virus
- Cytomegalovirus
- Rhinovirus
- Epstein-Barr Virus (correct)
What is the name of the infection caused by group A beta-hemolytic streptococci?
What is the name of the infection caused by group A beta-hemolytic streptococci?
What is the typical age range for streptococcal pharyngitis?
What is the typical age range for streptococcal pharyngitis?
What is a complication of streptococcal pharyngitis in about 1 in 10 cases?
What is a complication of streptococcal pharyngitis in about 1 in 10 cases?
What is the treatment approach for viral pharyngitis?
What is the treatment approach for viral pharyngitis?
What is a common symptom of viral pharyngitis?
What is a common symptom of viral pharyngitis?
What is the most common cause of acute pharyngitis?
What is the most common cause of acute pharyngitis?
What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in adults?
What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in adults?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a virus?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a virus?
What is the duration of acute pharyngitis?
What is the duration of acute pharyngitis?
What is the name of the bacterium that is the most common cause of bacterial pharyngitis?
What is the name of the bacterium that is the most common cause of bacterial pharyngitis?
What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?
What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?
What is the clinical syndrome associated with Epstein-Barr virus (EBV) infection?
What is the clinical syndrome associated with Epstein-Barr virus (EBV) infection?
What can be seen in all types of pharyngitis?
What can be seen in all types of pharyngitis?
What is a rare complication of GABHS pharyngitis in North America?
What is a rare complication of GABHS pharyngitis in North America?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?
What is the duration of chronic pharyngitis?
What is the duration of chronic pharyngitis?
What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is a complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is a complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is a characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?
What is a characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the estimated number of GABHS pharyngitis cases that need to be treated to prevent one case of acute rheumatic fever in the USA?
What is the estimated number of GABHS pharyngitis cases that need to be treated to prevent one case of acute rheumatic fever in the USA?
What is the term for the type of pharyngitis shown in the image?
What is the term for the type of pharyngitis shown in the image?
What is the primary method of confirming a peritonsillar abscess diagnosis?
What is the primary method of confirming a peritonsillar abscess diagnosis?
What is the primary goal of the general approach to acute pharyngitis?
What is the primary goal of the general approach to acute pharyngitis?
What is a common symptom of retropharyngeal abscess?
What is a common symptom of retropharyngeal abscess?
What is the age range of peak incidence of retropharyngeal abscess?
What is the age range of peak incidence of retropharyngeal abscess?
What is a red flag or alarm symptom in pharyngitis?
What is a red flag or alarm symptom in pharyngitis?
What is the treatment approach for retropharyngeal abscess?
What is the treatment approach for retropharyngeal abscess?
What is the difference between infectious and non-infectious causes of pharyngitis?
What is the difference between infectious and non-infectious causes of pharyngitis?
What is the most common non-infectious cause of pharyngitis?
What is the most common non-infectious cause of pharyngitis?
What is the definition of fever?
What is the definition of fever?
What is the significance of fever in the context of pharyngitis?
What is the significance of fever in the context of pharyngitis?
What is the name of the virus that causes herpes simplex pharyngitis?
What is the name of the virus that causes herpes simplex pharyngitis?
What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?
What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?
What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?
What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?
What is the likely diagnosis given Alex Best's symptoms and physical examination?
What is the likely diagnosis given Alex Best's symptoms and physical examination?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?
What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?
What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is a characteristic oral finding in scarlet fever?
What is a characteristic oral finding in scarlet fever?
What is a common finding on intraoral examination in strep throat?
What is a common finding on intraoral examination in strep throat?
What is the typical age range for streptococcal pharyngitis?
What is the typical age range for streptococcal pharyngitis?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What is the name of the complication of streptococcal pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is the name of the complication of streptococcal pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
Which of the following viruses is NOT a common cause of acute pharyngitis?
Which of the following viruses is NOT a common cause of acute pharyngitis?
What is the primary difference between acute and chronic pharyngitis?
What is the primary difference between acute and chronic pharyngitis?
Which of the following bacteria is NOT a common cause of bacterial pharyngitis?
Which of the following bacteria is NOT a common cause of bacterial pharyngitis?
