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Cover image: Viral pharyngitis, the most common cause of a sore throat. | CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=960953
Acute Tonsillopharyngitis or sore throat is thoat pain due to acute inflammation of pharynx (pharyngitis) and tonsils (tonsillitis).
Aetiology
Viral infections (M/C cause):
- Adenovirus
- Influenza
- Parainfluenza virus
- Enterovirus
- Epstein-Barr virus
Bacrerial infection:
- S. pyogenes esp. group A beta-hemolytic Streptococci
- Mycoplasma pneumoniae
- Candida albicans
- As disease prodrome:
- Measles
- Rubella
Clinical features
- Sore throat
- Tonsils
- Swollen and covered with exudates
- Fever
- Malaise
- Headache
- Nausea
Viral infection:
- Cough and rhinitis more common
- Gradual onset and less toxemia
Streptococcal infection:
- Enlarged cervical lymph nodes
- Acute illness with high fever
- Absence of nasal discharge or conjunctivitis
Complications
- Acute glomerulonephritis
- Rheumatic fever
- Otitis media
- Sinusitis
- Peritonsillar and retropharyngeal abscesses
- Spread down the tracheobronchial tree:
- Tracheobronchitis
- Pneumonia
Diagnosis
Investigations
- Group A beta-hemolytic Streptococcus:
- Throat swab culture
- Rapid antigen detection test (RADT)
- Enzyme immunoassays
Differential diagnosis
- Herpangina
- Acute febrile illness due to group A Coxsackie virus
- Dysphagia, sore throat and papulovesicular lesions surrounded by erythema over the tongue, pharynx, anterior tonsillar pillars and soft palate.
- Pharynx appears congested.
- Diphtheria
- Moderate fever, severe toxaemia, sore throat and membrane formation over the fauces or palate.
- Pharyngoconjunctival fever
- Fever, conjunctivitis, pharyngitis and cervical lymphadenitis due to infection with adenovirus type 3
- Infectious mononucleosis
- Lymphadenopathy, morbilliform rash, hepatosplenomegaly and sometimes, aseptic meningitis
Management
Supportive management:
- Warm saline gargles (older children)
- Sip warm tea/liquids (younger children)
- Soft food
- Symptomatic relief:
- Oral antihistaminics
- Chlorpheniramine or promethazine
- Oral antihistaminics
- Fever:
- Paracetamol
Antibiotic therapy:
- Penicillin V (250 mg q 8-12 hr)
- Amoxycillin (30-40 mg/kg/day)
- Erythromycin (40-50 mg/kg/day)
- Cephalexin (50 mg/kg/day for 10 days)
- Azithromycin (10-12 mg/kg/ day for 5 days)
- Noncompliance:
- Benzathine penicillin (single IM dose)
Recurrent Sore Throat
- Beta-lactamase producing bacteria:
- Amoxycillin + clavulanic acid
- Clindamycin
- Group A beta-hemolytic streptococcal infection:
- Penicillin prophylaxis (3-6 months)
- > 5-6 episodes of tonsillitis in a year or tonsillar or peritonsillar abscess:
- Tonsillectomy
- Does not prevent recurrence of pharyngeal infection
- Other indications:
- Diphtheria carriers
- Presence of retention cysts in tonsils
- Tonsils are a focus of infection for suppurative otitis media
- Tonsillectomy