Description

Pharyngitis specifically refers to inflammation of the pharynx as indicated by erythema and swelling of the structures in the posterior portion of the oral cavity including the tonsillar pillars, the tonsils, the inferior soft palate, the uvula, and the posterior wall. Pharyngitis is usually caused by viral or bacterial infections.

Epidemiology

• Prevalence and etiology of pharyngitis vary based on age of patient and time of year.
• In preschool-aged children, viral agents are most common and exhibit seasonal variation depending on the specific virus.
• Group A Streptococcus (GAS) pharyngitis is most common in children between the ages of 5 and 15 years, is very rare in children age <3 years, and may occur in outbreaks affecting up to 20% of children at risk.
• Pharyngitis caused by Neisseria gonorrhoeae occurs primarily in sexually active adolescents.

Etiology

• Viral
  • Common causes: adenovirus, Epstein-Barr virus (EBV), influenza A and B, enteroviruses (specifically, coxsackievirus A), herpes simplex virus (HSV) (especially in adolescents), and echoviruses
  • Uncommon: measles, rubella, cytomegalovirus, HIV
  • Rhinovirus, coronavirus, parainfluenza virus, and respiratory syncytial virus (RSV) may cause sore throat but not usually pharyngitis.
• Bacterial
  • Common: Streptococcus pyogenes (group A β-hemolytic Streptococcus)
  • Uncommon: Mycoplasma pneumoniae, group C or G streptococci, N. gonorrhoeae (more likely in sexually active adolescents), Arcanobacterium haemolyticum, Fusobacterium necrophorum (Lemierre syndrome), Corynebacterium diphtheriae (diphtheria), Chlamydophila pneumoniae, Chlamydophila psittaci, Yersinia enterocolitica, Treponema pallidum (syphilis), Francisella tularensis (tularemia), oral anaerobes (Vincent angina or trench mouth)
• Fungal: Candida species (oral thrush)

General Prevention

• Most infectious agents that cause pharyngitis are spread through contact with respiratory droplets or other body fluids, although many can live for some time outside of the body.
• Careful hand washing and avoiding respiratory secretions are keys to minimizing transmission.
• Return to school/child care
  • Children diagnosed with GAS pharyngitis may return to school the day following initiation of antibiotics.
  • Children with pharyngitis due to presumed viral etiology should be fever-free for 24 hours and have symptoms under control prior to return.

Risk Factors

• Children who are immunocompromised and children on chronic inhaled corticosteroids who are otherwise immune competent are at risk for candidiasis of the pharynx.
• Adolescents or sexually abused children engaging in oral sex are at risk for pharyngitis due to gonorrhea or HSV.
• Unvaccinated patients or travelers from certain areas are at risk for vaccine-preventable diseases: diphtheria and measles.