Materiały źródłowe

• #1 Pharyngitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK519550/

  About 50% to 80% of pharyngitis, or sore throat, symptoms are viral in origin and include a variety of viral pathogens. These pathogens are predominantly rhinovirus, influenza, adenovirus, coronavirus, and parainfluenza. Less common viral pathogens include herpes, Epstein-Barr virus, human immunodeficiency virus (HIV), and coxsackievirus. More severe cases tend to be bacterial and may develop after an initial viral infection. […] The most common bacterial infection is Group A beta-hemolytic streptococci, which causes 5% to 36% of cases of acute pharyngitis. Other bacterial etiologies include Group B C streptococci, Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Candida, Neisseria meningitidis, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Fusobacterium necrophorum, and Corynebacterium diphtheriae. Environmental allergies and chemical exposures may also cause acute pharyngitis. […] Bacteria and viruses can cause direct invasion of the pharyngeal mucosa. Certain viruses like rhinovirus can cause irritation secondary to nasal secretions. In almost all cases, there is a local invasion of the pharyngeal mucosa which also results in excess secretion and edema.

• #2 Sore throat – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sore-throat/symptoms-causes/syc-20351635

  A sore throat is pain or irritation of the throat. Swallowing often makes it feel worse. The most common cause of a sore throat, also called pharyngitis, is a viral infection, such as a cold or the flu. A sore throat from a virus goes away on its own. […] Strep throat, also called a streptococcal infection, is a less common type of sore throat. Bacteria causes it. Strep throat needs treatment with antibiotics. […] Viruses that cause the common cold and the flu also cause most sore throats. Less often, bacterial infections cause sore throats. […] Many bacterial infections can cause a sore throat. The most common bacterium that causes a sore throat is Streptococcus pyogenes, also called group A streptococcus. This bacterium causes strep throat and other illnesses. Strep throat is most common in school-age children and teens. […] Rarely, an infected area of tissue, also called an abscess, in the throat can cause a sore throat. So can swelling of the flap that covers the windpipe during swallowing, also called the epiglottis. Either can block the airway, which is a medical emergency.

• #2 Viral Pharyngitis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/225362-overview

  Several viruses can cause viral pharyngitis. […] More than 100 different serotypes of rhinovirus cause approximately 20% of cases of pharyngitis and 30-50% of common colds. […] Unlike rhinovirus infections, adenovirus directly invades the pharyngeal mucosa, as shown by the viral cytopathic effect. […] Epstein-Barr virus (EBV) is the causal agent of infectious mononucleosis. […] The influenza virus invades the respiratory epithelium, causing necrosis, which predisposes the patient to secondary bacterial infection. […] The pathogenesis of RSV infection remains unclear, although a number of theories exist. […] Pharyngitis develops in patients infected with human immunodeficiency virus (HIV) as part of the acute retroviral syndrome, a mononucleosislike syndrome that is the initial manifestation of HIV infection in one half to two thirds of recently infected individuals.

• #3 Sore Throat (Pharyngitis): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8274-sore-throat-pharyngitis

  A sore throat, or pharyngitis, is a scratchy, painful feeling in the back of your throat (pharynx). It happens when the tissue lining your throat (mucosa) becomes inflamed. […] Many things cause pharyngitis, from viral and bacterial infections to allergies and sleeping with your mouth open. […] Most sore throats happen because you have a viral infection, like the common cold or flu. Less often, a sore throat (pharyngitis) may be a sign of the following conditions or issues: […] Bacterial infection: Conditions like strep throat and bacterial sinus infections may cause a sore throat. […] Tonsillitis occurs when your tonsils become infected and inflamed. Bacteria and viruses can both cause tonsillitis. […] Allergic reactions from pollen, dust mites, pets or mold can cause mucus from your nose to drip down the back of your throat (postnasal drip). This can lead to a sore throat.

