Pharyngitis

Pharyngitis is infection of the throat (pharynx) and sometimes the tonsils. Most pharyngitis is caused by the same viruses that cause the common cold. Like the common cold, viral pharyngitis gets better by itself and is a problem only because it makes children miserable and causes them to miss school. Streptococcus bacteria are a less common but more serious cause of pharyngitis ("strep throat"); strep throat is unusual in children younger than 2 years. Pharyngitis is also rarely caused by unusual infections, such as infectious mononucleosis or-in countries with low vaccination rates-diphtheria.
The tonsils (patches of lymphoid tissue at the back of the throat) also can become infected in children with pharyngitis. A doctor may use the term tonsillitis when the tonsils are particularly enlarged. Occasionally, the tonsils remain infected, inflamed, or enlarged (chronic tonsillitis) after an episode of pharyngitis.
Bacterial pharyngitis can cause persistent inflammation, infection, and enlargement of the tonsils (chronic tonsillitis) ; pus within folds of the tonsils (cryptic tonsillitis) ; and abscesses in the tissues to the side of the pharynx (lateral pharyngeal abscesses), behind the pharynx (retropharyngeal abscesses), or around the tonsils (peritonsillar abscesses). Some rare complications of streptococcal pharyngitis include rheumatic fever, glomerulonephritis, or life-threatening infection of the tissues (necrotizing fasciitis) and bloodstream (toxic shock syndrome).

Symptoms
All children with pharyngitis have sore throats and some degree of pain when swallowing. Ear pain may occur because the throat and ears share the same nerves. The back of the throat and tonsils are typically red, and the tonsils may be enlarged or coated with white discharge. Children with pharyngitis as part of a head cold have a runny nose, cough, and slight fever. Children with pharyngitis caused by strep throat may have tender, enlarged lymph nodes in the neck and a high fever. Occasionally, a child with strep throat has symptoms of scarlet fever, which include bright white or red changes of the tongue ("strawberry tongue") and a distinctive red skin rash (scarlatiniform rash). Children with chronic tonsillitis may have a sore throat or discomfort or pain with swallowing.

Diagnosis and Treatment
Doctors suspect pharyngitis when they see redness and white discharge or pus in the back of the throat and when the lymph nodes in the neck are enlarged. If doctors suspect strep throat, they may take a swab from the back of the throat and send it for two tests: rapid antigen testing and a bacterial culture. Rapid antigen testing can detect strep throat within minutes. If the result of a rapid test is positive, the bacterial culture is not needed.
However, if the result of the rapid test is negative, most doctors perform a culture, which takes about 1 to 2 days for results. Strep throat is usually treated with penicillin, either in a single injection or over 10 days by mouth. If the child is allergic to penicillin, the doctor may give erythromycin or another antibiotic. Treatment of strep throat and viral pharyngitis includes giving ibuprofen or paracetamol for pain and fever and encouraging the child to drink fluids. Providing soup is a good way to keep the child well hydrated and nourished when swallowing is painful and before the appetite has returned. Gargling with salt water or using an anesthetic throat spray may also help to temporarily relieve pain.
[Merck]