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Epidemiology

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.
Etiology
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
3.
Clinical Manifestations
- Sore throat
- Dysphagia - hallmark
- Cervical lymphadenopathy
- High Fever
- Body malaise
- Headache
- GI upset
- Nonspecific rash
- Swollen, erythematous, purulent, exudative tonsils
- Palatal petechiae
Diagnosis
- Clinical evaluation
- Culture sensitive test 90% specific and 90% sensitive
- Rapid antigen test specific but not sensitive
Complications
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
Sinusitis
Necrrotizing Fasciitis
Others
Treatment
Penicillin V Drug of choice for streptococcal pharyngitis
Cephalosporins/ Macrolides alternative for patients allergic to Penicillin
Prevention
Vaccination
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
infection.

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
food.

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

Prognosis
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.
Pathophysiology
Ingestion of food with
microorganism
Airborne Droplets

Group A Beta hemolytic


streptococcus

Tonsil/Pharynx

Lymphocytes IgM

Inflammatory Process

Neutrophils/ 5 Cardinal Histamine/Kinins


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

Reset Hypothalamus
Regulator

Fever Loss of
Appetite

Malaise