Pediatric Pharyngitis 

  • Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 24, 2012
 

Background

Studies in the late 1940s and 1950s showed that penicillin (PCN) therapy for group A beta-hemolytic streptococcal (GABHS) pharyngitis could prevent rheumatic heart disease. The American Heart Association has recommended PCN therapy since 1953, and this remains the primary treatment of choice to prevent rheumatic heart disease.

Initial studies using a 5- to 7-day course showed a decline in the number of GABHS positive follow-up throat cultures from 53% to 18%. Subsequent 10-day courses of penicillin proved to be the most beneficial in eradicating GABHS from the pharynx. Therefore, the diagnosis and proper treatment of GABHS are of vital importance.

The effectiveness of antimicrobial therapy in the preventing poststreptococcal glomerulonephritis is less certain.

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Pathophysiology

GABHS pharyngitis is spread via respiratory secretions through close contacts. It has an incubation period of 2-5 days.

Over 80 M-protein types of GABHS have been isolated with serotypes 1, 3, 5, 6, 18, 19, and 24 associated with rheumatic fever (ie, rheumatogenic forms) and others, such as serotypes 49, 55, and 57, associated with pyoderma and acute poststreptococcal glomerulonephritis.

Causes of pharyngitis in children vary from viruses, which often require only supportive therapy, to bacterial pathogens, such as GABHS, which require antibiotics. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis in children include GABHS (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare).

Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus.

Other probable copathogens for pharyngitis in children include Staphylococcus aureus, Haemophilus influenzae, Branhamella catarrhalis, Bacteroides fragilis, Bacteroides oralis, Bacteroides melaninogenicus, Fusobacterium species, and Peptostreptococcus species.

Other, less common, causes of pharyngitis include Chlamydia trachomatis and Mycoplasma pneumoniae.

In approximately 30% of cases, no pathogen is isolated.

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Epidemiology

Frequency

United States

Approximately 10% of children evaluated by medical care providers each year are evaluated for pharyngitis, and 25-50% of them have GABHS. However, it is important to note that approximately 20% of asymptomatic children are long-term carriers of GABHS.

Sex

No sex predilection exists.

Age

  • Pharyngitis occurs in all age groups.
  • Streptococcal infections have the greatest incidence in those aged 5-18 years.
  • In children younger than 2 years, most pharyngitis is of viral etiology, although GABHS rarely can occur in this younger age group.
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Contributor Information and Disclosures
Author

Harold K Simon, MD, MBA  Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Director of Research, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston

Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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