Abstract
Background
Pharyngitis is a common disease in the emergency department (ED). Despite a relatively
low incidence of complications, there are many dangerous conditions that can mimic
this disease and are essential for the emergency physician to consider.
Objective
This article provides a review of the evaluation and management of group A β-hemolytic
Streptococcal (GABHS) pharyngitis, as well as important medical conditions that can
mimic this disease.
Discussion
GABHS pharyngitis often presents with fever, sore throat, tonsillar exudates, and
anterior cervical lymphadenopathy. History and physical examination are insufficient
for the diagnosis. The Centor criteria or McIsaac score can help risk stratify patients
for subsequent testing or treatment. Antibiotics may reduce symptom duration and suppurative
complications, but the effect is small. Rheumatic fever is uncommon in developed countries,
and shared decision making is recommended if antibiotics are used for this indication.
Oral analgesics and topical anesthetics are important for symptom management. Physicians
should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include
epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome,
Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess,
and viral pharyngitis. A focused history and physical examination can help differentiate
these conditions.
Conclusions
GABHS may present similarly to other benign and potentially deadly diseases. Diagnosis
and treatment of pharyngitis should be based on clinical evaluation. Consideration
of pharyngitis mimics is important in the evaluation and management of ED patients.
Keywords
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Article info
Publication history
Published online: March 06, 2018
Accepted:
January 19,
2018
Received in revised form:
January 10,
2018
Received:
November 4,
2017
Identification
Copyright
Published by Elsevier Inc.
