Pharyngitis natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
mNo edit summary |
mNo edit summary |
||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
The [[sore throat]], [[fever]], and [[malaise]] associated with acute pharyngitis are distressing, but with few exceptions, these illnesses are both benign and self limited. Many bacterial and viral organisms are capable of inducing pharyngitis, either as a single manifestation or as part of a more generalized illness.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> History and symptoms are essential to diagnosis to identify the treatable causes (e.g., [[Group A streptococcal infection|GAS]]) to prevent complications.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> | The [[sore throat]], [[fever]], and [[malaise]] associated with acute pharyngitis are distressing, but with few exceptions, these illnesses are both benign and self limited. Many bacterial and viral organisms are capable of inducing pharyngitis, either as a single manifestation or as part of a more generalized illness.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> History and symptoms are essential to diagnosis to identify the treatable causes (e.g., [[Group A streptococcal infection|GAS]]) to prevent complications.<ref name= Mandell>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> | ||
==Natural History== | ==Natural History== | ||
Acute pharyngitis is typically described as the triad of sore throat, fever, and pharyngeal inflammation characterized by erythema and edema, although exudates, vesicles, or ulcerations may also be present. Although pharyngitis may be a primary disorder, sore throat and pharyngeal erythema may also be prominent in systemic disorders, such as | Acute pharyngitis is typically described as the triad of [[sore throat]], [[fever]], and pharyngeal inflammation characterized by [[erythema]] and [[edema]], although exudates, vesicles, or ulcerations may also be present. Although pharyngitis may be a primary disorder, sore throat and pharyngeal erythema may also be prominent in systemic disorders, such as [[Human Immunodeficiency Virus (HIV)|acute retroviral syndrome]], or part of a more generalized [[upper respiratory tract infection]]. Most cases of acute pharyngitis are due to common viral infections and are benign, self-limited processes. The appropriate recognition of patients with more complicated infections that require diagnostic evaluations and treatment is one of the challenges of primary care medicine.<ref name= Mandell>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> An estimated 1-2% of acute pharyngitis progresses to recurrent or chronic disease.<ref name="pmid16970213">St Sauver JL, Weaver AL, Orvidas LJ, Jacobson RM, Jacobsen SJ (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16970213 Population-based prevalence of repeated group A beta-hemolytic streptococcal pharyngitis episodes.] ''Mayo Clin Proc'' 81 (9):1172-6. PMID: [https://pubmed.gov/16970213 16970213]</ref> Patients with recurrent episodes of pharyngitis and >1 episode of streptococcal pharyngitis at close intervals associated with laboratory evidence of [[GAS]] pharyngitis consider that they should also be alert to the possibility that the patient may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infections.<ref name="pmid23091044">Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23091044 Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America.] ''Clin Infect Dis'' 55 (10):1279-82. [http://dx.doi.org/10.1093/cid/cis847 DOI:10.1093/cid/cis847] PMID: [https://pubmed.gov/23091044 23091044]</ref> | ||
=== '''Group A Streptococcus''' === | === '''Group A Streptococcus''' === | ||
Strep pharyngitis occurs predominantly, though not exclusively, in school-age children.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> | Strep pharyngitis occurs predominantly, though not exclusively, in school-age children.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> Symptoms can vary widely, with some patients experiencing the full effects of the syndrome while others, such as those who have undergone [[tonsillectomy]], may have milder symptoms.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> Untreated, [[Group A beta-hemolytic streptococci|group A bete hemolytic streptococcus]] (GABHS) infection lasts 7-10 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.<ref name="pmid15053411" /> | ||
=== Corynebacterium diphtheriae === | === Corynebacterium diphtheriae === | ||