Which of the following is a common complication of pharyngitis in immunocompromised patients?
Which of the following is a common complication of pharyngitis in immunocompromised patients?
What is the term for the inflammation of the pharynx?
What is the term for the inflammation of the pharynx?
Which of the following is a characteristic of acute pharyngitis?
Which of the following is a characteristic of acute pharyngitis?
What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in children?
What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in children?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent one case of ARF in the USA?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent one case of ARF in the USA?
Which of the following is NOT a common cause of infectious pharyngitis?
Which of the following is NOT a common cause of infectious pharyngitis?
What is the term for the type of pharyngitis caused by infection of the pharynx by a fungus?
What is the term for the type of pharyngitis caused by infection of the pharynx by a fungus?
What is the characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?
What is the characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?
What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
In what population is the risk of ARF higher in Canada?
In what population is the risk of ARF higher in Canada?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?
What is the suppurative complication of GABHS pharyngitis that can affect the ear?
What is the suppurative complication of GABHS pharyngitis that can affect the ear?
What is the primary goal of the general approach to acute pharyngitis?
What is the primary goal of the general approach to acute pharyngitis?
What is a red flag or alarm symptom in pharyngitis?
What is a red flag or alarm symptom in pharyngitis?
What is the difference between infectious and non-infectious causes of pharyngitis?
What is the difference between infectious and non-infectious causes of pharyngitis?
What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?
What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?
What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?
What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is the typical age range for streptococcal pharyngitis?
What is the typical age range for streptococcal pharyngitis?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What percentage of sore throats in children are caused by Group A beta-hemolytic streptococci?
What percentage of sore throats in children are caused by Group A beta-hemolytic streptococci?
Which of the following viruses is NOT a common cause of viral pharyngitis?
Which of the following viruses is NOT a common cause of viral pharyngitis?
What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?
What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?
Which of the following is a clinical syndrome associated with Epstein-Barr virus (EBV) infection?
Which of the following is a clinical syndrome associated with Epstein-Barr virus (EBV) infection?
What is the duration of chronic pharyngitis?
What is the duration of chronic pharyngitis?
What is the most common cause of bacterial pharyngitis?
What is the most common cause of bacterial pharyngitis?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?
What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?
What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?
What is the term for the type of pharyngitis caused by infection of the pharynx by a bacterium?
What is the term for the type of pharyngitis caused by infection of the pharynx by a bacterium?
What is the primary cause of acute epiglottitis?
What is the primary cause of acute epiglottitis?
What is the typical age range for epiglottitis?
What is the typical age range for epiglottitis?
What is a characteristic finding on lateral radiograph of the neck in epiglottitis?
What is a characteristic finding on lateral radiograph of the neck in epiglottitis?
What is a complication of retropharyngeal abscess?
What is a complication of retropharyngeal abscess?
What is a risk factor for lymphoma, head and neck cancers?
What is a risk factor for lymphoma, head and neck cancers?
What is a symptom of primary HIV infection?
What is a symptom of primary HIV infection?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is the primary mode of transmission for group A beta-hemolytic streptococci?
What is a characteristic oral finding in scarlet fever?
What is a characteristic oral finding in scarlet fever?
What is a common finding on intraoral examination in strep throat?
What is a common finding on intraoral examination in strep throat?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the primary site of infection for group A beta-hemolytic streptococci?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What is the typical appearance of the tonsils in streptococcal pharyngitis?
What is a characteristic of the rash in scarlet fever?
What is a characteristic of the rash in scarlet fever?
What is a common complication of streptococcal pharyngitis?
What is a common complication of streptococcal pharyngitis?
What is the typical age range for streptococcal pharyngitis?
What is the typical age range for streptococcal pharyngitis?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent one case of acute rheumatic fever in Canada?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent one case of acute rheumatic fever in Canada?
What is the typical time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is the typical time frame for developing acute rheumatic fever after GABHS pharyngitis?
What is the name of the autoimmune disorder associated with GABHS infection that can lead to abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children?
What is the name of the autoimmune disorder associated with GABHS infection that can lead to abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children?
What is the name of the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is the name of the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?
