Pharyngitis is an inflammation and commonly an infection of the pharynx and its lymphoid tissues. Viral causes account for 90% of all cases. Group A ^-hemolytic streptococci (GABHS) is responsible for up to 50% of bacterial infections. Other bacterial causes include other streptococci, Mycoplasma pneumoniae, Neisseria gonorrhea, and Corynebacterium diphtheriae. In immunocompromised patients and patients on antibiotics, Candida species can cause thrush. Sore throats that last longer than 2 weeks should increase suspicion for either a deep-space neck infection or a neoplastic cause.
Patients with bacterial and especially GABHS pharyngitis present with an acute onset of sore throat, fever and frequently with nausea, vomiting, headache, and abdominal cramping. They may have a mild to moderate fever, an erythematous posterior pharynx and palatine tonsils, tender cervical lymphadenopathy, and palatal petechiae. Classically, the tonsils have a white or yellow exudate with debris in the crypts; however, many patients may not have exudate on examination. Viral pharyngitis is typically more benign, with a gradual onset, lower temperature, and less impressive erythema and swelling of the pharynx. Except for infectious mononucleosis, which can take weeks to resolve, most cases of viral pharyngitis are self-limited, with spontaneous resolution in a matter of days. Lingual and adenoid tonsillitis may also be present.
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