Cunha BA. Available at https://www.nice.org.uk/guidance/ng84/resources/sore-throat-acute-antimicrobial-prescribing-pdf-1837694694085. Pediatrics. Thus, people with group A strep pharyngitis should stay home from work, school, or daycare until: Humans are the only reservoir for group A strep. [10, 11] although these claims have not been validated by rigorous in vivo investigation. January 27, 2014; Accessed February 4, 2014. 29(7):228-34. N Engl J Med. It is rare in children younger than 3 years of age. Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). GABHS pharyngitis is most common in individuals aged 5-15 years, although adults may also acquire the disease. If the throat is affected, it is called pharyngitis. Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Persistent Sore Throat (Chronic Pharyngitis): Treatment & Symptoms 20:245-252. for: Medscape. [QxMD MEDLINE Link]. pharyngitis, inflammatory illness of the mucous membranes and underlying structures of the throat ( pharynx ). Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. 94 (1):24-31. Miller RA, Brancato F, Holmes KK. However, evidence from outbreak investigations indicate that environmental transmission of group A strep may be possible, although it is likely a less common route of transmission. [QxMD MEDLINE Link]. 2016 Jul 1. Ambulatory medical care utilization estimates for 2006. Clinicians should not treat viral pharyngitis with antibiotics. Clin Infect Dis. Note: If you are interested in reusing this table, first obtain permission from the journal; request by emailing journals.permissions@oup.com. Antibiotics are no longer appropriate. In adults, the positive predictive value of these criteria is around 40% if 3 criteria are met and about 50% if 4 criteria are met. Current status of group A streptococcal vaccine development. 1989 Apr 15. The virus then spreads to other mucosal surfaces through centrifugal migration of infectious virions via peripheral autonomic or sensory nerves. Arch Intern Med. Patients with group A strep pharyngitis typically do not have cough, rhinorrhea, hoarseness, oral ulcers, or conjunctivitis. [QxMD MEDLINE Link]. Crowded conditions such as those in schools, daycare centers, or military training facilities facilitate transmission. BMC Med Inform Decis Mak. The main ED concerns with pharyngitis are to rule out more serious conditions, such as epiglottitis or peritonsillar abscess, and to diagnose group A beta-hemolytic streptococcal (GABHS) infections. BMJ. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Testing for group A strep pharyngitis is not routinely indicated for: Acute rheumatic fever is very rare in those age groups. [5] This protein provides a potential target for a GABHS vaccine, although successful widespread implementation of such a vaccine remains elusive. 28 (6):830-4. Sardovski S. Dexamethasone Without Antibiotics for Sore Throat. [1], More than 100 different serotypes of rhinovirus cause approximately 20% of cases of pharyngitis and 30-50% of common colds. Several viruses can cause viral pharyngitis. Carriers have positive throat cultures or are RADT positive, but do not have clinical symptoms or an immunologic response to group A strep antigens on laboratory testing. Acute herpetic pharyngitis is the most common manifestation of the first episode of HSV-1 infection. 1998 Sep. 124(9):993-5. Marisse J Nepomuceno, MD, FPCP, FPSMID is a member of the following medical societies: Philippine College of Physicians, Philippine Medical Association, Philippine Society for Microbiology and Infectious DiseasesDisclosure: Nothing to disclose. Part 2: Alternative approach and practical office tool. Depending on the season and the patient's age, 70% to 90% of acute episodes are viral and involve a wide array of common viruses (Table 33-1). 1997 Jan. 55(1):131-8, 141-2. Streptococcal pharyngitis: A review of pathophysiology, diagnosis, and Br J Gen Pract. Pediatrics. Available at http://www.cdc.gov/flu/weekly/index.htm. Etiology and management of pharyngitis and pharyngotonsillitis in children: a current review. Treatment depends on symptoms and, in the case of group A beta-hemolytic streptococcus, involves antibiotics. