Pediatric Pharyngitis Clinical Presentation
- Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD more...
History
The clinical differentiation of the possible pathogens of pharyngitis often is difficult based on history or physical examination. In 1962, Feinstein et al wrote, "The only typical feature of streptococcal infections is their failure to show a single, consistent, typical feature."
- History of exposure to known carriers
- Fever
- Sore throat
- Headache
- Abdominal pain
- Anorexia
- Chills
- Malaise
Physical
While no single or combination of physical findings is specific for distinguishing GABHS from viral etiologies, several items on physical examination are suggestive.
- Enlarged tonsils
- Pharyngeal erythema
- Tonsillar exudates with necrotic crypts
- Soft-palate petechiae
- Tender cervical adenopathy
- Fever
- Scarlet fever rash (punctate erythematous macules and fine papules with reddened flexor creases and circumoral pallor), the so-called sandpaper rash
- Conjunctivitis (more commonly with adenovirus infections)
- Viral pharyngitis usually is associated with sneezing, rhinorrhea, and cough.
- Mononucleosis typically is exudative with extensive false membranes.
- Herpangina (usually coxsackievirus A) is associated with papulovesicular lesions.
- Diphtheria, which is rare in developed countries, is associated with a thick gray membrane that is difficult to remove.
Causes
- Acute bacterial pharyngitis
- Group A beta-hemolytic streptococci
- N gonorrhoeae
- C diphtheriae
- H influenzae
- Moraxella (Branhamella) catarrhalis
- Group C and G streptococci (rare)
- Acute viral pharyngitis
- Rhinovirus
- Adenovirus
- Parainfluenza virus
- Coxsackievirus
- Coronavirus
- Echovirus
- Epstein-Barr virus (mononucleosis)
- Cytomegalovirus
- Chronic pharyngitis (usually noninfectious)
- Irritation from postnasal discharge of chronic allergic rhinitis
- Chemical irritation
- Neoplasms and vasculitides
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