Viral Pharyngitis Symptoms and Causes

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Questions and Answers

What is the most common cause of pharyngitis in children?

Common cold

What is the typical presentation of streptococcal pharyngitis?

Acute onset fever and sore throat, with headache, nausea, and vomiting

What is the name of the virus that causes mononucleosis?

Epstein-Barr Virus

What is the name of the infection caused by group A beta-hemolytic streptococci?

Streptococcal pharyngitis Signup and view all the answers

What is the typical age range for streptococcal pharyngitis?

5-15 years Signup and view all the answers

What is a complication of streptococcal pharyngitis in about 1 in 10 cases?

Scarlet fever Signup and view all the answers

What is the treatment approach for viral pharyngitis?

Supportive care only Signup and view all the answers

What is a common symptom of viral pharyngitis?

Cough and rhinorrhea Signup and view all the answers

What is the most common cause of acute pharyngitis?

Viral infection Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in adults?

5-15% Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?

At least 25% of cases Signup and view all the answers

What is the name of the type of pharyngitis that is caused by infection of the pharynx by a virus?

Viral pharyngitis Signup and view all the answers

What is the duration of acute pharyngitis?

Less than 2 weeks Signup and view all the answers

What is the name of the bacterium that is the most common cause of bacterial pharyngitis?

Group A beta-hemolytic streptococci (GABHS) Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?

10% Signup and view all the answers

What is the clinical syndrome associated with Epstein-Barr virus (EBV) infection?

Infectious mononucleosis Signup and view all the answers

What can be seen in all types of pharyngitis?

Palatal petechiae Signup and view all the answers

What is a rare complication of GABHS pharyngitis in North America?

Acute rheumatic fever Signup and view all the answers

What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?

Bacterial pharyngitis Signup and view all the answers

What is the duration of chronic pharyngitis?

More than 2 weeks Signup and view all the answers

What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?

1-4 weeks Signup and view all the answers

What is a complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?

Acute rheumatic fever Signup and view all the answers

What is a characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?

Abrupt onset of severe exacerbations of obsessive-compulsive type behaviors Signup and view all the answers

What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?

All of the above Signup and view all the answers

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?

3000-4000 Signup and view all the answers

What is the term for the type of pharyngitis shown in the image?

Viral pharyngitis Signup and view all the answers

What is the primary method of confirming a peritonsillar abscess diagnosis?

Culture of pus from abscess drainage Signup and view all the answers

What is the primary goal of the general approach to acute pharyngitis?

Rule out serious diagnoses and red flags/alarm symptoms Signup and view all the answers

What is a common symptom of retropharyngeal abscess?

Drooling Signup and view all the answers

What is the age range of peak incidence of retropharyngeal abscess?

3-5 year olds Signup and view all the answers

What is a red flag or alarm symptom in pharyngitis?

A symptom that prompts emergent or urgent management Signup and view all the answers

What is the treatment approach for retropharyngeal abscess?

All of the above Signup and view all the answers

What is the difference between infectious and non-infectious causes of pharyngitis?

Infectious causes include viral and bacterial causes, while non-infectious causes include smoking and allergies Signup and view all the answers

What is the most common non-infectious cause of pharyngitis?

Smoking Signup and view all the answers

What is the definition of fever?

Body temperature over 38°C (100.4°F) Signup and view all the answers

What is the significance of fever in the context of pharyngitis?

It strongly suggests an infectious cause Signup and view all the answers

What is the name of the virus that causes herpes simplex pharyngitis?

Herpes simplex virus (HSV) Signup and view all the answers

What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?

Acute rheumatic fever Signup and view all the answers

What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?

Streptococcus pyogenes Signup and view all the answers

What is the likely diagnosis given Alex Best's symptoms and physical examination?

Pharyngitis Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?

40-50% Signup and view all the answers

What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?

Type II hypersensitivity reaction Signup and view all the answers

What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?

Viral pharyngitis Signup and view all the answers

What is the name of the type of pharyngitis that is caused by infection of the pharynx by a bacterium?

Bacterial pharyngitis Signup and view all the answers

What is the primary mode of transmission for group A beta-hemolytic streptococci?

Through direct contact with mucus from the nose or throat of infected persons Signup and view all the answers

What is a characteristic oral finding in scarlet fever?

Marked erythema and prominent papillae on the tongue Signup and view all the answers

What is a common finding on intraoral examination in strep throat?

Redness and edema of the oropharynx, with petechiae on the soft palate Signup and view all the answers

What is the typical age range for streptococcal pharyngitis?

Any age, but most common in children Signup and view all the answers

What is the primary site of infection for group A beta-hemolytic streptococci?

The respiratory tract Signup and view all the answers

What is the typical appearance of the tonsils in streptococcal pharyngitis?

Yellowish-white exudate on the surface Signup and view all the answers

What is the name of the complication of streptococcal pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?

Rheumatic fever Signup and view all the answers

Which of the following viruses is NOT a common cause of acute pharyngitis?

Hepatitis C virus Signup and view all the answers

What is the primary difference between acute and chronic pharyngitis?

The duration of symptoms Signup and view all the answers

Which of the following bacteria is NOT a common cause of bacterial pharyngitis?

Escherichia coli Signup and view all the answers

Which of the following is a common complication of pharyngitis in immunocompromised patients?

Fungal pharyngitis Signup and view all the answers

What is the term for the inflammation of the pharynx?

Pharyngitis Signup and view all the answers

Which of the following is a characteristic of acute pharyngitis?

