Acute pharyngitis

Case history #1

A 7-year-old girl presents with abrupt onset of fever, nausea, vomiting, and sore throat. The child denies cough, rhinorrhea, or nasal congestion. On physical exam, oral temperature is 101°F (38.5°C) and there is an exudative pharyngitis with enlarged, tender anterior cervical lymph nodes. A rapid antigen test is positive for group A Streptococcus (GAS).

Case history #2

A 7-year-old girl presents with acute sore throat accompanied by fever. On exam, oral temperature is 98.6°F (37°C) and there is an exudative pharyngitis without palpable cervical nodes. Both the rapid antigen test and throat culture are negative for GAS.

Other presentations

Pharyngitis may be part of the presentation of viral upper respiratory infections that usually can be distinguished by the presence of rhinorrhea, nasal congestion, and/or cough.[4]Centers for Disease Control and Prevention. Pharyngitis (strep throat). Jun 2022 [internet publication]. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html ​ Acute pharyngitis frequently occurs with acute infectious mononucleosis (Epstein-Barr virus). It may rarely, in sexually active or sexually abused individuals, accompany acute HIV infection (with associated adenopathy, rash, fever, and splenomegaly), chlamydia, or gonorrhea (no distinctive clinical features).[10]Bisno AL. Acute pharyngitis. New Engl J Med. 2001 Jan 18;344(3):205-11. http://www.ncbi.nlm.nih.gov/pubmed/11172144?tool=bestpractice.com ​​ Diphtheria and measles may present as pharyngitis, and should always be a consideration when sore throat is encountered in low- and middle-income countries or in unvaccinated children. Tularemia should be considered if symptoms are not responsive to penicillin treatment or if there is a history of eating meat from undomesticated animals.[7]Centers for Disease Control and Prevention. Tularemia. May 2024 [internet publication]. https://www.cdc.gov/tularemia/about/index.html [9]Auwaerter PG, Penn RL. Francisella tularensis. In: Bennett J, Dolin R, Blaser M, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th ed. Philadelphia, PA: Elsevier; 2019:2759-73.[13]European Centre for Disease Prevention and Control. Factsheet on tularaemia. Jul 2017[internet publication]. https://www.ecdc.europa.eu/en/tularaemia/facts ​​​​ Candida infection is common as a source of sore throat in immunocompromised individuals, including those undergoing chemotherapy or oropharyngeal irradiation for cancer.[5]Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. https://academic.oup.com/cid/article/62/4/e1/2462830 http://www.ncbi.nlm.nih.gov/pubmed/26679628?tool=bestpractice.com ​​

[Figure caption and citation for the preceding image starts]: Intraoral view of a patient with group A Streptococcus pharyngitisCDC/Heinz F. Eichenwald, MD; public domain [Citation ends].