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Patient Story
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A mother brings her nine year-old daughter to the pediatrician’s office with complaints of sore throat, fever, and malaise for 2 days. The girl has not had cough or runny nose. The mother is concerned about strep throat because a classmate of the daughter’s was just diagnosed with this. On exam, the girl has erythematous tonsillar pillars, palatal petechiae, and impressive cervical lymphadenopathy (Figure 29-1). A throat swab for rapid streptococcal antigen is positive and the girl is treated with penicillin VK for 10 days and recovers completely.

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FIGURE 29-1

Erythema and edema of the pharynx, and palatal petechiae in a child with Group A Streptococcal pharyngitis. (Used with permission from CDC/Public Health Image Library/Heinz F. Eichenwald, MD.)

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Introduction
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Upper respiratory tract infection (URI), also known as the common cold, and pharyngitis, inflammation and pain of the pharyngeal tissues, including the pharynx, tonsils and adenoids are among the most common illnesses of childhood. URIs are characterized by rhinorrhea, nasal congestion, and sore or scratchy throat. They are caused by viruses. Symptoms and signs of pharyngitis include throat soreness or scratchiness, fever, headache, malaise, rash, joint and muscle pains, and cervical lymphadenopathy. Viruses are responsible for the majority of cases of pharyngitis in infants and children, although Group A β-hemolytic streptococci (GABHS) are important causes of pharyngitis because of their ability to cause suppurative (peritonsillar and parapharyngeal abscesses) and non-suppurative (acute rheumatic fever and glomerulonephritis) complications.

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Epidemiology
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  • Acute URI and pharyngitis account for 3.4 percent and 1 percent of primary care visits, respectively.1

  • Viral infections account for the vast majority of cases of URI and 60 to 90 percent of cases of pharyngitis in children. GABHS is responsible for the majority of bacterial pharyngitis.

  • In temperate climates, the highest prevalence of URI and pharyngitis occurs from autumn until spring. This corresponds directly with circulating viruses over this period of time.

  • Frequency of URIs varies with age: highest frequency is in children 1 to 5 years of age, who experience 7 to 8 colds per year; infants less than one year of age average 6.5 colds a year; adolescents average 4.5 colds per year.2

  • Highest incidence of GABHS pharyngitis is in school-aged children and adolescents.

  • Acute rheumatic fever is rare in the US (see Chapter 45, Acute Rheumatic Fever).

  • Viruses causing URIs and pharyngitis can be spread via small particle aerosol (Influenza and Coronaviruses), large particle droplet (Rhinoviruses), or direct hand-to-hand transmission (Rhinoviruses and RSV).

  • Up to 14 percent of deep neck infections result from pharyngitis.3

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Anatomy
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  • The lingual tonsils on the base of tongue, the lateral palatine tonsils (“tonsils”) and the superior pharyngeal tonsils (“adenoids”) together make up Waldeyer’s ring. This ring of lymphoid tissue is favorably located ...

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