• #3 Pharyngitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/uriphyn.htm

  In viral pharyngitis, viruses gain access to the mucosal cells lining the nasopharynx and replicate in these cells. Damage to the host is often caused by damage to the cells where the viruses are replicating. […] In bacterial pharyngitis, S pyogenes attaches to the mucosal epithelial cells using M protein, lipoteichoic acid, and fibronectin-binding protein (protein F). It has a capsule composed of hyaluronic acid that prevents phagocytosis by host macrophages; because the hyaluronic acid in the bacterial capsule is identical to host hyaluronic acid. The capsule facilitates bacterial survival by covering the bacterial antigens. Extracellular factors produced by S pyogenes during the infection include protease and hyaluronidase. These extracellular factors assist the bacteria in invading the mucosa.

• #4 Understanding Pharyngitis: Causes, Symptoms, and Pathophysiology Explained | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-pharyngitis-causes-symptoms-and-pathophysiology-explained-26

  Pharyngitis, commonly referred to as a sore throat, involves inflammation of the mucous membranes lining the oropharynx. This inflammatory condition can arise due to a variety of pathogens, with the most common culprits being viruses and bacteria. […] The initial stage of pharyngitis typically begins when infectious agents enter and populate the pharyngeal mucosa. The pharynx often serves as the first site of infection, acting as a gateway for pathogens. Once these viral or bacterial pathogens infiltrate the tissues, they trigger a local inflammatory response. […] During this inflammatory response, your body’s immune system jumps into action. Immune cells such as macrophages and neutrophils are dispatched to the site of infection. These immune cells release signaling molecules called cytokines, which are instrumental in mediating the inflammatory response. Cytokines, like interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), recruit additional immune cells to the site, amplifying the body’s defensive efforts.

• #5 Pharyngitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pharyngitis_pathophysiology

  The pathogenesis of the sore throat due to pharyngitis is poorly understood. The pharynx is often the first site of infection for many contagious diseases such as pharyngitis because pathogens such as viruses and bacteria often settle in the nasopharynx through inhalation or through droplets. […] Most viruses, such as adenovirus or coxsackie virus, can cause inflammation of the pharyngeal mucosa by direct invasion of the mucosa or by secondary to suprapharyngeal secretions. Other viruses, such as rhinoviral infections produce bradykinin and lysyl bradykinin, which are known inflammatory mediators that can excite nerve endings in the pharynx to cause pain. […] Pathogenesis of bacterial pharyngitis varies with etiology. In streptococcal pharyngitis (which is the most common bacterial pharyngitis), the bacteria release exotoxins and proteases. Erythrogenic exotoxins are responsible for the development of the scarlatiniform exanthem. Secondary antibody cross react against M2-protein of the myocardial tissue that may result in rheumatic fever and valvular heart disease (type II hypersensitivity reaction) and the antigen-antibody complexes can lead to acute poststreptococcal glomerulonephritis (type 3 hypersensitivity reaction).

• #6 What is a Sore Throat? Causes, Symptoms, Treatment, Prevention | Vicks

  https://vicks.com/en-us/symptom/sore-throat

  A sore throat is an inflammation at the back of throat and surrounding area, known as the pharynx, in medical terminology. An inflamed throat is commonly referred to by healthcare providers as pharyngitis. The pain and discomfort you feel when you have a sore throat comes from the activation of pain receptors by inflammatory molecules, such as prostaglandins. These molecules are part of the immune response. They help ward off infection and begin the healing and repair process. They have potent activating effects on pain-sensing nerves and also promote inflammation, which is how your body fights pathogens and infection. […] In sore throat caused by infection, the infectious agent triggers inflammation at the infection site (along with accompanying pain, redness, and swelling), signaling the body to send white blood cells and antibodies into the affected tissues to fight off the invading pathogen. The soreness you feel in your throat is the direct result of this inflammation.

