Pharyngitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Natural History
Group A Streptococcus
Symptoms develop after a short incubation period of 24 to 72 hours.[1] Most cases of pharyngitis go away on their own without complications. Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.[1]
Corynebacterium diphtheriae
The incubation period for Corynebacterium diphtheriae infection is two to four weeks.[1]
Complications
Complications of pharyngitis based on the causing agent include the following: [2] Identifying the cause of pharyngitis, especially group A beta-hemolytic streptococcus (GABHS), is important to prevent potential life-threatening complications.[1] Serious complications of pharyngitis may include peritonsillar abscess or retropharyngeal abscess.[3]
| Common complications | ||
| Pathogen | Complications | |
|---|---|---|
| Group A Streptococcus |
Suppurative complications
Non suppurative complications
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| Influenza |
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| Adenovirus |
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| Cocksackie A virus |
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| Ebstein barr virus |
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| Less common complications | ||
| Gonococcus |
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| Diphtheria |
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| Heamophilis influenza | ||
| Fusobacterium necrophorum | ||
| Parainfluenza virus |
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Group A Streptococcal Pharyngitis Complications
Rheumatic fever
Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. Patients will have an elevated antistreptolysin- O titer and erthrocyte sedimentation rate.[1]
Post streptococcal glomerulonephritis
Post streptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer.[1]
Scarlet fever
Scarlet fever is associated with GABHS pharyngitis and usually presents as a punctate, erythematous, blanchable, sandpaperlike exanthem. The rash is found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastia’s lines). The pharynx and tonsils are erythematous and covered with exudates. The tongue may be bright red with a white coating (strawberry tongue).
Prognosis
Most cases of pharyngitis go away on their own without complications.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
- ↑ 2.0 2.1 2.2 2.3 Murray RC, Chennupati SK (2012). "Chronic streptococcal and non-streptococcal pharyngitis". Infect Disord Drug Targets. 12 (4): 281–5. PMID 22338589.
- ↑ Cohen, J (2010). Infectious diseases. Edinburgh: Mosby/Elsevier. ISBN 978-0323045797.