What is the estimated incidence of acute rheumatic fever (ARF) in remote, Canadian Indigenous communities?
What is the estimated incidence of acute rheumatic fever (ARF) in remote, Canadian Indigenous communities?
What is the name of the complication of GABHS pharyngitis that can lead to injury to the glomerulus due to deposition of immune complexes and circulating autoantibodies?
What is the name of the complication of GABHS pharyngitis that can lead to injury to the glomerulus due to deposition of immune complexes and circulating autoantibodies?
What is the name of the suppurative complication of GABHS pharyngitis that can lead to fever, neck stiffness, and swelling of the neck?
What is the name of the suppurative complication of GABHS pharyngitis that can lead to fever, neck stiffness, and swelling of the neck?
Study Notes
Viral Pharyngitis
- Most pharyngitis cases are viral in origin
- Associated symptoms: cough, nasal congestion, conjunctivitis, hoarseness, diarrhea, oropharyngeal lesions (ulcers or vesicles)
- Viruses that cause pharyngitis in children:
- Common cold (50%): rhinovirus, coronavirus, adenovirus, parainfluenza virus, respiratory syncytial virus
- Influenza (5%): Influenza virus (type A and B)
- Mononucleosis (5%): Epstein-Barr Virus (EBV), cytomegalovirus (CMV)
Streptococcal Pharyngitis (GABHS)
- Infection of pharynx caused by group A beta-hemolytic streptococci (GABHS)
- Most common in children aged 5-15
- Risk factors: exposure to sick contact with GABHS, winter or early spring
- Typical presentation:
- Acute onset fever and sore throat
- Headache, nausea, vomiting, malaise, dysphagia, abdominal pain
- Cough and rhinorrhea usually absent
- Edema and erythema of tonsils and pharynx; non-adherent tonsillar and/or pharyngeal exudate
- Enlarged and tender anterior cervical lymph nodes
- May evolve into scarlet fever (1 in 10 cases): scarlatiniform rash and strawberry tongue
- May have palatine petechiae
Causes of Pharyngitis
- Infectious causes:
- Viral: most common cause of sore throat
- Bacterial: group A beta-hemolytic streptococci (GABHS) most common cause
- Fungal: rare, consider in immunocompromised patients or those with chronic steroid or antibiotic use
- Non-infectious causes:
- Unknown
Complications of Pharyngitis
- Non-suppurative complications:
- Acute rheumatic fever (ARF): rare in North America, more common in children than adolescents and adults
- Poststreptococcal glomerulonephritis: can develop 1-2 weeks after infection with GABHS
- Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection: abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children following GABHS infection
- Suppurative complications:
- Peritonsillar abscess
- Retropharyngeal abscess
- Otitis media
- Sinusitis
- Mastoiditis
- Cervical lymphadenitis
- Meningitis
- Bacteremia
Acute Pharyngitis
- Definition: Inflammation of the pharynx
- Duration: Less than 2 weeks is considered acute pharyngitis, more than 2 weeks is chronic pharyngitis
Causes of Pharyngitis
- Infectious causes:
- Viral: Rhinovirus, Coronavirus, Adenovirus, Herpes Simplex Virus, Influenza A and B, Parainfluenza virus, Epstein-Barr virus, Cytomegalovirus, Human herpesvirus 6, HIV
- Bacterial: Group A beta-hemolytic streptococci (GABHS), Fusobacterium necrophorum, Group C beta-hemolytic streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Non-infectious causes:
- Persistent cough
- Upper airway cough syndrome (postnasal drip)
- Gastroesophageal reflux disease
- Acute thyroiditis
- Neoplasm
- Allergies
- Smoking
General Approach to Acute Pharyngitis
- Rule out serious diagnoses and red flags/alarm symptoms that prompt emergent/urgent management
- Determine the specific infectious cause (viral or bacterial)
- Identify acute sore throat caused by Group A beta-hemolytic streptococcal (GABHS) pharyngitis, which may require antibiotic treatment