• #7 Bacterial Pharyngitis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/225243-overview

  Pharyngitis, or sore throat, often is caused by infection. Common respiratory viruses account for the vast majority of cases, and these usually are self-limited. Bacteria also are important etiologic agents, and, when identified properly, may be treated with antibacterials, resulting in decreased local symptoms and prevention of serious sequelae. The most common and important bacterial cause of pharyngitis is Streptococcus pyogenes (group A Streptococcus [GAS]). When suspected, bacterial pharyngitis should be confirmed with routine diagnostic tests and treated with various antibiotics. Swabbing the throat and testing for GAS pharyngitis via rapid antigen detection test (RADT) and/or culture should be performed, as clinical features alone cannot reliably distinguish GAS pharyngitis from viral pharyngitis. If left untreated, S pyogenes pharyngitis may lead to local and distant complications.

• #8 Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0315/p1465.html

  Transmission of typical viral and GABHS pharyngitis occurs mostly by hand contact with nasal discharge, rather than by oral contact. Symptoms develop after a short incubation period of 24 to 72 hours. […] Sore throat most often is caused by direct infection of the pharynx (pharyngitis), primarily by viruses or bacteria. GABHS pharyngitis accounts for 15 to 30 percent of cases in children and 5 to 15 percent of cases in adults. […] Symptoms of strep throat may include pharyngeal erythema and swelling, tonsillar exudate, edematous uvula, palatine petechiae, and anterior cervical lymphadenopathy. Untreated, GABHS infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.

• #9 Pharyngitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/uriphyn.htm

  In viral pharyngitis, viruses gain access to the mucosal cells lining the nasopharynx and replicate in these cells. Damage to the host is often caused by damage to the cells where the viruses are replicating. […] In bacterial pharyngitis, S pyogenes attaches to the mucosal epithelial cells using M protein, lipoteichoic acid, and fibronectin-binding protein (protein F). It has a capsule composed of hyaluronic acid that prevents phagocytosis by host macrophages; because the hyaluronic acid in the bacterial capsule is identical to host hyaluronic acid. The capsule facilitates bacterial survival by covering the bacterial antigens. Extracellular factors produced by S pyogenes during the infection include protease and hyaluronidase. These extracellular factors assist the bacteria in invading the mucosa.

• #10 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Strep-Throat.aspx

  Beta-hemolytic group A streptococcus or Streptococcus pyogenes, a gram-positive human pathogen that habitually colonizes the throat or skin of the host, is a cause of streptococcal pharyngitis more commonly known as strep throat. Infections with this microorganism are underpinned by a panoply of virulence factors that are produced in direct response to environmental signals in the host. […] Adherence and subsequent growth of Streptococcus pyogenes on pharyngeal mucosal surfaces are usually sufficient to cause the clinical entity of streptococcal pharyngitis. Adhering to epithelial cells is a prerequisite event in the disease pathogenesis, which is facilitated by fibronectin-binding protein or protein F (although M-protein and peptidoglycan may also contribute). […] Together with M-protein, think capsules formed of hyaluronic acid found in some strains of Streptococcus pyogenes confer resistance to phagocytosis. The microorganism can also stimulate T cell responses and cytokine induction, resulting in fever and further tissue injury. This can be especially important in the development of complications that can be provoked by certain strains of streptococci.

• #11 Bacterial Pharyngitis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/225243-overview

  Beta-hemolytic streptococci have the ability to cause large zones of hemolysis on blood agar, aiding in microbiological identification. Perhaps the most important virulence factor of GABHS is the M protein. This protein, located peripherally on the cell wall, is required for invasive infection. T cells exposed to this M protein are postulated to cross-react with similar epitopes on human cardiac myosin and laminin, contributing to the pathogenesis of rheumatic heart disease. GABHS contains a hyaluronic acid capsule, which also plays an important role in infection. Certain GABHS exotoxins act as superantigens by up-regulating T cells. These superantigens can prompt a release of proinflammatory cytokines and may synergize with lipopolysaccharide. It has been speculated that these superantigens evade the pharyngeal immune response, resulting in proliferation of GABHS while permitting immune-mediated elimination of commensal organisms. Adhesins enable GABHS attachment at sites such as the pharynx. This attachment allows for colonization and competition with normal host flora.

