Pharyngitis in Adults

Flashcards on Pharyngitis in Adults.

Acute Pharyngitis

A common condition in outpatient practice where differentiating between viral, bacterial, and other serious causes is critical due to most cases being viral and self-limited.

Pharyngitis Epidemiology

Approximately 12 million ambulatory care visits annually in the United States, representing 1–2% of all outpatient visits, with incidence peaking during childhood and adolescence (≈50% of cases before age 18). In adults, it's most common before age 40 with declining frequency thereafter.

Respiratory Viruses and Pharyngitis

Account for 25–45% of infectious causes of pharyngitis, with examples including adenovirus, rhinovirus, various coronaviruses (including SARS-CoV-2), influenza, and parainfluenza.

Group A Streptococcus (GAS)

The most common bacterial cause of pharyngitis (5–15% in adults).

GAS Pharyngitis Symptoms

Sudden-onset sore throat, high fever, tonsillar exudates, palatal petechiae, and a scarlatiniform rash.

Key symptoms of Pharyngitis

Sore throat worsens with swallowing, Cervical lymphadenopathy (often tender, anterior nodes), fever, headache, fatigue, and sometimes malaise.

Centor Criteria

Used to determine the likelihood of Group A Streptococcus (GAS) in adults, with one point given for each criterion: tonsillar exudates, tender anterior cervical lymphadenopathy, fever, and absence of cough. Testing is generally recommended if ≥3 criteria are met.

Red Flags for Pharyngitis

Airway obstruction, muffled or 'hot potato' voice, hoarseness, drooling, stridor, respiratory distress, bulging of the pharyngeal wall, trismus, or severe unilateral sore throat.

Initial Assessment for Pharyngitis

Detailed history (onset, associated symptoms, exposure, and risk factors, including sexual history and recent exposures) along with a physical examination focused on throat, tonsils, lymph nodes, and airway status.

GAS Testing Indications

Patients with clinical features (fever, tonsillar exudates, tender anterior cervical adenopathy) who lack viral symptoms, and those meeting ≥3 Centor criteria.

Rapid Antigen Detection Test (RADT)

A testing method of GAS with high specificity (88–99%) but moderate sensitivity (77–92%).

Viral Pharyngitis Management

Supportive care including rest, hydration, analgesics, humidification, and saline gargles.

Bacterial Pharyngitis (GAS) Management

Antibiotic treatment is recommended to shorten the illness duration and prevent complications and Immediate referral required for patients exhibiting red flags or signs of deep neck space infection.

Expected Clinical Course of Viral Pharyngitis

Most patients recover within 5–7 days with supportive care.

Expected Clinical Course of GAS Pharyngitis

Improvement is usually evident within 24–72 hours once antibiotics are started.

Key findings suggestive of streptococcal pharyngitis

Acute onset pharyngitis with tonsillar exudates, fever, cervical lymphadenopathy, and absence of other upper respiratory infection symptoms (e.g., cough).