Pharyngitis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
=== '''Group A Streptococcus''' === | === '''Group A Streptococcus''' === | ||
Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> | Strep pharyngitis occurs predominantly, though not exclusively, in school-age children.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> Not all patients have the full-blown syndrome; many cases are milder and nonexudative, and patients who have undergone tonsillectomy may have milder symptoms.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.<ref name="pmid15053411" /> | ||
=== Corynebacterium diphtheriae === | === Corynebacterium diphtheriae === | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
The sore throat, fever, and malaise associated with acute pharyngitis are distressing, but with few exceptions, these illnesses are both benign and self limited. Many bacterial and viral organisms are capable of inducing pharyngitis, either as a single manifestation or as part of a more generalized illness.[1]
Natural History
Group A Streptococcus
Strep pharyngitis occurs predominantly, though not exclusively, in school-age children.[1] Symptoms develop after a short incubation period of 24 to 72 hours.[2] Not all patients have the full-blown syndrome; many cases are milder and nonexudative, and patients who have undergone tonsillectomy may have milder symptoms.[1] Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.[2]
Corynebacterium diphtheriae
The incubation period for Corynebacterium diphtheriae infection is two to four weeks.[2]
Complications
Identifying the cause of pharyngitis, especially group A beta-hemolytic streptococcus (GABHS), is important to prevent potential life-threatening complications.[2] Serious complications of pharyngitis may include peritonsillar abscess or retropharyngeal abscess.[3] Complicationsof pharyngitis based on the causing agent include the following: [4]
| Common complications | ||
| Pathogen | Complications | |
|---|---|---|
| Group A Streptococcus |
Suppurative complications
Non suppurative complications
| |
| Influenza |
| |
| Adenovirus |
| |
| Cocksackie A virus |
| |
| Ebstein barr virus |
| |
| Less common complications | ||
| Gonococcus |
| |
| Diphtheria |
| |
| Heamophilis influenza | ||
| Fusobacterium necrophorum | ||
| Parainfluenza virus |
| |
Group A Streptococcal Pharyngitis Complications
Rheumatic fever
Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. Patients will have an elevated antistreptolysin- O titer and erthrocyte sedimentation rate.[2]
Post streptococcal glomerulonephritis
Post streptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer.[2]
Scarlet fever
Scarlet fever is associated with GABHS pharyngitis and usually presents as a punctate, erythematous, blanchable, sandpaperlike exanthem. The rash is found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastia’s lines). The pharynx and tonsils are erythematous and covered with exudates. The tongue may be bright red with a white coating (strawberry tongue).
Prognosis
Most cases of pharyngitis go away on their own without complications.
References
- ↑ 1.0 1.1 1.2 Bisno AL (2001) Acute pharyngitis. N Engl J Med 344 (3):205-11. DOI:10.1056/NEJM200101183440308 PMID: 11172144
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
- ↑ Cohen, J (2010). Infectious diseases. Edinburgh: Mosby/Elsevier. ISBN 978-0323045797.
- ↑ 4.0 4.1 4.2 4.3 Murray RC, Chennupati SK (2012). "Chronic streptococcal and non-streptococcal pharyngitis". Infect Disord Drug Targets. 12 (4): 281–5. PMID 22338589.