Tonsillopharyngitis is characterized by an acute infection of the pharynx, palatine tonsils. Complications include sore throat, dysphagia, cervical lymphadenopathy, and fever. The diagnosis is made clinically, with the help of a culture or a fast antigen test. Treatment for group A beta-hemolytic streptococcus is based on symptoms and includes antibiotics in the case of group A beta-hemolytic streptococcus.
The tonsils have a role in immunological surveillance throughout the body. Local tonsillar defenses also contain an antigen-processing squamous epithelium lining that triggers B- and T-cell responses.
Etiology of Tonsillopharyngitis
The common cold viruses (adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus) are the most prevalent causes of tonsillopharyngitis, but Epstein-Barr virus, herpes simplex virus, cytomegalovirus, and HIV can also cause it.
The cause is bacterial in approximately 30% of individuals. The most frequent streptococcal infection is Group A beta-hemolytic streptococcus (GABHS), however Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae are also implicated. Pertussis, Fusobacterium, Diphtheria, Syphilis, and Gonorrhea are all rare causes.
GABHS is most common between the ages of 5 and 15, and it is rare before the age of 3.
Symptoms and Signs of Tonsillopharyngitis
The hallmark is swallowing pain, which is frequently attributed to the ears. Children who are unable to complain about a sore throat frequently refuse to eat. High fevers, lethargy, headaches, and GI trouble, as well as halitosis and a muffled voice, are all frequent symptoms. There could also be a rash. Tonsils that are large, red, and have purulent exudates are common. There could be sensitive lymphadenopathy in the neck. Fever, adenopathy, palatal pruritus, and exudates are more prominent in GABHS than in viral tonsillopharyngitis, but the two conditions are quite similar. A scarlatiniform rash (scarlet fever) may accompany GABHS.
Diagnosis of Tonsillopharyngitis
Clinically, pharyngitis is easily identifiable. Its cause, on the other hand, is not. Rhinorrhea and cough are frequently signs of a viral infection. Posterior cervical or widespread adenopathy, hepatosplenomegaly, lethargy, and malaise for more than one week; a full neck with soft palate petechiae; and thick tonsillar exudates are all signs of infectious mononucleosis. Diphtheria is indicated by a dirty gray, thick, rough membrane that bleeds when peeled away (rare in the US).
GABHS must be diagnosed early since it requires antibiotics. The testing criteria are debatable. All children should be tested with a fast antigen test or a culture, according to several experts. Rapid antigen tests are specific but not sensitive, thus a culture, which is 90 percent specific and 90 percent sensitive, may be required. Many sources propose adopting the modified Centor score (1) in adults based on the following four criteria:
- History of fever
- Tonsillar exudates
- Absence of cough
Anterior cervical lymphadenopathy is a painful condition.
Patients who meet one or none of the criteria for GABHS are unlikely to have it and should not be tested. Patients who meet two requirements are eligible for testing. GABHS can be tested or treated empirically in patients who meet three or four criteria.
Treatment of Tonsillopharyngitis
Analgesia, hydration, and rest are examples of supportive therapy. Analgesics can be taken orally or topically. NSAIDs (nonsteroidal anti-inflammatory medications) are commonly used as systemic analgesics. Some doctors may also administer a single corticosteroid dose (e.g., dexamethasone 10 mg IM) to assist decrease symptom duration without increasing recurrence rates or side effects (1). Lozenges and sprays containing benzocaine, phenol, lidocaine, and other chemicals are available as topical analgesics. These topical analgesics can help with pain relief, but they must be used frequently and can have a negative impact on taste. Methemoglobinemia is a rare side effect of benzocaine, which is used to treat pharyngitis.
For GABHS tonsillopharyngitis, penicillin V is usually the antibiotic of choice; the dose is 250 mg orally 2 times a day for 10 days for patients weighing less than 27 kg, and 500 mg for those weighing more than 27 kg. If a liquid formulation is essential, amoxicillin is more effective and more appealing. A single dosage of benzathine penicillin 1.2 million units IM (600,000 units for children under 27 kg) is effective if adherence is a problem. Other oral medications include macrolides, a first-generation cephalosporin, and clindamycin for people allergic to penicillin. Gargling with a 1:1 mixture of over-the-counter hydrogen peroxide and water promotes debridement and improves oropharyngeal cleanliness.