Description

• Inflammation of the pharynx most commonly caused by acute viral infection
• Group A streptococcus is a focus due to its potential for preventable rheumatic sequelae.
• Chronic low-grade symptoms usually are related to reflux disease or vocal abuse.

• System(s) affected: Respiratory
• Synonym(s): Sore throat; Tonsillitis; Streptococcal throat

Epidemiology

• Estimated 30 million cases diagnosed yearly
• 12–25% of all sore throats are thought to prompt visits to physicians.
• Predominant age: All age groups
• Predominant sex: Male = Female

• Respiratory infections account for 38% of the 129 million visits per year to physicians in the US. This is ~200 visits to a physician per 1,000 population in the US annually (1).
• The etiology of the vast majority of these infections is viral.
• Group A streptococcus is the most common bacterial cause of acute pharyngitis, accounting for ~15–30% of cases in children and 5–10% of cases in adults.
• Rheumatic fever is rare in the US; 112 cases reported to the CDC in 1994, the last year this was a reportable disease.

Pediatric Considerations
Rheumatic fever has its greatest incidence in children aged 5–18 years, but is currently a rare sequel of streptococcal pharyngitis in the US.

Prevalence
Prevalence is quite variable in this acute, self-limited disease of short duration.

Risk Factors

• Epidemics of group A β-hemolytic streptococcal disease occur.
• Age (i.e., young people are more susceptible)
• Family history
• Close quarters, such as in new military recruits
• Immunosuppression
• Fatigue
• Smoking
• Excess alcohol consumption
• Receptive oral sex
• Diabetes mellitus
• Recent illness

Genetics
Patients with a positive family history of rheumatic fever have a higher risk of rheumatic sequelae following an untreated group A β-hemolytic streptococcal infection.

General Prevention

Avoid contact with infected people.

Etiology

• Acute, viral:
  • Rhinovirus
  • Adenovirus
  • Parainfluenza virus
  • Coxsackievirus
  • Coronavirus
  • Echovirus
  • Herpes simplex virus
  • Epstein-Barr virus (EBV) (mononucleosis)
  • Cytomegalovirus
• Acute, bacterial:
  • Group A β-hemolytic streptococci <10% of adult pharyngitis
  • Neisseria gonorrhoeae
  • Corynebacterium diphtheriae (diphtheria)
  • Haemophilus influenzae
  • Moraxella (Branhamella) catarrhalis
  • Groups C and G streptococcus, rarely
• Chronic:
  • More likely noninfectious
  • Irritation from postnasal discharge of chronic allergic rhinitis or reflux
  • Chemical irritation or smoking
  • Neoplasms and vasculitides