Pharyngitis clinical presentation

Clinical presentations of primary HIV infection vary, but patients often have a viral syndrome or mononucleosis-like illness with fever, pharyngitis, and adenopathy (Table 40-3). Symptoms may last for 2 weeks. 

The incubation period is 2 to 5 days, and the illness often occurs in clusters. The clinical presentation of Group A streptococcal pharyngitis is presented in Table 44-4. 

Clinical Presentation and Diagnosis of Group A Streptococcal Pharyngitis... 

Clinical presentations of primary HIV infection vary, but patients often have a viral syndrome or mononucleosis-like illness with fever, pharyngitis, and adenopathy (Table 40-3). Symptoms may last for 2 weeks. Probability of progression to acquired immune deficiency syndrome (AIDS) is related to RNA viral load in one study, 5-year progression rates to AIDS were 8% and 62% for RNA copies per mElfliter of less than 4,530 and greater than 36,270, respectively. The mortality rates were 5% and 49%, respectively. 

Tularemia pneumonia can result from an inhalation exposure or from hematogenous spread of the infection. An aerosol release could be expected to result in large numbers of patients experiencing systemic symptoms accompanied by signs and symptoms associated with one or more of the following conditions pharyngitis, bronchiolitis, pleuropneumonitis and hilar lymphadenitis (43). However, many people with inhalational exposure will likely develop a clinical presentation of systemic symptoms without prominent signs or symptoms of respiratory disease. 

Seasonal outbreaks occur, and the occurrence of group A streptococcal pharyngitis is highest in winter and early spring. The incubation period is 2 to 5 days, and the illness often occurs in clusters. Spread occurs via direct contact with droplets of saliva or nasal secretions, and transmission is thus worse in institutions, schools, families, and areas of crowding. See Table 107-7 for clinical presentation and diagnosis of pharyngitis. 

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

For a patient presenting with pharyngitis, the most important clinical decision that needs to be made is whether the pharyngitis is caused by group A Streptococcus. Diagnosis is essential because it it directs management. 

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