Infectious Disease Compendium

Pharyngitis

Diagnosis

Sore throat.

Epidemiologic Risks

Depends of the organism.

S. pyogenes: part of life, human to human spread. It can be spread by food leading to outbreaks (PubMed).

There was an outbreak in Japan due to Group G streptococcus contaminated broccoli salad. 140 kids got sick (PubMed).

Microbiology

Viral: Adenovirus (Pharyngoconjunctival fever), Coronavirus, Coxsackievirus A (Herpangina and hand-foot-and-mouth disease), Cytomegalovirus, Epstein-Barr virus, Herpes simplex virus types 1 and 2, HIV (Primary HIV infection), Influenza A and B viruses, Parainfluenzavirus, Rhinovirus.

Bacteria: S. pyogenes, Group C and G streptococci, Arcanobacterium haemolyticum, Corynebacterium diphtheriae, Francisella tularensis, Mycoplasma pneumoniae, Mixed anaerobes Vincent's angina, N. gonorrhoeae(PubMed), Yersinia enterocolitica, Yersinia pestis.

In adolescents, Fusobacterium necrophorum can cause 10% of pharyngitis (PubMed) and is twice as common as GAS in the 15 to 30 year age group (PubMed).

Empiric Therapy

Penicillin VK, amoxicillin, any oral cephalosporin and any oral macrolides will probably take care of group A streptococcal pharyngitis (IDSA Guidelines). The rest depend on what you grow or suspect from history.

One meta-analysis suggests "There is considerable evidence to suggest that clindamycin and amoxicillin with clavulanate is superior to penicillin" for treatment and preventing relapse (PubMed).

In kids one 750 mg or 1 gm dose of amoxicillin is curative (but will not prevent Rheumatic Fever which requires 10 count 'em 10 days of therapy (PubMed)).

Chlorhexidine gluconate and benzydamine hydrochloride mouth spray, in addition to antibiotic treatment, significantly decreased the intensity pain in patients with streptococcal pharyngitis, although endpoint was the same (PubMed).

Probiotics do nothing for symptoms (PubMed).

Pearls

Watch for abscesses; will often present as asymmetry of the back of the throat. Prophylaxis of family members to prevent spread doth not work (PubMed). Recurrent disease in adults can be treated by removing the tonsils (PubMed).

- "Acute nonrheumatic streptococcal myocarditis is an under recognized and treatable cause of ST­segment elevation and chest pain in young adults with a history of recent pharyngitis (PubMed).

Rants

Curious Cases

Relevant links to my Medscape blog

Sore Throat

An appeeling case

Glee