• #12 Bacterial Pharyngitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559007/

  Bacteria invade the mucosal tissues of the pharynx directly. The remaining details of the pathogenesis of bacterial pharyngitis vary based on the underlying pathogen. […] GABS has a number of virulence factors that subvert the host’s natural immune response. Cell surface proteins, hemolytic toxins, pyrogenic exotoxins, and bacterial structural components all contribute to its virulence. M and M-like proteins help the organism evade phagocytosis and complement deposition. Toxins like streptolysin O further exacerbate tissue damage by affecting platelets and endothelial cells, leading to ischemic injury. […] All GABS strains secrete streptokinase and have plasminogen binding sites on the surface. When plasminogen binds, streptokinase converts plasminogen to plasmin and interrupts the coagulation cascade, aiding the spread of infection to deep tissues.

• #13 Bacterial Pharyngitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559007/

  Streptococcal pyrogenic exotoxins elicit lymphocyte blastogenesis, exacerbate endotoxin-induced shock, cause fever, dampen antibody synthesis, and function as superantigens. The toxins contribute to fever and shock by reducing the threshold for endotoxin effects, prompting human mononuclear cells to produce tumor necrosis factor-, interleukin-1, and interleukin-6. […] Recognizing the diverse bacterial causes of acute pharyngitis is essential for effective treatment. Each pathogen’s unique infectious mechanisms require tailored approaches to ensure proper management and reduce the risk of complications.

• #14 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Using a recommended antibiotic regimen to treat group A strep pharyngitis shortens the duration of symptoms, reduces the likelihood of transmission to close contacts, and decreases the development of complications. […] Nonsuppurative sequelae of group A strep pharyngitis include acute rheumatic fever and post-streptococcal glomerulonephritis. […] These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. They’re thought to be the result of the immune response and not of direct group A strep infection.

• #14 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Group A streptococcal pharyngitis is an infection of the oropharynx caused by Streptococcus pyogenes (group A strep bacteria). […] The incubation period of group A strep pharyngitis is approximately 2 to 5 days. […] Patients with group A strep pharyngitis usually have anterior cervical lymphadenopathy, palatal petechiae, pharyngeal and tonsillar erythema, and tonsillar hypertrophy with or without exudates. […] Patients with group A strep pharyngitis may also present with a scarlatiniform rash. The resulting syndrome is scarlet fever. […] Experts estimate that group A strep, the most common bacterial cause, causes 20% to 30% of pharyngitis episodes in children and 5% to 15% of pharyngitis infections in adults. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture.

• #15 Bacterial Pharyngitis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/225243-overview

  GABHS is spread from person to person through large droplet nuclei. Consequently, close quarters facilitate transmission. In temperate regions, the prevalence of GABHS infection increases in the colder months, presumably because of the tendency of people to congregate indoors. The risk of acquiring GABHS from an infected family member is 40%, and nearly 1 in 4 infected individuals eventually exhibit symptoms. GABHS pharyngitis may also cause suppurative and nonsuppurative complications. Invasion of nearby structures may cause suppurative complications such as otitis media, sinusitis, peritonsillar abscess, retropharyngeal abscess, and cervical adenitis. Nonsuppurative complications of bacterial pharyngitis include rheumatic heart disease and poststreptococcal glomerulonephritis. […] GABHS pharyngitis usually is a self-limited illness. Throat symptoms resolve within 3-4 days in untreated patients. Administration of penicillin shortly after disease onset may shorten symptoms by 1-2 days.

• #16 Pharyngitis (Tonsillitis) – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.3.

  Diagnostic Tests: Rapid GAS antigen-detection tests: Material: throat swab. The tests have moderate sensitivity and high specificity. A positive result confirms GAS infection, whereas a negative result excludes infection in immunocompetent adult patients; in children, or in patients in whom the likelihood of GAS infection is high, a negative rapid test result requires confirmation using culture or a nucleic acid amplification test (NAAT). […] Do not use antimicrobial agents in viral pharyngitis. Therapeutic options are available for streptococcal pharyngitis, primarily to prevent the development of rheumatic fever. […] Streptococcal pharyngitis can result in the following: Suppurative complications (early): Peritonsillar abscess, retropharyngeal abscess, suppurative cervical lymphadenitis, suppurative otitis media and/or mastoiditis, suppurative sinusitis. […] Prognosis is good. Even when untreated, streptococcal pharyngitis usually resolves spontaneously. Complications in adults are rare.