Red Flags/Alarm Symptoms
- Peritonsillar abscess
- Retropharyngeal abscess
- Stridor
- Drooling
- Dysphonia (muffled voice)
- Neck stiffness; limited neck ROM (especially hyperextension)
Complications
- Non-suppurative complications:
- Acute rheumatic fever (ARF)
- Poststreptococcal glomerulonephritis
- Pediatric autoimmune neuropsychiatric disorder associated with Group A streptococcal (PANDAS) infection
- Suppurative complications:
- Peritonsillar abscess
- Retropharyngeal abscess
- Otitis media
- Sinusitis
- Mastoiditis
- Cervical lymphadenitis
- Meningitis
- Bacteremia
Acute Pharyngitis
- Definition: Inflammation of the pharynx
- Duration: Acute pharyngitis - less than 2 weeks, Chronic pharyngitis - more than 2 weeks
- Causes:
- Infectious:
- Viral: Rhinovirus, Coronavirus, Adenovirus, Herpes simplex virus, Influenza A and B, Parainfluenza virus, Epstein-Barr virus, Cytomegalovirus, Human herpesvirus 6, HIV
- Bacterial: Group A beta-hemolytic streptococci, Fusobacterium necrophorum, Group C beta-hemolytic streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Non-infectious:
- Persistent cough
- Upper airway cough syndrome (postnasal drip)
- Gastroesophageal reflux disease
- Acute thyroiditis
- Neoplasm
- Allergies
- Smoking
- Infectious:
Causes of Pharyngitis
- Viral:
- Rhinovirus: 20% of sore throats, common cold
- Coronavirus: 5% of sore throats, common cold
- Adenovirus: 5% of sore throats, acute respiratory disease
- Herpes Simplex Virus (HSV): 4% of sore throats, stomatitis, pharyngitis
- Influenza A and B: 2% of sore throats, influenza
- Parainfluenza virus: 2% of sore throats, common cold, croup
- Epstein-Barr virus (EBV): <1% of sore throats, infectious mononucleosis
- Cytomegalovirus (CMV): <1% of sore throats, infectious mononucleosis
- HIV: <1% of sore throats, primary HIV infection
- Bacterial:
- Group A beta-hemolytic streptococci (GABHS): 15-30% of sore throats, pharyngitis, tonsillitis
- Fusobacterium necrophorum: 10% of sore throats, pharyngitis, peritonsillar abscess, Lemierre syndrome (rare)
- Group C beta-hemolytic streptococci: 5% of sore throats, pharyngitis, tonsillitis
- Neisseria gonorrhoeae: <1% of sore throats, pharyngitis
- Corynebacterium diphtheriae: <1% of sore throats, diphtheria
- Mycoplasma pneumoniae: <1% of sore throats, pneumonia, bronchitis
- Chlamydophila pneumoniae: unknown, pneumonia, bronchitis
General Approach to Acute Pharyngitis
- Rule out serious diagnoses and red flags/alarm symptoms that prompt emergent/urgent management
- Most cases of acute pharyngitis are due to infectious cause - determine the specific infectious cause (i.e., viral or bacterial)
- Identify acute sore throat caused by Group A beta-hemolytic streptococcal (GABHS) pharyngitis
- Antibiotic treatment may be indicated
Red Flags/Alarm Symptoms
- History of recent foreign body impaction or oropharyngeal procedure (trauma)
- Fever, rash, diffuse adenopathy, sore throat (Primary HIV infection)
- Recent cocaine smoking (Mucosal burn injury to pharynx and larynx)
- Weight loss, fevers, night sweats (Lymphoma, head and neck cancers)
- Acute epiglottitis (Rare but potentially fatal condition, bacterial infection primarily caused by Haemophilus influenzae)
Complications
- Non-suppurative complications:
- Acute rheumatic fever (ARF)
- Poststreptococcal glomerulonephritis
- Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection
- Suppurative complications:
- Peritonsillar abscess
- Retropharyngeal abscess
- Otitis media
- Sinusitis
- Mastoiditis
- Cervical lymphadenitis
- Meningitis
- Bacteremia
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Description
Learn about the common symptoms and viruses that cause viral pharyngitis, including the common cold, influenza, and others. Identify the associated symptoms and viruses that affect children.
