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Sukhman Athwal, Group 1

Acute Pharyngitis
Epidemiology.
The epidemiology of acute pharyngitis can be divided into the
prevalence, causes, and control of the disease.
Acute pharyngitis is a common condition, occurring frequently in
children and half as much in adults. In children the occurrence
averages about 5 upper respiratory infections every year and one strep
infection in 4 years. (Acerra JR, et al, 2009). Most adult cases of
pharyngitis are limited to the infection itself and merely require
supportive treatment. (Tasar A, et al, 2008) An estimated 12 million
individuals are diagnosed with acute pharyngitis each year (Halsey E,
2009). GAS infection is diagnosed in about 15% percent of all
presenting with a painful sore throat in accident and emergency rooms.
(Acerra JR, et al, 2009)
Every year, GAS pharyngitis is approximated to occur in 616 million
individuals worldwide. Out of this, the acute cases result in rheumatic
heart disease in 6 million individuals (Halsey E, 2009). The incidence
of acute pharyngitis is reported to be high internationally, mainly
because of the higher rates of resistance of bacterial pharyngitis to
antibiotics. (Acerra JR, et al, 2009)
In developed countries, including the UK, the consequences of
untreated GAS pharyngitis, including acute rheumatic fever (ARF) and
rheumatic heart disease (RHD), are now rare. However, in regions with
limited resources, ARF and RHD are still significant causes of
morbidity and mortality, with prevalence rates that range from 1 to 5
per 1000 school-aged children, leading to more than 400 000 deaths
annually. (Carapetis JR, et al, 2005)
Acute pharyngitis usually occurs secondary to viral or bacterial
infection. A less likely cause is a fungal infection (Swedo SE, et al,
1998)
There are a number of microbial causes of acute pharyngitis (Prescott
HP, et al, 2007). These are listed below ( this table has been pasted
from wrongdiagnosis.com).
Viral:
o Adenovirus types 17, 7a, 9, 14, 15, and 16
o EpsteinBarr virus (EBV)
o Influenza A, B: Usually associated with more severe
systemic complaints
o Parainfluenza 1, 2, and 3
o Enteroviruses: Coxsackie A and B and echoviruses
o Measles, rubella, coronavirus, and cytomegalovirus
o Herpes simplex virus (HSV)

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Sukhman Athwal, Group 1
Acute Pharyngitis
Epidemiology.
o Rhinovirus and respiratory syncytial virus (RSV): Not
usually associated with pharyngeal inflammation
o HIV
Bacterial:
o Streptococcus pyogenes (group A -hemolytic
streptococcus)
o Group C or G streptococci
o Corynebacterium diphtheriae (diphtheria)
o Corynebacterium hemolyticum
o Neisseria gonorrhoeae and Neisseria meningitidis
o Mycoplasma pneumoniae and Mycoplasma hominis
o Chlamydia pneumoniae, Chlamydia psittaci
o Yersinia enterocolitica
o Treponema pallidum (syphilis)
o Oral anaerobes (Vincent angina)
Fungi: Candida species (oral thrush)
Of these, the most common bacterial cause of acute Pharyngitis is
Streptococcus pyogenes (Group A strep GAS). Streptococci are
usually found in school age children, as is the 6 year old patient in this
case. The most common viral causes of acute Pharyngitis are
Adenoviruses, Epstein-Barr virus, and a few other respiratory viruses.
(Brooks GF et al, 2007) The patient has not presented with a runny
nose or other cold symptoms, so the cause is unlikely to be of viral
origin. Thus laboratory tests are necessary to determine if a bacterial
infection is present, hence allowing the course of treatment to be
determined. (If the infection is found not to be of bacterial origin, then
antibiotics are not to be administered.)
The etiologic pathogen is not seen in 50% of all cases,
of pharyngitis, although full bacteriological and virologic
investigations are executed. Only GAS pharyngitis should be treated
with antibiotics. ( Tasar A, et al, 2008)
Other, less commonly occurring causes of acute pharyngitis include
oral thrush, dry air, post-nasal drip and smoking.
To detect the presence of GAS, the tests required are a rapid strep test,
and a throat culture. The rapid strep test is based on an antigenantibody reaction and uses blood agar or another selective culture
medium. This allows detecting of the presence of beta-Hemolytic
Streptococcus groups A, C and G. (Brooks GF et al, 2007)
These tests will ensure the control of the disease in this case, as they
will allow accurate diagnosis and treatment. In other cases of acute
pharyngitis, the control of the disease also relies on accurate diagnosis
and treatment of the disease. However, as mentioned, in developing
countries with limited resources, the prevalence rates are higher and

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this must be altered to control the disease so that further repercussions
such as RHD and ARF can be limited.

References.
Acerra JR, and Aronson A, 2009, "Pharyngitis," eMedicine,
Medscape, available at:
http://emedicine.medscape.com/article/764304-overview ,
accessed on: 16/11/2010.
Brooks GF, Butel JS, Ornston LN, 2007, Medical Microbiology,
24 t h edition, McGraw Hill, USA.
Carapetis JR, Steer AC, Mulholland EK, and Weber M, 2005, The
global burden of group A streptococcal diseases, Lancet Infect
Dis, 685694.
Halsey E, 2009, "Pharyngitis, Bacterial," eMedicine , Medscape
available at: http://emedicine.medscape.com/article/225243overview , accessed on: 16/11/2010.
Prescott LM, Harley JP, Klein DA, 2007, Microbiology, 7 t h
edition, Wm.C. Brown Publishers, Oxford.
Swedo SE, Leonard HL, Garvey M, et al,1998, Paediatric
autoimmune neuropsychiatric disorders associated with
streptococcal infections: Clinical description of the first 50
cases, Am J Psychiatry.155:264271.
Tasar A, Yanturali S, Topacoglu H, Ersoy G, Unverir P, Sarikaya
S, 2008, CLINICAL EFFICACY OF DEXAMETHASONE FOR
ACUTE EXUDATIVE PHARYNGITIS, Journal of emergency
medicine, 35: 363-367.
http://www.wrongdiagnosis.com/a/acute_pharyngitis/intro.htm :
web source, accessed on: 16/11/2010.