Recent onset of sore throat Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by Group A beta-hemolytic streptococci (GABHS) in children?

15-30% Signup and view all the answers

What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent one case of ARF in the USA?

3000-4000 Signup and view all the answers

Which of the following is NOT a common cause of infectious pharyngitis?

Parasitic pharyngitis Signup and view all the answers

What is the term for the type of pharyngitis caused by infection of the pharynx by a fungus?

Fungal pharyngitis Signup and view all the answers

What is the characteristic of pediatric autoimmune neuropsychiatric disorder associated with GABHS infection?

Abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children Signup and view all the answers

What is the time frame for developing acute rheumatic fever after GABHS pharyngitis?

1-4 weeks Signup and view all the answers

What is the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?

Acute rheumatic fever Signup and view all the answers

In what population is the risk of ARF higher in Canada?

Indigenous communities in Northern Ontario Signup and view all the answers

What is the term for the autoimmune response that leads to poststreptococcal glomerulonephritis?

Deposition of immune complexes and circulating autoantibodies Signup and view all the answers

What is the suppurative complication of GABHS pharyngitis that can affect the ear?

Otitis media Signup and view all the answers

What is the primary goal of the general approach to acute pharyngitis?

To rule out serious diagnoses and red flags/alarm symptoms Signup and view all the answers

What is a red flag or alarm symptom in pharyngitis?

Severe headache Signup and view all the answers

What is the difference between infectious and non-infectious causes of pharyngitis?

Infectious causes are caused by pathogens, while non-infectious causes are not Signup and view all the answers

What is the name of the bacterium that causes group A beta-hemolytic streptococcal (GABHS) pharyngitis?

Streptococcus pyogenes Signup and view all the answers

What is the complication of streptococcal pharyngitis that Alex Best may be at risk for?

Acute rheumatic fever Signup and view all the answers

What is the primary mode of transmission for group A beta-hemolytic streptococci?

Direct contact Signup and view all the answers

What is the typical age range for streptococcal pharyngitis?

Children between 5-15 years old Signup and view all the answers

What is the primary site of infection for group A beta-hemolytic streptococci?

Pharynx Signup and view all the answers

What is the typical appearance of the tonsils in streptococcal pharyngitis?

Red and swollen Signup and view all the answers

What percentage of sore throats in children are caused by Group A beta-hemolytic streptococci?

20-30% Signup and view all the answers

Which of the following viruses is NOT a common cause of viral pharyngitis?

HIV Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by Fusobacterium necrophorum in adults?

10% Signup and view all the answers

Which of the following is a clinical syndrome associated with Epstein-Barr virus (EBV) infection?

Infectious mononucleosis Signup and view all the answers

What is the duration of chronic pharyngitis?

More than 2 weeks Signup and view all the answers

What is the most common cause of bacterial pharyngitis?

Group A beta-hemolytic streptococci Signup and view all the answers

What is the estimated percentage of cases of sore throat caused by rhinoviruses and coronaviruses?

At least 25% Signup and view all the answers

What is the term for the type of pharyngitis caused by infection of the pharynx by a virus?

Viral pharyngitis Signup and view all the answers

What is the term for the type of pharyngitis caused by infection of the pharynx by a bacterium?

Bacterial pharyngitis Signup and view all the answers

What is the primary cause of acute epiglottitis?

Haemophilus influenzae Signup and view all the answers

What is the typical age range for epiglottitis?

Children aged 2-6 Signup and view all the answers

What is a characteristic finding on lateral radiograph of the neck in epiglottitis?

Thumb sign Signup and view all the answers

What is a complication of retropharyngeal abscess?

All of the above Signup and view all the answers

What is a risk factor for lymphoma, head and neck cancers?

Weight loss, fever, and night sweats Signup and view all the answers

What is a symptom of primary HIV infection?

Fever, rash, and sore throat Signup and view all the answers

What is the primary mode of transmission for group A beta-hemolytic streptococci?

Direct contact with mucus from the nose or throat of infected persons Signup and view all the answers

What is a characteristic oral finding in scarlet fever?

Strawberry tongue Signup and view all the answers

What is a common finding on intraoral examination in strep throat?

Petechiae on the soft palate Signup and view all the answers

What is the primary site of infection for group A beta-hemolytic streptococci?

Throat Signup and view all the answers

What is the typical appearance of the tonsils in streptococcal pharyngitis?

White and exudative Signup and view all the answers

What is a characteristic of the rash in scarlet fever?

It is typically sandpaper-like in texture Signup and view all the answers

What is a common complication of streptococcal pharyngitis?

All of the above Signup and view all the answers

What is the typical age range for streptococcal pharyngitis?

5-15 years old Signup and view all the answers

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?

3000-4000 Signup and view all the answers

What is the typical time frame for developing acute rheumatic fever after GABHS pharyngitis?

1-4 weeks Signup and view all the answers

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?

PANDAS Signup and view all the answers

What is the name of the complication of GABHS pharyngitis that can lead to fever, arthralgia, and subcutaneous nodules?

Acute rheumatic fever (ARF) Signup and view all the answers

What is the estimated incidence of acute rheumatic fever (ARF) in remote, Canadian Indigenous communities?

8.33/100,000 Signup and view all the answers

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?

Poststreptococcal glomerulonephritis (PSGN) Signup and view all the answers

What is the name of the suppurative complication of GABHS pharyngitis that can lead to fever, neck stiffness, and swelling of the neck?

Retropharyngeal abscess Signup and view all the answers

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

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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