Group A Streptococcus (GAS) pharyngitis remains the leading bacterial cause of acute sore throat worldwide. Surges in GAS infections are driven by hypervirulent strains such as M1UK. The 2025 clinical practice guideline update from the Infectious Diseases Society of America introduces evidence-based recommendations for risk assessment using clinical scoring systems to optimize diagnostic testing and reduce unnecessary antibiotic use. This review examines current diagnostic approaches, treatment protocols, antimicrobial resistance patterns, and emerging therapeutic strategies to support nurse practitioners in delivering evidence-based, stewardship-aligned patient care.

Infectious mononucleosis is clinically difficult to distinguish from bacterial causes of tonsillitis/pharyngitis. First-line investigations include monospot testing, despite 63% sensitivity in certain cohorts. Therefore, national recommendations include repeating an initial negative monospot within five to seven days. A point-of-care clinical scoring tool could improve clinical outcomes, increase diagnostic accuracy and reduce unnecessary testing. We conducted a retrospective cohort study at Luton and Dunstable University Hospital including patients aged 15-24 presenting with sore throat, lymphadenopathy or fever between 01/01/2021 and 31/01/2024 who underwent monospot testing. Extracted data included demographics, observations, and laboratory results. Patients were randomly split into training (80%) and testing (20%) cohorts. Eleven parameters were used to develop four predictive models; classical multivariate logistic regression, machine-learning logistic regression with LIBLINEAR approximation, machine-learning decision tree classifier, and a simplified clinical risk-stratification model from machine-learning methods. Total of 278 presentations from 264 patients were included. The machine-learning decision tree classifier demonstrated superior performance, achieving 100% sensitivity, 98.0% specificity, and 98.2% diagnostic accuracy using only three parameters: lymphocyte count, neutrophil count, and alanine aminotransferase. The simplified clinical risk-stratification model demonstrated 83.3% sensitivity, 98.0% specificity, and overall 96.4% accuracy. All four models represent potential methods for developing clinical tools to predict monospot positivity. Our risk-stratification model showed significant promise as an easily memorisable, point-of-care clinical scoring tool. Using this, we propose an alternative diagnostic pathway with early counselling and de-escalation of antibiotics in high-risk cases, and reduced testing in low-risk cases; reducing population-level morbidity and epidemiological spread, whilst improving diagnostic accuracy and conserving resources.

Deep neck space infections in children can deteriorate quickly, especially when diagnosis and source control are delayed. We describe a 4-year-old boy admitted on 28 March 2026 with 4 days of progressive right lateral neck swelling, fever, muffled voice, and breathing difficulty. Ultrasonography showed a right cervical inflammatory mass with moderate upper-airway compression but was reported as Ludwig's angina, which did not match the lateral clinical findings. Needle aspiration yielded no pus, contrast-enhanced computed tomography was not obtained, and surgical drainage was not performed at that stage. The child deteriorated and required emergency tracheostomy with parapharyngeal incision and drainage on 1 April; approximately 20 mL of pus was evacuated. Persistent illness and delayed lateral neck radiography later identified a retropharyngeal component, prompting wider drainage of both spaces on 11 April. Gram stain and pus and blood cultures were negative. He improved after definitive drainage, airway care, antimicrobial escalation, and nutritional support and was discharged on hospital day 20. This course highlights the clinical cost of delayed anatomic definition and source control. In a child with progressive neck swelling and airway symptoms, a negative aspiration or discordant ultrasound should prompt urgent cross-sectional imaging where feasible or operative reassessment; early multidisciplinary action may prevent avoidable airway deterioration.

