Pharyngitis

Abstract

This article reviews the commonly encountered agents causing acute inflammation of the pharynx and tonsils, with special attention to a practical approach for identifying and dealing with the group A beta-hemolytic streptococcus. Ubiquitous viral agents such as Epstein-Barr virus, rhinovirus, and adenovirus are reviewed. Some agents such as group A beta-hemolytic streptococcus and Epstein-Barr virus are susceptible to treatment. Additionally, unusual infectious agents and noninfectious causes of pharyngitis are enumerated.

Figure 1

Infectious mononucleosis. Note the thick, continuous tonsillar exudate and swollen uvula.

Figure 2

Palatal petechiae. Commonly seen in GABHS or EBV pharyngitis.

Figure 3

Plating for GABHS requires rolling the throat swab across area 1 of sheep blood agar plate. A wire loop is heated to red then briefly cooled. Two passes are made into area 1 and spread in area 2. This process is repeated from area 2 to 3 in an attempt to isolate single colonies of GABHS. The loop is heated again and then stabs (⊖) are made through the agar, first in area 3, then 2, then two in area 1. The loop is flamed red again after use. Finally, an A disc (A) is applied and lightly tapped down in area 1. The plate is labeled and incubated upside down at 37°C.

Figure 4

Diagnostic scheme for GABHS pharyngitis. Rx = treatment;+ = positive; − = negative; TC = throat culture; Dx = diagnosis.

Figure 5

Kawasaki disease. Peeling skin is a defining criterion.