I. Introduction
Acute pharyngitis is the most common condition that mostly meets in clinical practice. Most of the germs that cause pharyngitis are respiratory viruses. Group A Streptococcus (GAS) is the frequent bacteria infection for pharyngitis.
II. Epidemiology
III.Etiology and clinical findings
The 2 most infectious causes for pharyngitis are respiratory viruses and group A Streptococcus(GAS).
Respiratory viruses, including SARS-CoV-2: adenovirus, rhinovirus, and coronavirus are the leading causes of viral pharyngitis.Other causes: enteroviruses, influenza A and B, parainfluenza viruses, and respiratory syncytial virus.
The patients infected by viruses have symptoms and signs of upper respiratory tract infection, such as fatigue, nasal congestion, oral ulcers, and viral exanthem. Cervical lymphadenopathy may be present but is generally not prominent.
Group A Streptococcus :
The most common bacterial cause of acute pharyngitis. Rates are higher in less developed countries. Classic signs and symptoms of GAS include:
Acute-onset sore throat Fever Pharyngeal edema Pathy tonsillar exudates Arterial cervical lymphadenopathy
Other features: palatal petechiae, scarlatiniform rash, and a strawberry tongue(eg, Scarlet fever). GAS infection can lead to suppurative and nonsuppurative complications. Suppurative complications of GAS pharyngitis are due to the invasion of the organism beyond the pharynx and include otitis media, peritonsillar cellulitis or abscess, sinusitis, meningitis, bacteremia, and necrotizing fasciitis. Nonsuppurative complications of GAS pharyngitis are immune-mediated and include acute rheumatic fever,post-streptococcal glomerulonephritis, and reactive arthritis.
Other bacterias :
Group C and G streptococcus: less common causes of pharyngitis than GAS. Infection with group C or G streptococci most often occurs among college students and young adults and has been associated with community and foodborne outbreaks. Arcanobacterium haemolyticum : It is a facultative anaerobic gram-positive bacillus that is an uncommon cause of acute pharyngitis.A.haemolyticum is usually resistant to trimethoprim-sulfamethoxazole and may be penicillin tolerant. The treatment of choice is erythromycin. Mycoplasma and Chlamydia species: have been reported to cause pharyngitis, most commonly in children and young adults Corynebacterium diphtheriae: IT is the causative agent of diphtheria. The clinical syndrome of diphtheria is characterized by pharyngitis, low-grade fever, malaise, and cervical lymphadenopathy. Acute HIV infection: the presence of painful mucocutaneous lesions is one of the most characteristics of acute HIV infection. Ulcers are typically shallow and sharply with a white base and erythematous perimeter. The presence of generalized rash, usually maculopapular, should raise suspicion for HIV infection. Neisseria gonorrhoeae: Mostly occur in men sex with men(MSM). Risk factors for STIs, in particular receptive oral intercourse, should raise suspicion for gonococcal pharyngitis. Treponema pallidum: Pharyngeal examination often reveals mucous patches on the oral mucosa and tongue(round or oval elevated lesion covered by a pink-gray membrane). The onset of symptoms typically occurs weeks to months after exposure.
Noninfectious causes : The causes include allergic rhinitis or sinusitis, gastroesophageal reflux disease, smoking or exposure to second-hand smoke, and exposure to dry air(particularly in the winter). Trauma also has been reported to cause sore throat. Medications associated with pharyngitis: ACE(angiotensin-converting enzyme inhibitors) and some chemotherapeutics. Autoimmune disorders include Kawasaki disease, periodic fever with aphthous stomatitis, pharyngitis, and adenitis, and Behçet syndrome.
IV.Diagnosis
Clinical features should raise suspicion for GAS pharyngitis include:
Sudden-onset sore throat Fever, Tonsillopharyngeal and/or uvular edema Patchy tonsillar exudates Scarlatiniform skin rash and/or strawberry tongue(scarlet fever) For patients suspected of group A streptococcus(GAS) pharyngitis, testing with a sensitive Rapid antigen detection test(RADT)is sufficient for diagnosis. PCR-based assays are more sensitive than RADTs and culture, particularly when the bacterial burden is low. Specimen collection and transport: Specimens should be obtained by swabbing of both tonsils(or tonsillar fossae in patients without tonsils) and the posterior pharynx.
V.Management
Symptom reduction: patients with streptococcal pharyngitis should be treated with antibiotic treatment. Symptoms typically resolve in about 3 to 5 days for most patients. Penicillin is the treatment of choice for group A streptococcus (GAS) pharyngitis. The duration of penicillin or amoxicillin is 10 days. Alternative to penicillin 
Clindamycin and macrolides for those who are allergic to penicillin or who cannot tolerate penicillin. Cephalosporin such as cephalexin can be used too.
VI. Prevention
Hand hygiene is key for preventing spread to others after sneezing and before eating foods Antibiotic prophylaxis is used for patients with a history of acute rheumatic fever.
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