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Pediatr Infect Dis J. Cleveland Clinic is a non-profit academic medical center. 29th ed. Rapid diagnosis of pharyngitis caused by group A streptococci. Optimal management of adults with pharyngitis--a multi-criteria decision analysis. Dagnelie CF, van der Graaf Y, De Melker RA. J Pediatr. Pharyngitis management: defining the controversy. The prevalence rates of these serotypes of GAS have been becoming rarer over the past several years. Pharyngitis and sore throat develop in about 50% of the patients with influenza A and in a lesser proportion of patients with influenza B. 2018 Jul. [QxMD MEDLINE Link]. 110(8):612-6. [7] The US Centers for Disease Control and Prevention (CDC) stopped tracking the incidence of rheumatic heart disease in the United States in 1994, when the incidence dropped to less than 1 case per million US general population. 2014 Apr 10. Parainfluenza virus type 1 infection occurs in epidemics, mainly in late fall or winter, while parainfluenza virus type 2 infection occurs sporadically. Part I: Problems with current clinical practice. Please confirm that you would like to log out of Medscape. Option 1: Treat if rapid test result is positive for GAS. J Pediatr. Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, Society of General Internal MedicineDisclosure: Nothing to disclose. Laboratory studies that may be helpful include the following: Group A beta-hemolytic streptococcal rapid antigen detection test (preferred diagnostic method in emergency settings), Throat culture (criterion standard for diagnosis of GAS infection [90-99% sensitive]), Mono spot (up to 95% sensitive in children; less than 60% sensitive in infants), Gonococcal culture if indicated by the history. [4], Children experience more than 5 upper respiratory infections (URIs) per year and an average of one streptococcal infection every 4 years. The role of group C and group G streptococci in acute pharyngitis in children. Dry indoor air and chronic mouth breathing, especially in the winter, can lead to recurrent sore throat, particularly in the morning, after waking up. To a lesser extent, bacteria other than S pyogenes are known to cause pharyngitis, and these are discussed in Causes. 2019 Oct 4. Clin Infect Dis. Clin Microbiol Infect. [2]. Nishiyama M, Morioka I, Taniguchi-Ikeda M, et al. John R Acerra, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Shapiro DJ, Barak-Corren Y, Neuman MI, Mandl KD, Harper MB, Fine AM. Pharyngitis, more commonly described as sore throat, represents inflammation or irritation of the posterior oropharynx. Common respiratory viruses account for the vast majority of cases (see Viral Pharyngitis), and these are usually self-limited. In addition to symptoms localized to the oropharynx, GABHS pharyngitis may also cause suppurative and nonsuppurative complications. Protective immunity induced by an intranasal multivalent vaccine comprising 10 Lactococcus lactis strains expressing highly prevalent M-protein antigens derived from Group A Streptococcus. [QxMD MEDLINE Link]. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical practice guideline: tonsillitis II. Acute tonsillitis and pharyngitis Epiglottitis is an acute inflammation of the epiglottis or supraglottis that may lead to the rapid onset of life-threatening airway obstruction caused by Haemophilus influenzae type b (Hib) and is an otolaryngologic emergency. [QxMD MEDLINE Link]. rash. A chronic sore throat can appear as a common symptom of a viral or bacterial infection. Examination of patients who present with sore throat may reveal tonsillitis, tonsillopharyngitis, or. [QxMD MEDLINE Link]. 87(5):598-603. American Academy of Paediatrics. [QxMD MEDLINE Link]. 2007 Jul. Antibiotic allergy. [QxMD MEDLINE Link]. Management of adults with acute streptococcal pharyngitis: minimal value for backup strep testing and overuse of antibiotics. 2016 Jun 3. Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review. Ear Nose Throat J. Economic Burden of Adult Pharyngitis: The Payer's Perspective. Arch Otolaryngol Head Neck Surg. Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals. 47-49 Chlamydia pneumoniae has been reported to cause fever, cough, and sore throat . Gordon L Woods, MD is a member of the following medical societies: Society of General Internal MedicineDisclosure: Nothing to disclose. 