The incubation period of [[Corynebacterium diphtheriae]] infection range between | The incubation period of [[Corynebacterium diphtheriae]] infection range between 2-4 weeks.<ref name="pmid15053411" /> Diphtheria common in children and primarily among unimmunized or poorly immunized members of socioeconomically disadvantaged groups.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> | ||
==Complications== | ==Complications== | ||
| Line 29: | Line 29: | ||
*[[Tonsillar abscess]]<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | *[[Tonsillar abscess]]<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | ||
*[[Sinusitis]] | *[[Sinusitis]] | ||
*Otitis media | *[[Otitis media]] | ||
*[[Necrotizing fasciitis]] | *[[Necrotizing fasciitis]] | ||
*[[Meningitis]] | *[[Meningitis]] | ||
*Jugular vein thrombophlebitis | *[[Jugular vein]] [[thrombophlebitis]] | ||
'''Non suppurative complications''' | '''Non-suppurative complications''' | ||
*[[Acute rheumatic fever]] (ARF)<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | *[[Acute rheumatic fever]] (ARF)<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | ||
*[[Scarlet fever]] | *[[Scarlet fever]] | ||
*Streptococcal toxic shock syndrome<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | *Streptococcal [[toxic shock syndrome]]<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | ||
*Acute [[glomerulonephritis]] ([[Post-streptococcal glomerulonephritis]])<ref name="pmid15053411" /> | *Acute [[glomerulonephritis]] ([[Post-streptococcal glomerulonephritis]])<ref name="pmid15053411" /> | ||
*Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) | *Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) | ||
| Line 42: | Line 42: | ||
| style="padding: 5px 5px; background: #DCDCDC;" |'''Influenza''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''Influenza''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Pneumonia | *[[Pneumonia]] | ||
*Encephalitis | *[[Encephalitis]] | ||
*Aseptic meningitis | *[[Aseptic meningitis]] | ||
*Guillain | *[[Guillain-Barre syndrome]] | ||
*[[Transverse myelitis]] | *[[Transverse myelitis]] | ||
*[[Myositis]] and rhabdomyolysis | *[[Myositis]] and rhabdomyolysis | ||
| Line 53: | Line 53: | ||
*[[Laryngotracheitis]] | *[[Laryngotracheitis]] | ||
*[[Bronchitis]] | *[[Bronchitis]] | ||
*Pneumonia | *[[Pneumonia]] | ||
*[[Otitis media]] | *[[Otitis media]] | ||
*Meningoencephalitis | *Meningoencephalitis | ||
*[[Hepatitis]] | *[[Hepatitis]] | ||
*Myocarditis | *[[Myocarditis ]] | ||
*[[Nephritis]] | *[[Nephritis]] | ||
*Neutropenia | *[[Neutropenia]] | ||
*[[Disseminated intravascular coagulation]] | *[[Disseminated intravascular coagulation]] | ||
|- | |- | ||
| Line 65: | Line 65: | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Aseptic [[meningitis]] | *Aseptic [[meningitis]] | ||
*Myocarditis | *[[Myocarditis]] | ||
*Acute flaccid paralysis | *Acute flaccid paralysis | ||
*Conjunctival ulceration | *Conjunctival ulceration | ||
*Brainstem [[encephalitis]] | *Brainstem [[encephalitis]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" |''' | | style="padding: 5px 5px; background: #DCDCDC;" |'''Epstein barr virus''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Airway obstruction | *[[Airway obstruction]] | ||
*Splenic rupture | *[[Splenic rupture]] | ||
*X-linked lymphoproliferative disease | *X-linked lymphoproliferative disease | ||
*Lymphomatoid granulomatosis | *Lymphomatoid granulomatosis | ||
| Line 87: | Line 87: | ||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Diphtheria''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''Diphtheria''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Airway obstruction<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> | *[[Airway obstruction]]<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> | ||
*[[Myocarditis]] | *[[Myocarditis]] | ||
*[[Polyneuropathies]] | *[[Polyneuropathies]] | ||
| Line 110: | Line 110: | ||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Parainfluenza virus''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''Parainfluenza virus''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Retropharyngeal | *[[Retropharyngeal abscess]] | ||
*[[Pneumonia]] | *[[Pneumonia]] | ||
|- | |- | ||
| Line 124: | Line 124: | ||
=== Scarlet fever === | === Scarlet fever === | ||