• #17 Pharyngitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/uriphyn.htm

  Nonsuppurative lesions resulting in rheumatic fever and glomerulonephritis still occur following throat infections caused by S pyogenes. It is believed that several bacterial antigens from S pyogenes share antigenic epitopes with the heart and renal tissues. An autoimmune reaction occurs in some patients following production of an immune response to these cross-reactive bacterial antigens and damages the patients heart or kidneys. Note: Rheumatic fever and glomerulonephritis can occur after an episode of pharyngitis; only glomerulonephritis occurs after skin infections (e.g., impetigo).

• #18

  https://link.springer.com/article/10.1007/s00011-012-0540-9

  The aim of this review is to examine the causes, pathophysiology and experimental models of non-infectious pharyngitis (sore throat). […] The pathophysiology underlying non-infectious sore throat is largely uncharacterised, although neurogenic inflammation looks to be a promising candidate. […] The mechanism underlying sore throat in people with gastroesophageal reflux disorder is likely to be chemical, that is, due to refluxed gastric content, although indirect effects through vagal (sensory) mechanisms have also been implicated. […] Inflammation has also been implicated in non-infectious aetiologies, with inflammatory cells and mediators isolated from the upper respiratory tract. […] Neurogenic inflammation may be responsible for the airway response to particulate matter and other environmental irritants such as ozone or sulphur dioxide.

• #19 Sore Throat (Pharyngitis): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8274-sore-throat-pharyngitis

  People with gastroesophageal reflux disease (GERD) feel burning and pain in their throats. This pain, called heartburn, happens when acid from your stomach backs up into your food tube (esophagus). […] You can strain your throat by yelling or screaming. […] You may have a sore throat if you breathe through your mouth instead of your nose when you’re sleeping. […] Although a sore throat rarely means cancer, it’s one potential symptom of throat cancer or benign (noncancerous) growths. […] Treatment depends on what’s causing your pharyngitis. Viral infections usually clear up on their own within a week. […] You may need antibiotics to treat a bacterial infection. […] Antihistamines may dry postnasal drip related to allergies. […] Antacids may help with acid reflux that causes heartburn and sore throats.

• #20

  https://link.springer.com/article/10.1007/s00011-012-0540-9

  The irritants are proposed to interact with transient receptor potential (TRP) channels. […] TRPV1 and TRPA1 are both activated and sensitised through inflammatory receptor pathways. […] The field of TRP channel research is rapidly expanding, as it becomes clear that these ion channels may be involved in a vast range of diseases and chronic pain situations.

• #21 Pharyngitis (Tonsillitis) – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.3.

  The majority of pathogens listed above infect or colonize the human respiratory tract and are spread by large infectious respiratory particles (historically termed droplets) or close contact. Many people with these active viral or bacterial infections or colonizations may not be overtly symptomatic but can still transmit the pathogen. […] Given that most pharyngitis is caused by respiratory viruses, this infection is most commonly observed in the fall, winter, and early spring. […] The incubation period for pharyngitis is 2 to 5 days. The patients are contagious up to 24 hours after the start of an effective antimicrobial treatment or for ~7 days after the resolution of symptoms in the case of no antimicrobial treatment. The risk of transmission to household contacts is substantial. […] The vast majority of pharyngitis cases, bacterial or otherwise, resolve spontaneously within 3 to 7 days. Untreated GAS pharyngitis is associated with an increased risk of rheumatic fever (primarily in children) and suppurative complications (eg, peritonsillar abscess).