3:CD004406. Pharyngitis, especially GAS infection, is rare in children younger than 3 years. Treat if rapid test result is positive for GAS. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Nurse Pract. They exhibit -hemolysis (complete hemolysis) when grown on blood agar plates. [2]. Antibiotic prescribing to adults with sore throat in the United States, 1997-2010. Immunologic mechanisms may contribute to the pathogenesis of the severe disease in infants and elderly patients. Vaccine. 2011 Nov. 41(10):256-83. The resulting syndrome is called scarlet fever or scarlatina. While no role for routine Fusobacterium PCR, keep suspicion for this pathogen. [4] Lancefield antigens, carbohydrates in the cell wall, provide further differentiation of streptococci. Picture of Streptococcus pyogenes at 100 X magnification. Most children and adults experience 3-5 viral upper respiratory tract infections (including pharyngitis) per year. For more information on pharyngitis in children, see the Medscape Reference article Pediatric Pharyngitis. Pathogen shifts and changing cure rates for otitis media and tonsillopharyngitis. Bacteria that can cause pharyngitis in some cases: Strep throat is caused by group A streptococcus. 300060517752954. A 12-case outbreak of pharyngeal plague following the consumption of camel meat, in north-eastern Jordan. Other causes include allergy, trauma, toxins, and neoplasia. Pain or difficulty when swallowing or talking Swollen, sore glands in the neck or throat Red throat and red, swollen tonsils A hoarse voice White or grey patches on the back of the throat A sore throat is the characteristic symptom of pharyngitis and - in some cases - may be the only symptom. Cochrane Database Syst Rev. Clin Pediatr (Phila). [Full Text]. June 14, 2021; Accessed: July 17, 2022. Vol 1: 656-62. Treatment of a chronic sore throat depends on the cause of the problem. Adhesins enable GABHS attachment at sites such as the pharynx. Clin Infect Dis. [1], The most common and important bacterial cause of pharyngitis is Streptococcus pyogenes (group A Streptococcus [GAS]). In temperate regions, the prevalence of GABHS infection increases in the colder months, presumably because of the tendency of people to congregate indoors. GABHS pharyngitis has no sexual predilection. Viral Features and Testing for Streptococcal Pharyngitis. Invasion of nearby structures may cause suppurative complications such as otitis media, sinusitis, peritonsillar abscess, retropharyngeal abscess, and cervical adenitis. Pharyngitis is defined as an infection or irritation of the pharynx or tonsils (see the image below). American Academy of Pediatrics. Pharyngitis is caused by swelling in the back of the throat (pharynx) between the tonsils and the voice box (larynx). Clegg HW, Ryan AG, Dallas SD, et al. 17 (3):571-80, table of contents. 34(1):39-58. 367:l5337. 238-9. Table 1. Antibiotics covering atypical pathogens should not routinely be used to treat pharyngitis. [Full Text]. The vast majority of upper respiratory tract infections are due to viruses. [Full Text]. 2017 Sep. 67 (662):e634-e642. Twefik TL, Al Garni M. Tonsillopharyngitis: Clinical highlights. 2022 Jan. [QxMD MEDLINE Link]. Acute rheumatic fever is a nonsuppurative sequelae of group A strep pharyngitis. 2007 Nov. 59(3):259-64. Etiologic agents are passed through person-to-person contact, most likely via droplets of nasal secretions or saliva. 1988 Nov 5. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. Pharyngitis, or sore throat, is often caused by infection. The virus does not invade the pharyngeal mucosa. Dexamethasone Without Antibiotics for Sore Throat. [ 2] When suspected, bacterial pharyngitis should be confirmed with. 2005 Jun. Kassutto S, Rosenberg ES. These symptoms strongly suggest a viral etiology. Kimberlin DW, Brady MT, Jackson MA, Long SS. [6], In the developing world, an estimated 20 million people are affected by acute rheumatic fever and rheumatic heart disease, making this the leading cause of cardiac death during the first 5 decades of life. The most common risk factor is close contact with another person with group A strep pharyngitis. Pharyngitis is redness, pain, and swelling of the throat (pharynx). In comparison, experts estimate it causes approximately 5% to 15% of pharyngitis infections in adults. