Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1164 Persistent Vegetative State Pharyngitis

specific therapy

■None

follow-up

n/a

complications and prognosis

■Most pts will die in weeks/months

■Recovery is rare & typically insufficient to permit independent living

PHARYNGITIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Viral (rhinovirus, coronavirus, adenovirus, herpes simplex,

influenza, Epstein-Barr virus) etiology in 40%

■Bacteria cause 15–30%; most common etiology is group A strep-

tococcus, but group C streptococcus,Chlamydia pneumoniae, and

Neisseria gonorrhoeaealso causes

■In 30% no known etiology

■Young age, crowding, temperate climate, contact with infected indi-

vidual, sexual practices (gonorrhea and acute HIV) predispose to

illness

■Major clinical distinction is between group A streptococcus and all

the others

Signs & Symptoms

■Acute onset of sore throat, painful swallowing and fever; erythema of

posterior pharynx and tonsils, with or without exudate, with tender

enlarged anterior cervical nodes

■Signs and symptoms NOT specific for group A streptococcus-seen

with viruses and other bacteria

■Absence of fever and presence of conjunctivitis, viral exanthem, diar-

rhea or pharyngeal vesicles suggests viral etiology

tests

■Leukocytosis may be present

■Pharyngeal swab for rapid antigen test 80–90% sensitive for diagnosis

of group A streptococcus and >95% specific

■If rapid antigen test negative, culture should be obtained