II. Epidemiology

  1. One of four most common episodic clinic visit reasons

III. Anatomy: Waldeyer's Tonsillar ring

  1. Nasopharynx
    1. Adenoids (pharyngeal Tonsils) at posterior wall
  2. Oropharynx
    1. Faucial (Palatine Tonsils) at lateral wall)
  3. Hypopharynx
    1. Lingual Tonsil at Tongue base

IV. Causes

V. Symptoms

  1. Sore Throat
  2. Dysphagia (Difficulty Swallowing)
  3. Odynophagia (pain with Swallowing)
  4. Generalized symptoms
    1. Fever, Chills, Malaise
    2. Headache
    3. Abdominal Pain
    4. Nausea or Vomiting
  5. Symptoms suggestive of viral illness
    1. Coryza
    2. Conjunctivitis (esp. Adenovirus)
    3. Hoarseness
    4. Diffuse myalgias (seen in Influenza)
    5. Diffuse Lymphadenopathy in Cytomegalovirus (CMV), Mononucleosis (EBV), Acute HIV Infection
  6. Symptoms suggestive of Bacterial illness (Group A Streptococcal Pharyngitis)
    1. Fever (resolves within 3-5 days)
    2. Anterior Cervical Lymphadenopathy
    3. Tonsillar Exudate
    4. Lack of cough

VI. Signs: Red flags (suggestive of serious cause)

  1. Unilateral Pharyngitis
  2. Toxic appearance
  3. Prolonged Pharyngitis >3-5 days
  4. Associated neck swelling
  5. Drooling or Stridor (airway compromise)

VII. Signs

  1. Viral
    1. Non-exudative pharyngeal erythema
      1. Exception: Tonsillar exudate in Mononucleosis (EBV)
    2. Vesicular OR ulcerative Oral Lesions
    3. Conjunctivitis in Adenovirus and Kawasaki Disease
  2. Streptococcus and other Bacteria
    1. Enlarged Tonsils with or without exudate
    2. Petechiae on Soft Palate (pathognomonic)
    3. Erythema
    4. Tender Cervical Lymphadenopathy
    5. Strawberry Tongue (in Scarlet Fever)
  3. Peritonsillar Cellulitis or Peritonsillar Abscess
    1. Unilateral erythema of Soft Palate
    2. Uvula deviated
    3. Dysphagia
    4. Odynophagia
    5. Fever
  4. Diphtheria
    1. Gray membranous exudate covers Tonsils and pharynx
    2. Exudate bleeds easily on removal
  5. Kawasaki Disease
    1. Pharyngitis with strawberry Tongue in age <5 years
    2. Non-purulent Conjunctivitis (also in Adenovirus)
    3. Palmar erythema and cracked red lips after 3 days

VIII. Diagnosis

IX. Labs

  1. Leukocytosis on Complete Blood Count (CBC)
    1. WBC greater than 12.5 with Bacterial Pharyngitis
    2. Lymphocytes more than 10% atypical in EBV
  2. Streptococcal Rapid Antigen Test and Throat Culture (or Point-Of-Care GAS Nucleic Acid Amplification Test)
  3. Epstein Bar Virus (Mononucleosis)
    1. Mono-Spot (False Negative in young children)
    2. Heterophil Antibody Test (Positive if Titre >= 1:56)
  4. Diphtheria: Fluorescent Antibody
  5. Fungus: Sabouraud dextrose agar Fungal Culture
  6. Gonorrhea Culture
  7. Consider Laryngoscopy for severe or refractory symptoms

X. Management

XI. Precautions: Consider serious complications and alternative diagnoses

XII. References

  1. Anderson (2019) Crit Dec Emerg Med 33(9): 3-10
  2. Degowin (1987) Diagnostic Exam p. 149-151
  3. Gwaltney in Mandell (2000) Infectious Dis, p. 656-61
  4. Vincent (2004) Am Fam Physician 69(6):1465-70 [PubMed]

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Related Studies

Ontology: Pharyngitis (C0031350)

Definition (MSH) Inflammation of the throat (PHARYNX).
Definition (MSHCZE) Faryngitida (pharyngitis) – zánět hltanu. Větš. součást zánětu horních cest dýchacích (virových, bakteriálních). Projevuje se bolestivostí v hrdle, zarudnutím, hlenovým povlakem. Existují i chronické formy zánětu jako následek častých zánětů akutních, zejm. při současném působení dalších faktorů (snížená odolnost, vystavení dráždivým látkám). Srov. nazofaryngitida, angína, laryngitida. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Inflammation of the throat most often caused by viral and bacterial infections. Other causes include allergens, chemical substances, and trauma.
Definition (NCI_CTCAE) A disorder characterized by inflammation of the throat.
Definition (CSP) inflammation of the throat.
Concepts Disease or Syndrome (T047)
MSH D010612
SnomedCT 141458004, 164261009, 37616004, 405737000
English Pharyngitides, Inflamed throat, pharynx inflammation, inflammation of pharynx (physical finding), pharyngeal inflammation, inflammation of pharynx, pharyngitis (diagnosis), pharyngitis, Pharyngitis NOS, Pharyngitis [Disease/Finding], throat inflammation, sore throat, throat infection, infections throat, inflammation throat, soreness throat, Inflamed;throat, Inflammation;throat, inflamed throat, throat soreness, inflamed throats, infection throat, throat inflamed, irritation of the throat, Inflamed throat (finding), Inflamed throat (disorder), Pharynx inflamed, PHARYNGITIS, Pharyngitis, Pharyngitis (disorder), inflammation; pharynx, inflammation; throat, pharynx; inflammation, throat; inflammation, Pharyngitis, NOS, inflammation of the throat, Pharyngeal inflammation
French PHARYNGITE, Inflammation du pharynx, Pharyngite SAI, Pharyngite
Portuguese FARINGITE, Inflamação faríngea, Faringite NE, Faringite
Spanish FARINGITIS, Inflamación faríngea, Faringitis NEOM, faringitis infecciosa, garganta inflamada, garganta inflamada (trastorno), faringitis (trastorno), faringitis, Faringitis
German PHARYNGITIS, Rachenentzuendung, Pharyngitis NNB, Pharyngitis
Dutch farynxontsteking, faryngitis NAO, farynx; ontsteking, keel; ontsteking, ontsteking; farynx, ontsteking; keel, faryngitis, Faryngitis
Italian Infiammazione faringea, Faringite NAS, Faringite
Japanese 咽頭炎, 咽頭炎NOS, 咽頭の炎症, イントウエン, イントウノエンショウ, イントウエンNOS
Swedish Svalginflammation
Czech zánět hltanu, faryngitida, hltan - zánět, Faryngitida, Faryngitida NOS, Faryngeální zánět, pharyngitis
Finnish Nielutulehdus
Polish Ból gardła, Zapalenie gardła
Hungarian Pharyngealis gyulladás, pharyngitis k.m.n., pharyngitis
Norwegian Faryngitt, Svelgbetennelse

