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Acute pharyngitis etiology

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"pharyngitis"[MeSH Terms] AND etiology

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CDC group A strep pharyngitis causes viral pharyngitis etiology

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Acute pharyngitis: etiology

1. Viral causes - most common

Viruses cause the majority of acute pharyngitis, especially in young children. In pediatric cases, approximately 50% to 80% are viral. Common agents include:
  • Rhinovirus and coronavirus
  • Adenovirus
  • Influenza A and B
  • Parainfluenza virus
  • Enteroviruses, especially coxsackievirus
  • Respiratory syncytial virus
  • Epstein-Barr virus - infectious mononucleosis
  • Cytomegalovirus
  • Herpes simplex virus types 1 and 2
  • Acute HIV infection
  • Measles virus
Features such as cough, coryza, hoarseness, conjunctivitis, oral ulcers, or diarrhea favor a viral cause. Tintinalli's Emergency Medicine: A Comprehensive Study, Table 124-2.

2. Bacterial causes

  • Group A beta-hemolytic Streptococcus, Streptococcus pyogenes: the most important bacterial cause because treatment prevents acute rheumatic fever. It accounts for about 20% to 30% of pharyngitis in children and 5% to 15% in adults, according to CDC guidance.
  • Group C and Group G streptococci
  • Arcanobacterium haemolyticum - often adolescents; may cause a scarlatiniform rash
  • Corynebacterium diphtheriae - pseudomembranous pharyngitis in nonimmune persons
  • Neisseria gonorrhoeae - following oral sexual exposure
  • Fusobacterium necrophorum - mainly adolescents and young adults; important because of possible Lemierre syndrome
  • Mycoplasma pneumoniae and Chlamydia pneumoniae - less common

3. Other infectious syndromes presenting with pharyngitis

  • Peritonsillar infection/abscess
  • Acute epiglottitis or deep neck-space infection
  • Oral candidiasis in immunocompromised patients
  • Primary HSV gingivostomatitis
  • Hand-foot-mouth disease due to coxsackievirus

Key point

Acute pharyngitis is usually viral. Exudates alone do not establish bacterial infection. Group A streptococcus is the principal bacterial diagnosis to identify and confirm with appropriate testing when viral features are absent.

Viral etiology

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"pharyngitis"[MeSH Terms] AND virus

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acute viral pharyngitis common viral causes CDC

Viral etiology of acute pharyngitis

The common viral causes are:
  1. Rhinovirus
  2. Coronavirus
  3. Adenovirus
  4. Influenza A and B
  5. Parainfluenza virus
  6. Enteroviruses, especially coxsackievirus
  7. Respiratory syncytial virus (RSV)
  8. Epstein-Barr virus (EBV) - infectious mononucleosis
  9. Cytomegalovirus (CMV)
  10. Herpes simplex virus type 1 or 2
  11. Acute HIV infection
  12. Measles virus
Viruses are the most frequent cause of pharyngitis across age groups. In children with acute pharyngitis, about 50% to 80% of cases are viral. Viral pharyngitis is suggested by cough, rhinorrhea/coryza, hoarseness, conjunctivitis, oral ulcers, or diarrhea. CDC clinical guidance supports that viruses are the commonest cause.
Tintinalli's Emergency Medicine: A Comprehensive Study, Table 124-2.
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