Pharyngitis: (Sore Throat)

Presentation

The patient with bacterial pharyngitis complains of a rapid onset of throat pain worsened by swallowing. There is usually sudden onset of the following: fever; pharyngeal erythema; edematous uvula; palatine petechiae ( Fig. 39.1 ); purulent, patchy yellow, gray, or white exudate; tender anterior cervical adenopathy; headache; and absence of a cough. Children who are younger than 3 years of age more often have coryza and are less likely to present with exudative pharyngitis.

Viral infections are typically accompanied by conjunctivitis, nasal congestion, hoarseness, cough, aphthous ulcers on the soft palate, and myalgias. There are circumstances where the appearance of the pharynx may be seen in either bacterial or viral infections ( Fig. 39.2 ). Children with viral pharyngitis can present with mouth breathing, vomiting, abdominal pain, and diarrhea.

It is helpful to differentiate pain on swallowing (odynophagia) from difficulty swallowing (dysphagia); the latter is more likely to be caused by obstruction or abnormal muscular movement.