• #22 Strep throat: Causes, diagnosis, and treatments

  https://www.medicalnewstoday.com/articles/155412

  Strep throat is a sore throat caused by bacteria known as Streptococcus pyogenes, or group A streptococcus. […] The only cause of strep throat is group A Streptococcus (group A strep). […] These bacteria are highly transmissible and can spread through respiratory droplets that a person makes when they sneeze, cough, or talk. […] Strep throat thrives in crowded settings, such as day care centers and schools. […] For example, people tend to move indoors when it gets cold. Spending more time in enclosed spaces makes it much easier to pass on and catch infections like strep throat. […] If a doctor thinks a person may have strep throat, they will order tests to determine if group A strep is causing the sore throat. […] A rapid antigen test, or rapid strep test, detects group A strep antigens from a throat swab sample.

• #23 Streptococcal pharyngitis – Wikipedia

  https://en.wikipedia.org/wiki/Streptococcal_pharyngitis

  Strep throat is caused by group A -hemolytic Streptococcus (GAS or S. pyogenes). Humans are the primary natural reservoir for group A streptococcus. Other bacteria such as nongroup A -hemolytic streptococci and fusobacterium may also cause pharyngitis. It is spread by direct, close contact with an infected person; thus crowding, as may be found in the military and schools, increases the rate of transmission. Dried bacteria in dust are not infectious, although moist bacteria on toothbrushes or similar items can persist for up to fifteen days. Contaminated food can result in outbreaks, but this is rare. Of children with no signs or symptoms, 12% carry GAS in their pharynx, and, after treatment, approximately 15% of those remain positive, and are true „carriers”. […] The primary reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscesses. Antibiotics prevent acute rheumatic fever if given within 9 days of the onset of symptoms. […] Appropriate antibiotics decrease the average 3-5 day duration of symptoms by about one day, and also reduce contagiousness. They are primarily prescribed to reduce rare complications such as rheumatic fever and peritonsillar abscess.

• #24 Tonsillopharyngitis – Ear, Nose, and Throat Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/tonsillopharyngitis

  Tonsillopharyngitis is acute infection of the pharynx, palatine tonsils, or both. […] The tonsils participate in systemic immune surveillance. In addition, local tonsillar defenses include a lining of antigen-processing squamous epithelium that involves B- and T-cell responses. […] In about 30% of patients, the cause is bacterial. Group A beta-hemolytic streptococcus (GABHS) is most common. […] Pain when swallowing is the hallmark of tonsillopharyngitis and is often referred to the ears. […] GABHS usually resolves within 7 days, with or without antibiotics. Untreated GABHS may lead to local suppurative complications and sometimes leads to rheumatic fever or glomerulonephritis. […] Because GABHS requires antibiotics, it must be diagnosed early. […] Penicillin V is usually considered the drug of choice for GABHS tonsillopharyngitis. […] Accumulating evidence suggests that tonsillotomy (partial intracapsular removal of tonsil tissue), when done to treat various disorders is as efficacious as traditional tonsillectomy and preferable because of better outcomes related to pain, postoperative complications, and patient satisfaction.

• #25 SORE THROAT – a patient’s guide – Family Doctor

  https://www.familydoctor.co.nz/categories/infections/sore-throat-a-patients-guide/

  A sore throat is also known as pharyngitis. […] It is usually caused by either a bacterial or viral infection. […] Approximately 90% of cases are caused by viruses. […] Strep throat is the most common bacterial infection and is caused by the bacteria group A streptococci (approximately 10%). […] A sore throat is caused by inflammation at the back of the throat. The proper medical term is pharyngitis. […] Most sore throats are caused by a bacterial or viral infection, and can be the first sign of a cold or flu starting. […] The majority of sore throats are caused by viruses which are spread by coughing, sneezing, kissing and sharing cups and utensils with someone who has the illness. Bacterial causes of sore throats are also contagious. […] The tonsils are thought to be part of the first line of the body’s defence against potentially harmful germs.