Ontology: Sore Throat (C0242429)

Definition (MEDLINEPLUS)

Your throat is a tube that carries food to your esophagus and air to your windpipe and larynx (also called the voice box). The technical name for the throat is pharynx.

You can have a sore throat for many reasons. Often, colds and flu cause sore throats. Other causes can include:

Treatment depends on the cause. Sucking on lozenges, drinking lots of liquids, and gargling may ease the pain. Over-the-counter pain relievers can also help, but children should not take aspirin.

Definition (NCI_CTCAE) A disorder characterized by of marked discomfort in the throat
Definition (NCI) Any kind of inflammatory process of the tonsils, pharynx, or/and larynx characterized by pain in swallowing.
Concepts Sign or Symptom (T184)
MSH D010612
ICD9 784.1
ICD10 R07.0
SnomedCT 206949003, 51388003, 162390001, 139668004, 158299009, 266379007, 304521001, 195654001, 155502006, 162386003, 37616004, 139660006, 267180009, 162397003, 267102003
English Sore Throat, Sore Throats, Throat, Sore, THROAT SORE, [D]Throat pain, [D]Throat pain (context-dependent category), Sore throat symptom NOS, [D]Throat discomfort, throat pain (symptom), sore throat (symptom), sore throat, throat pain, sore throat (diagnosis), Pain throat, Sore throat NOS, Pharynx discomfort, Pain pharynx, Throat sore, throat soreness, sore symptoms throat, sore throat symptom (non-specific), throat discomfort, Pain;throat, sore symptom throat, sore throats, Pharyngeal pain (finding), Sore throat symptom NOS (finding), [D]Throat pain (situation), Sore throat (finding), Throat soreness (& symptom), Throat soreness (& symptom) (finding), Faucitis, SORE THROAT, THROAT, SORE, Throat pain, Pain in the pharynx, Pain in throat, Throat discomfort, Sore throat symptom, Pain in throat (finding), Sore throat symptom (finding), Pharyngeal pain, Sore throat, Throat soreness, faucitis, pain; pharynx, pain; throat, pharynx; pain, Sore throat, NOS, pain; throat (symptom), sore throat; (symptom)
Portuguese DOR DE GARGANTA, Dor de Garganta, Mal-estar faríngeo, Dor de garganta, Dor na faringe, Feringite, Feringite NE
Spanish [D]dolor de fauces (categoría dependiente del contexto), Dolor de Garganta, GARGANTA, DOLOR DE, Molestias en la faringe, Garganta dolorosa, Dolor de garganta, Garganta dolorosa NEOM, Anginas, Dolor de faringe, síntoma relacionado con dolor de garganta, SAI (hallazgo), [D]molestia en las fauces, dolor faríngeo (hallazgo), síntoma relacionado con dolor de garganta, SAI, Sore throat symptom NOS, [D]dolor de fauces (situación), [D]dolor de fauces, dolor faríngeo, dolor de garganta (hallazgo), dolor de garganta, síntoma de dolor de garganta (hallazgo), síntoma de dolor de garganta
Czech bolení v krku, Hltanová bolest, Diskomfort faryngu, Bolest v krku, Bolest v krku NOS
French Mal de gorge, MAL DE GORGE, Mal de gorge SAI, Douleur dans la gorge, Douleur à la gorge, Douleur du pharynx, Gêne du pharynx, Mal à la gorge, Angine
German Halsschmerzen, HALS RAUH, rauer Hals, Schmerz Hals, Pharynxbeschwerden, Hals rau, rauer Hals NNB, Halsschmerz
Dutch keel zeer, zere keel NAO, pijn pharynx, pijn keel, farynx ongemak, zere keel, keelpijn, farynx; pijn, pijn; farynx, pijn; keel, Pijn in keel, keelpijn; (symptoom), pijn; keel (symptoom), Keelontsteking
Italian Faringodinia, Gola dolente, Dolore faringeo, Dolore alla gola, Fastidio della faringe, Dolore alla gola NAS, Mal di gola
Japanese 咽頭不快感, 咽頭痛, イントウツウ, イントウフカイカン, インコウツウ, 咽喉痛, インコウツウNOS, 咽喉痛NOS
Korean 목구멍의 통증
Hungarian Garat fájdalma, Torokfájás, Garat-fájdalom, Torokgyulladás, Torokgyulladás k.m.n., Garatfájás, Garatkellemetlenség
Norwegian Sår hals, Vond hals