I. Bacterial pharyngitis:
- Streptococcal pharyngitis - positive rapid antigen test
- Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis.
- Less likely exudative: CMV, EBV (mononucleosis), adenovirus, influenza, herpes simplex
- Infectious mononucleosis - caused by EBV, characterized by malaise, fever, severe sore throat, splenomegaly
- Rash with penicillins
- Diagnosed by atypical lymphocytes, heterophile agglutination test (monospot)
- Splenic rupture possible with trauma
- symptomatic treatment, steroids if respiratory distress,
III. Fungal Pharyngitis
- Common in patients using inhaled steroids – counsel patients to rinse mouth after use of inhaled steroids.
Throat culture is the gold standard for diagnosis
Penicillin first line, macrolides (Azithromycin) second line for pen allergic patients.
No media at this time
Antibiotics are not indicated in the treatment infectious mononucleosis, or Epstein-Barr virus infections.
See A for explanation.
Acyclovir is not approved for use in treatment of EBV, although it is active against the EBV in vitro and in vivo. It may be used in certain patients with AIDS, but has not been shown to affect the outcome of EBV in these patients.
Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.
Group C Streptococcus
Group C Streptococcus presents with a red pharynx and enlarged tonsils with a yellow, blood tinged exudates
Neisseria gonorrhea of the pharynx may be asymptomatic