Pharyngitis

Pharyngitis is inflammation of the throat caused by viral or bacterial infection. Centor criteria (tonsillar exudates, tender anterior cervical adenopathy, fever, and absence of cough) tend to over-diagnose Group A Streptococcus infections.

CASES/YEAR
15,000,000 (US); 300,000,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Bacteria
OTHER NAMES
ACUITY
Acute-Moderate
INCUBATION
1-4 days for Group A Strept; [Harrisons, p. 454] Estimated: 1 day to 1 month for all causes;
INITIAL SYMPTOMS
Centor criteria (tonsillar exudates, tender anterior cervical adenopathy, fever, and absence of cough) tend to over-diagnose Group A Strept infection. [ABX Guide]
PRECAUTIONS
COMMENTS
Viral pharyngitis is more likely if runny nose, hoarseness, conjunctivitis, or mucosal ulcers. Negative rapid antigen test for Group A Strept should be confirmed with throat culture. [Harrisons, p. 454] Up to 90% of cases in adults are viral--treat with antibiotics if rapid antigen test or culture are positive for Group A Strept. Consider epiglottitis and retropharyngeal abscess in differential diagnosis. [ABX Guide] Symptoms of adenoviral pharyngitis include fever, myalgia, headache, cough, and conjunctivitis. Vesicular stomatitis is present in pharyngitis caused by coxsackievirus (herpangina) and primary herpes simplex infection. Fatigue and splenomegaly are findings of mononucleosis. Acute HIV infection causes pharyngitis, arthralgias, and occasionally maculopapular rash. [Harrison ID, p. 211] Rhinitis is a symptom in pharyngitis caused by influenza and rhinovirus infections. M. pneumoniae causes mild pharyngitis and pneumonia. [ID, p. 458] Vomiting and abdominal pain can occur in Group A Streptococcus infections. [PPID, p. 826] See "Streptococcal infection, Group A" and "Parapharyngeal space infections." See "Infectious mononucleosis" and "Epiglottitis."
DIAGNOSTIC
Group A Strept: treat if positive rapid antigen test or use throat culture; [Merck Manual, p. 845]
SCOPE
Global
SIGNS & SYMPTOMS
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >myalgia
  • E dysphagia
  • E pharyngitis
  • E rhinitis
  • E stomatitis
  • G abdominal pain
  • G nausea, vomiting
  • H lymphadenopathy
  • H splenomegaly
  • N headache
  • O conjunctivitis, acute
  • R cough
  • S rash (exanthem)
  • *pneumonia
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Inhalation
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
DRUG LINK
Merck Manual: Sore Throat
REFERENCES FOR CASES/YEAR
1. (US) Estimated 15 million cases diagnosed every year; [5MCC-2020]
2. (Global) 20 X US cases/yr;