7. Exudative Pharyngitis

John Moorhead and Colby Austin

FIGURE 1. Exudative pharyngitis. (Photo courtesy of American Academy of Pediatrics.)

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Clinical Presentation

• Fever, sore throat, and odynophagia are most common complaints.
• Associated symptoms of an upper respiratory infection may be present.
• Patients should not have any airway compromise, uvular deviation, or trismus; which would be more indicative of deeper tissue infections such as peritonsillar abscess, submandibular/retropharyngeal space infections, and epiglottitis.

Diagnosis

• Diagnosis is made by history and physical exam alone.
• Must be able to rule out life threats such as epiglottitis, peritonsillar abscess, submandibular space infections, and retropharyngeal space infections
• Time course and risk factors are important elements of history.

Management

• Typically bacterial in etiology; rarely can be associated with viral etiologies such as acute infectious mononucleosis
• Most common organism is group A β-hemolytic Streptococcus (GABHS). Penicillin is considered first-line treatment.
• If GABHS is suspected, use Centor criteria to determine if treatment with antibiotics is warranted. Centor criteria include tonsillar exudates, tender anterior cervical lymphadenopathy, abscence of cough, and fever. For patients with two or more criteria, consider rapid strep test. For patients with three or more criteria, consider empiric antibiotic treatment.
• Be vigilant for infection due to atypical organisms such as gonococcal pharyngitis or diphtheria from Corynebacterium diphtheria in high-risk patients.