Overview
Definition
An acute infection of the pharynx and palatine tonsils caused by Group A Streptococcus.
Epidemiology
Most common in children ages 5-15, particularly during winter and early spring.
Etiology & Risk Factors
- Group A beta-hemolytic Streptococcus (Streptococcus pyogenes)
Clinical Symptoms
- Sudden onset of severe sore throat and odynophagia (painful swallowing)
- Fever
- Tonsillar exudates (white/yellow patches on red, swollen tonsils)
- Tender anterior cervical lymphadenopathy
- ABSENCE of cough (viral pharyngitis usually has cough, rhinorrhea, and conjunctivitis)
Clinical Approach
Diagnosis
- Centor Criteria (Fever, Exudates, Tender anterior cervical adenopathy, NO cough): Used to risk-stratify
- Rapid Antigen Detection Test (RADT): Initial test of choice
- Throat Culture: Gold Standard (performed if RADT is negative in children/adolescents to avoid missing the diagnosis)
Management
- Penicillin V (oral) or Amoxicillin for 10 days
- Cephalexin or Azithromycin for Penicillin-allergic patients
- Goal of treatment: Accelerate symptom resolution AND prevent Acute Rheumatic Fever
Complications
- Acute Rheumatic Fever (molecular mimicry affecting the heart valves, prevented by antibiotics)
- Post-Streptococcal Glomerulonephritis (PSGN - NOT prevented by antibiotics)
- Peritonsillar Abscess (Quinsy)