• #26 Evaluation of acute pharyngitis in adults – UpToDate

  https://www.uptodate.com/contents/evaluation-of-acute-pharyngitis-in-adults

  Acute pharyngitis is one of the most common conditions encountered in outpatient clinical practice. Most cases of acute pharyngitis are caused by respiratory viruses and are self-limited. However, symptoms of viral pharyngitis broadly overlap with pharyngitis caused by important treatable causes, such as group A Streptococcus (GAS). […] The specific microbiologic cause of pharyngitis can rarely be distinguished based on clinical features alone. However, understanding the relative prevalence of the causes of pharyngitis and their clinical features can help focus evaluation.

• #27 Acute pharyngitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/5

  Acute pharyngitis is characterized by acute onset of sore throat; the absence of cough, nasal congestion, and nasal discharge suggests a bacterial etiology. […] Acute pharyngitis is characterized by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). It can be caused by a variety of viral and bacterial pathogens, including group A Streptococcus (GAS), as well as fungal pathogens (e.g., Candida albicans). Absence of cough, nasal congestion, and nasal discharge suggests a bacterial, rather than viral, etiology. […] The goal of treatment of GAS infection is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission. […] Treatment typically involves supportive care (e.g., analgesics) and treatment of the causative pathogen (e.g. antibiotics for GAS infections). […] Antibiotic prophylaxis is recommended only in individuals with a history of rheumatic fever.

• #28 Pharyngitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/uriphyn.htm

  Pharyngitis (sore throat) is a common disease resulting in over 15 million physician office visits each year in the US. Most cases of pharyngitis are caused by viruses. […] Pharyngitis can be caused by many different microorganisms; however, 90% of sore throats in adults and 6075% of sore throats in children are caused by viruses. S pyogenes (b-hemolytic group A Streptococcus) is the most common bacterial cause of acute pharyngitis. […] Fever, sore throat, edema, and hyperemia of the tonsils and pharyngeal walls are common findings in patients with viral and bacterial causes of pharyngitis. Other findings strongly suggest that a viral, rather than a bacterial, agent cause pharyngitis and include conjunctivitis, cough, coryza, hoarseness, and diarrhea; anterior stomatitis and discrete ulcerative lesions; and viral exanthem.

• #29 Sore Throat – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/sore-throat

  With supraglottitis/epiglottitis, severe throat pain and dysphagia begin abruptly, usually with no preceding upper respiratory infection (URI) symptoms. […] In tonsillopharyngitis, throat culture is the most reliable way to differentiate viral infection from GABHS. […] Specific conditions are treated. Patients with severe symptoms of tonsillopharyngitis may be started on a broad-spectrum antibiotic (eg, amoxicillin/clavulanate, dose based on age and indication) pending culture results. […] Corticosteroids (eg, dexamethasone, 10 mg orally) are occasionally used to reduce inflammation and throat pain for example, for tonsillopharyngitis that appears to pose a risk of airway obstruction (eg, due to mononucleosis) or very severe tonsillopharyngitis symptoms. […] Most sore throats are caused by viral tonsillopharyngitis.

• #30 Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0315/p1465.html

  The incidence of complications with GABHS infection, such as rheumatic fever and peritonsillar abscess, is much lower than generally perceived. […] Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). […] Poststreptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. […] Scarlet fever is associated with GABHS pharyngitis and usually presents as a punctate, erythematous, blanchable, sandpaper-like exanthem. […] When a patient presents with sore throat, the family physician must consider a wide range of illnesses. Infectious causes range from generally benign viruses to GABHS. Inflammatory presentations may be the result of allergy, reflux disease or, rarely, neoplasm or Kawasaki disease.

