DEFINITIONS AND EPIDEMIOLOGY
Pharyngitis refers to inflammation of the mucous membranes of the pharynx that manifests as a sore throat. Inflammation of the adjoining tonsils (tonsillopharyngitis) and isolated tonsillar infection (tonsillitis) are commonly included in this diagnostic category. Stomatitis refers to inflammation of the mucous membranes of the oral cavity, including the buccal mucosa, palate, gingiva, tongue, and lips. This chapter covers the major aspects (i.e., epidemiology, epidemiology, pathogenesis, clinical features, diagnosis, treatment) of pharyngitis and stomatitis in separate subsections.
Pharyngitis may be part of a broader respiratory tract infection or one manifestation of a systemic illness. Pharyngitis is one of the most common reasons that patients seek care. An estimated 12 million ambulatory-care visits are made annually for evaluation of pharyngitis among children 3–17 years of age.1 Most episodes of pharyngitis are caused by viruses that typically target upper and lower respiratory tract loci (Table 27-1). Viral pharyngitis is common in children of all age groups, although Epstein–Barr virus (EBV) is more common in older children and adolescents.2 In the United States and other countries with temperate climates, the incidence of viral pharyngitis peaks in the winter. Certain viruses (e.g., adenovirus, enterovirus) are common causes of pharyngitis in the summer and fall.3 This seasonality is not maintained in tropical climates.
TABLE 27-1Pharyngitis Causative Organisms3,64 ||Download (.pdf) TABLE 27-1Pharyngitis Causative Organisms3,64
|Infectious mononucleosis; exudative pharyngitis with fever, headache, malaise, ± hepatosplenomegaly; gradual onset and often prolonged course, lasting 7–21 days
|Abrupt onset of fever, myalgias, headache with typically nonexudative pharyngitis; cough and coryza develop shortly thereafter
|Other respiratory viruses
|Nonexudative pharyngitis–often with symptoms of common cold, bronchiolitis, or viral pneumonia (e.g., rhinovirus, parainfluenza virus, human metapneumovirus, respiratory syncytial virus, coronavirus)
|Pharyngitis is frequently exudative;. presents with pronounced fever, conjunctivitis, cough, rhinorrhea in toddlers and young children
|Herpangina—pharyngeal erythema with discrete ulcers on soft palate, uvula, tonsillar pillars
|Heterophile negative mononucleosis, with exudative pharyngitis
|Human immunodeficiency virus (HIV)
|Primary HIV infection. acute onset of fever, nonexudative pharyngitis ± oral ulcers; frequently associated with maculopapular rash, headache, aseptic meningitis, and/or diarrhea
|Diffuse pharyngeal erythema and Koplik spots with fever, cough, coryza, and conjunctivitis, preceding onset of rash
|Group A hemolytic Streptococcus
|Exudative pharyngitis ± fever; abrupt onset, can be associated with scarlet fever (sandpaper rash, strawberry tongue, Pastia’s lines); typical features of viral respiratory illness absent.
|Groups C and G streptococci
|Resembles exudative pharyngitis of GABHS, also may have associated scarlatiniform rash
|Fine maculopapular or scarlatiniform rash on trunk, neck, and extensor surfaces, sparing palms and soles; typically seen in adolescents and young adults
|Mycoplasma pneumoniae and Chlamydophila pneumoniae
|Usually nonexudative pharyngitis with cervical lymphadenopathy; may present without upper/lower respiratory ...