Ultraviolet (UV) radiation can cause several skin issues including inflammation, oxidative stress and photoaging. The seeds of Oroxylum indicum (L.) Kurz are well-known herbal medicines commonly used to treat pharyngitis, bronchitis, and other ailments. This study sought to investigate the protective effects of Oroxylum indicum seed extract (OISE) against UV-induced skin damage and the underlying mechanism. Our findings revealed that OISE effectively attenuated UVB-induced oxidative stress and inflammation in keratinocytes. Specifically, OISE treatment reduced ROS and MDA levels, promoted the expression of genes involved in regulating oxidative stress such as NFE2L2, HMOX1, SOD1, CAT, GCLC, GCLM, and NQO1, suppressed the production of inflammatory cytokines including TNF-α, IL-6 and IL-8, and downregulated the gene expression of pro-inflammatory enzymes such as iNOS and COX-2. Moreover, we employed HFF-1 cells to evaluate the protective effect of OISE against UVA radiation and found that OISE effectively mitigated UVA-induced inflammation and photoaging in HFF-1 cells. Network pharmacological analysis and molecular experiments indicated that OISE effectively inhibited the activation of STING and NF-κB pathways induced by both UVB and UVA radiation. Further research revealed that oroxin A and oroxin B, the major components in OISE, were sufficient to inhibit UVB-induced inflammation and activation of the STING pathway. Thus, this study demonstrated that OISE could effectively alleviate both UVB and UVA-induced skin photodamage through inhibiting the STING and NF-κB pathways and revealed that oroxin A and oroxin B are the key components that enable OISE to protect skin from damage caused by ultraviolet radiation.

Post-streptococcal uveitis syndrome (PSUS) is a rare immune-mediated condition typically affecting children and young adults following group A Streptococcus infection. We describe a 53-year-old woman who developed bilateral panuveitis following documented streptococcal pharyngitis, representing one of the oldest reported cases of PSUS. The patient presented with photophobia, blurred vision and floaters, with examination revealing bilateral anterior segment inflammation, cystoid macular oedema, optic disc oedema and retinal vasculitis. Elevated anti-streptolysin O titres and characteristic multimodal imaging findings supported the diagnosis. Treatment with topical and systemic corticosteroids led to complete resolution over 8 months, with sustained remission at 22-month follow-up. This case demonstrates that PSUS should remain in the differential diagnosis of uveitis regardless of patient age when there is a clear temporal association with recent streptococcal infection.

Infectious mononucleosis (IM) is a common cause of pharyngitis in children, particularly among adolescents. IM is a self-limiting condition, and differentiating it from other causes of pharyngitis that require treatment is key to its management. One such condition is group A streptococcal (GAS) pharyngitis, which can be complicated by acute rheumatic fever if left untreated. In this report, we present a case of suspected IM with a positive GAS rapid antigen detection test, highlight the evidence surrounding these two conditions, and discuss the clinical dilemma of performing GAS testing in patients with an IM-like presentation.

Topical non-steroidal anti-inflammatory drugs (NSAIDs) such as flurbiprofen and benzydamine may be used for the symptomatic relief of pharyngitis, triggered by infections. The onset and spectrum of anti-inflammatory activity of both drugs were compared in human tonsil (HTEpiC) and bronchial epithelial (BEAS-2B) cells stimulated with poly I:C against key inflammatory mediators. Cells were stimulated with poly I:C for 24 h and treated with flurbiprofen or benzydamine for 20 s, 2 min and 5 min. Production of prostaglandin E2 (PGE2), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-1 beta (IL-1β), interleukin-8 (IL-8), interleukin-18 (IL-18), monocyte chemotactic protein-3 (MCP-3) and C-X-C motif chemokine ligand 10 (CXCL10), as well as cyclooxygenase-2 (COX-2) protein expression, was evaluated. Flurbiprofen significantly (p < 0.05) reduced PGE2 production and COX-2 expression in both cell types within 20 s of treatment and maintained these effects at 2 and 5 min. However, benzydamine produced delayed, inconsistent inhibition. Although both drugs reduced poly I:C induced IL-6, IL-1β, IL-8 and IL-18 production, the magnitude and onset were greater with flurbiprofen. Flurbiprofen also reduced MCP-3 and CXCL10 in both cell types, alongside significant inhibition of caspase-1 activity. Benzydamine showed limited or no effect and less inhibition of caspase-1. With rapid suppression of the COX-2/PGE2 pathway, rapid onset and a broad inhibition spectrum, flurbiprofen more comprehensively modulates inflammatory processes in epithelial respiratory models.