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Acute Tonsilophargyngitis is an infection of the pharynx, palatine tonsils or both.

Pharyngitis occurs in all age groups. The peak prevalence of GABHS pharyngitis is in
children aged 5-10 years. In children younger than 2 years, most pharyngitis is of viral
origin, although GABHS is responsible in rare instances. Viral pharyngitis occurs in
persons of all ages. No sex predilection exists. Prevalence is equal among all races.
ATP is usually viral, most often caused by the common cold viruses such as adenovirus,
rhinovirus, influenza, coronavirus and respiratory syncytial virus. Occasionally, it is
caused by Epstein-barr virus, herpes simplex virus, cytomegalovirus, or HIV.
In about 30% of patients, the cause is bacterial. Group A -hemolytic streptococcus
(GABHS) is most common, but Staphylococcus pneumoniae, Mycoplasma pneumoniae,
Streptococcus pneumoniae are sometimes involved.
GABHS occurs most commonly between ages 5 and 15 and uncommon before age of
Clinical Manifestations
- Sore throat
- Dysphagia - hallmark
- Cervical lymphadenopathy
- High Fever
- Body malaise
- Headache
- GI upset
- Nonspecific rash
- Swollen, erythematous, purulent, exudative tonsils
- Palatal petechiae
- Clinical evaluation
- Culture sensitive test 90% specific and 90% sensitive
- Rapid antigen test specific but not sensitive
GABHS usually resolves within 7 days.
Complications of Streptococcal Tonsillopharyngitis

Non Suppurative Complications:

Acute rheumatic fever
Scarlet fever
Streptococcal toxic shock syndrome
Acute glomerulonephritis
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with
Group A Streptococci)

Suppurative Complications:
Tonsillopharyngitis pharyngeal cellulitis or Abscess
Otitis Media
Necrrotizing Fasciitis
Penicillin V Drug of choice for streptococcal pharyngitis
Cephalosporins/ Macrolides alternative for patients allergic to Penicillin
There is no vaccine against GAS available for clinical use, although
development of this preventive measure is under investigation. An important
area of uncertainty is whether vaccine-induced antibodies may cross-react with
host tissue to produce nonsuppurative sequelae in the absence of clinical

Foodborne Illness
Streptococcal contamination of food has been implicated in foodborne
outbreaks of pharyngitis, and foodborne transmission of GAS pharyngitis by
asymptomatic food service workers with nasopharyngeal carriage has been
reported. Factors that can reduce foodborne transmission of GAS pharyngitis
include thorough cooking, complete reheating, and use of gloves while handling

Continuous antimicrobial prophylaxis is only appropriate for prevention of
recurrent rheumatic fever in patients who have experienced a previous episode
of rheumatic fever.

For all types of pharyngitis, the prognosis is excellent. Streptococcal pharyngitis has a
5- to 7-day course, and symptoms usually resolve spontaneously, without treatment
though in rare cases, rheumatic fever can develop if GABHS is left untreated.
Ingestion of food with
Airborne Droplets

Group A Beta hemolytic



Lymphocytes IgM

Inflammatory Process

Neutrophils/ 5 Cardinal Histamine/Kinins

Macrophages signs: Secretions (causes
Warmth vascular permeability
Redness & vasodilator)
Pyrogen Secretions Pain
Stimulates fever Decreased
Function Dysphagia

Reset Hypothalamus

Fever Loss of