• #31 Group A Streptococcus Treatment and Management

  https://www.uspharmacist.com/article/group-a-streptococcus-treatment-and-management

  GAS is the most common bacterial cause of streptococcal pharyngitis in children and young adults and peaks in winter and early to mid spring.2 GAS pharyngitis is also more common in children or in friends and families with a direct relation to school-age children.5,6 […] A recent meta-analysis showed that the prevalence of GAS pharyngitis in children aged younger than 5 years was 24%; in those aged younger than 18 years who presented to an outpatient center for treatment, it was 37%.7 However, GAS pharyngitis will typically occur in adults aged younger than 40 years, and the occurrence declines steadily thereafter.8 […] Many regions of the world with low income and poor infrastructure continue to suffer a high burden of S pyogenes diseases, with millions of deaths annually.9 The majority of these deaths follow the development of rheumatic heart disease (RHD), which remains a concern in both developed and developing countries. In many developed countries, the prevalence of RHD is much lower; however, the majority of S pyogenes associated deaths are attributed to the clinical manifestations associated with invasive disease.10

• #32 Pathogenesis, epidemiology and control of Group A Streptococcus infection | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-023-00865-7

  Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. […] GAS deploys a range of virulence determinants to allow colonization, dissemination within the host and transmission, disrupting both innate and adaptive immune responses to infection. […] The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. […] This paper reports demonstrating that SpeB triggers keratinocyte pyroptosis by cleaving GSDMA, providing a mechanism for inflammatory response stimulation at the epithelial cell layer.

• #33 Pathogenesis, epidemiology and control of Group A Streptococcus infection | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-023-00865-7

  This paper demonstrates the roles of SpeB in caspase 1-independent activation of GSDMA in skin cells. […] This study utilizes biomimetic virulomics to show that GAS S protein captures lysed red blood cell membranes to cloak the bacterial cell surface, which allows bacteria to evade host immunity. […] This comprehensive report details the molecular basis of natural selection of hypervirulent bacterial variants with increased risk of systemic dissemination. […] This important study demonstrates that epithelial cytokine IL-36 is a global sensor of pathogen-derived proteases during epithelial infection. […] This study uses a combination of in vitro evolution and metabolic rescue experiments to demonstrate that a new antimicrobial resistance mechanism undetectable using traditional laboratory testing methods is responsible for high levels of resistance to sulfamethoxazole in GAS.

• #34 Understanding Pharyngitis: Causes, Symptoms, and Pathophysiology Explained | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-pharyngitis-causes-symptoms-and-pathophysiology-explained-26

  Pharyngitis, commonly referred to as a sore throat, involves inflammation of the mucous membranes lining the oropharynx. This inflammatory condition can arise due to a variety of pathogens, with the most common culprits being viruses and bacteria. […] The initial stage of pharyngitis typically begins when infectious agents enter and populate the pharyngeal mucosa. The pharynx often serves as the first site of infection, acting as a gateway for pathogens. Once these viral or bacterial pathogens infiltrate the tissues, they trigger a local inflammatory response. […] During this inflammatory response, your body’s immune system jumps into action. Immune cells such as macrophages and neutrophils are dispatched to the site of infection. These immune cells release signaling molecules called cytokines, which are instrumental in mediating the inflammatory response. Cytokines, like interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), recruit additional immune cells to the site, amplifying the body’s defensive efforts.

• #35 Understanding Pharyngitis: Causes, Symptoms, and Pathophysiology Explained | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-pharyngitis-causes-symptoms-and-pathophysiology-explained-26

  However, these immune reactions also give rise to the symptoms of pharyngitis. The influx of immune cells and the increased blood flow to the affected area lead to the hallmark signs of inflammation: redness, swelling, heat, and pain. This is why when you have pharyngitis, you experience a sore, red, and swollen throat. […] While viral pharyngitis is the most prevalent, accounting for the majority of cases, bacterial infections such as those caused by Group A beta-hemolytic streptococci also play a significant role. In bacterial pharyngitis, bacterial toxins can further exacerbate inflammation and tissue damage. […] In some instances, the body’s response to the infection can inadvertently contribute to systemic symptoms. Fever, for instance, is a common systemic manifestation spurred by the release of pyrogenic cytokines. Additionally, painful cervical adenopathy (swollen lymph nodes) and general malaise are frequent accompaniments of this condition. […] Understanding the pathophysiology of pharyngitis is fundamental for accurate diagnosis and effective management. This insight helps healthcare providers anticipate potential complications, such as otitis media, pneumonia, nephritis, and, albeit rarely, meningitis, especially in severe cases.

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