Pharyngitis and Tonsillitis
Overview
Pharyngitis (throat inflammation) and tonsillitis (tonsillar inflammation) are common emergency presentations.
Most cases are viral and self‑limiting, but bacterial causes-especially Group A Streptococcus (GAS, Streptococcus pyogenes) and Fusobacterium necrophorum-may require antibiotics or specialist care because of risks of suppurative and systemic complications (peritonsillar and deep‑neck space infection, invasive GAS, Lemierre’s syndrome, post‑streptococcal immune complications).
Early identification of red flags, use of validated clinical scores to stratify bacterial risk, and prompt management of airway compromise or deep‑neck sepsis are the priorities.
Key pathogens
- Viral (majority): rhinovirus, coronavirus, parainfluenza, influenza A/B, adenovirus, HSV‑1, Epstein-Barr virus (EBV).
- Bacterial: Streptococcus pyogenes (GAS), group C/G streptococci, Fusobacterium necrophorum, and anaerobes.
- Rare bacterial causes: Corynebacterium diphtheriae and Yersinia species, depending on geography and epidemiology.
Presentation and initial assessment
- History: Establish onset and duration, presence of fever, cough or coryzal symptoms, severity of sore throat, odynophagia, trismus, drooling, voice change, neck pain, and systemic features such as rigors or severe malaise. Ask about recent close contacts with scarlet fever or invasive GAS and any history of rheumatic fever.
- Examination: Assess airway patency, hydration, and systemic toxicity. Inspect for tonsillar erythema and exudate, unilateral tonsillar swelling or uvular deviation, tender anterior cervical lymphadenopathy, lateral neck swelling, skin rash consistent with scarlet fever, and hepatosplenomegaly suggestive of EBV.