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Cohen D, Ferne M, Rouach T, Bergner-Rabinowitz S. Food-borne outbreak of group G streptococcal sore throat in an Israeli military base. These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. 12 (2):e0172871. McIsaac WJ, Goel V, Slaughter PM. The group A streptococcal upper respiratory tract carrier state: an enigma. [QxMD MEDLINE Link]. Am Fam Physician. J Gen Intern Med. Group A strep pharyngitis is most commonly spread through direct person-to-person transmission. 2016 Apr. [QxMD MEDLINE Link]. This website also contains material copyrighted by 3rd parties. 2009 Feb. 123 (2):437-44. Infection in the immunocompetent host rarely results in clinically apparent disease. These viruses enter the body through the ciliated epithelium that lines the nose, causing edema and hyperemia of the nasal mucous membranes. [Full Text]. 34 (26):2953-2958. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. J Gen Intern Med. Clin Infect Dis. 15:18-19. Infrequently, immunocompetent hosts exhibit a mononucleosislike syndrome with mild pharyngitis. If left untreated, S pyogenes pharyngitis may lead to local and distant complications. 412-29. The most common cause of a sore throat (pharyngitis) is a viral infection, such as a cold or the flu. 1998 Apr. 2007 Feb. 22(2):272-4. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. For information on bacterial pharyngitis, seeBacterial Pharyngitis. There has never been a report of a clinical isolate of group A strep that is resistant to penicillin. Acute pharyngitis accounts for approximately 12 million annual ambulatory care visits in the United States. Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical InvestigationDisclosure: Nothing to disclose. Brook I. Overcoming penicillin failures in the treatment of Group A streptococcal pharyngo-tonsillitis. fever. Little P, Stuart B, Hobbs FD, Butler CC, Hay AD, Delaney B, et al. KoKo Aung, MD, MPH, FACP Professor of Internal Medicine and Associate Academic Dean, Vice President, Texas Tech University Health Sciences Center at El Paso, Paul L Foster School of Medicine Kaplan EL. 318 (8):753. Clin Infect Dis. Physical examination includes the following: Head, ears, eyes, nose, and throat Conjunctivitis, scleral icterus, rhinorrhea, tonsillopharyngeal/palatal petechiae, tonsillopharyngeal exudate, oropharyngeal vesicular lesions, Lymphadenopathy (cervical or generalized). [Full Text]. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Safety and effectiveness of azithromycin in the treatment of respiratory infections in children. Prehospital care usually is not necessary for uncomplicated pharyngitis unless airway compromise is an issue. First-line Oral Gonorrhea Treatment Available Again in United States. 39(1):12-9. [QxMD MEDLINE Link]. Arch Intern Med. Can Fam Physician. Del Mar CB, Glasziou PP, Spinks AB. [QxMD MEDLINE Link]. 43(10):1284-9. Pediatric Pharyngitis: Background, Pathophysiology and Etiology J Med Microbiol. [1] Perhaps the most important virulence factor of GABHS is the M protein. Reflexive culture in adolescents and adults with group A streptococcal pharyngitis. Most sore throats are caused by colds, the flu, coxsackie virus or mono (mononucleosis). 2004 Jul. J Emerg Med. Acute pharyngitis is one of the most common conditions encountered in outpatient clinical practice. Eur Arch Otorhinolaryngol. GAS is most prevalent in late fall through early spring. 2017 Sep. 67 (662):e623-e633. [QxMD MEDLINE Link]. 2008 Aug 6. [QxMD MEDLINE Link]. 119(11):1541-51. [QxMD MEDLINE Link]. An approach to diagnosing the acute sore throat. Jensen A, Hagelskjaer Kristensen L, Prag J. Sore throat (acute): antimicrobial prescribing. Clinical Impact of a Rapid Streptococcal Antigen Test on Antibiotic Use in Adult Patients. 18 Suppl 1:1-28. Chronic Pharyngitis: Six Causes of Chronic Sore Throat - Verywell Health Patel NN, Patel DN. 319(7203):173-4. Graham A, Fahey T. Evidence based case report. The mucus irritates your throat and causes pain. Antibiotic prescription for sore throat or the legacy of Mr X2.. Lancet Infect Dis.