Scarlet fever is another complication of [[Group A streptococcal infection|GABHS]] pharyngitis and usually presents as a rash characterized by punctate, erythematous, blanchable, | Scarlet fever is another complication of [[Group A streptococcal infection|GABHS]] pharyngitis and usually presents as a rash characterized by punctate, erythematous, blanchable, sandpaper-like exanthematic rash. Rash distribute in the neck, groin, and axillae, and is accentuate specifically in the body folds and creases. Other findings include pharynx and tonsils appears erythematous and covered with exudates and toungue appears as bright red with white coating, also known as [[strawberry tongue]]. | ||
==Prognosis== | ==Prognosis== | ||
| Line 131: | Line 131: | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:17, 28 February 2017
|
Pharyngitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pharyngitis natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Pharyngitis natural history, complications and prognosis |
|
FDA on Pharyngitis natural history, complications and prognosis |
|
CDC on Pharyngitis natural history, complications and prognosis |
|
Pharyngitis natural history, complications and prognosis in the news |
|
Blogs on Pharyngitis natural history, complications and prognosis |
|
Risk calculators and risk factors for Pharyngitis natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2], Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]
Overview
The sore throat, fever, and malaise associated with acute pharyngitis are distressing, but with few exceptions, these illnesses are both benign and self limited. Many bacterial and viral organisms are capable of inducing pharyngitis, either as a single manifestation or as part of a more generalized illness.[1] History and symptoms are essential to diagnosis to identify the treatable causes (e.g., GAS) to prevent complications.[2]
Natural History
Acute pharyngitis is typically described as the triad of sore throat, fever, and pharyngeal inflammation characterized by erythema and edema, although exudates, vesicles, or ulcerations may also be present. Although pharyngitis may be a primary disorder, sore throat and pharyngeal erythema may also be prominent in systemic disorders, such as acute retroviral syndrome, or part of a more generalized upper respiratory tract infection. Most cases of acute pharyngitis are due to common viral infections and are benign, self-limited processes. The appropriate recognition of patients with more complicated infections that require diagnostic evaluations and treatment is one of the challenges of primary care medicine.[2] An estimated 1-2% of acute pharyngitis progresses to recurrent or chronic disease.[3] Patients with recurrent episodes of pharyngitis and >1 episode of streptococcal pharyngitis at close intervals associated with laboratory evidence of GAS pharyngitis consider that they should also be alert to the possibility that the patient may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infections.[4]
Group A Streptococcus
Strep pharyngitis occurs predominantly, though not exclusively, in school-age children.[1] Symptoms develop after a short incubation period of 24 to 72 hours.[5] Symptoms can vary widely, with some patients experiencing the full effects of the syndrome while others, such as those who have undergone tonsillectomy, may have milder symptoms.[1] Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts 7-10 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.[5]
Corynebacterium diphtheriae
The incubation period of Corynebacterium diphtheriae infection range between 2-4 weeks.[5] Diphtheria common in children and primarily among unimmunized or poorly immunized members of socioeconomically disadvantaged groups.[1]
Complications
Identifying the cause of pharyngitis, especially GABHS, is important to prevent potential life-threatening complications.[5] Serious complications of pharyngitis may include peritonsillar abscess or retropharyngeal abscess.[6] Complicationsof pharyngitis based on the causing agent include the following: [7]
| Common complications | |
| Pathogen | Complications |
|---|---|
| Group A Streptococcus |
Suppurative complications
Non-suppurative complications
|
| Influenza |
|
| Adenovirus | |
| Cocksackie A virus |
|
| Epstein barr virus |
|
| Less common complications | |
| Gonococcus |
|
| Diphtheria |
|
| Heamophilis influenza | |
| Fusobacterium necrophorum | |
| Parainfluenza virus | |
Group A Streptococcal Pharyngitis Complications
Rheumatic fever
Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. Patients will have an elevated antistreptolysin- O titer and erthrocyte sedimentation rate.[5]
Post streptococcal glomerulonephritis
Post streptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer.[5]
Scarlet fever
Scarlet fever is another complication of GABHS pharyngitis and usually presents as a rash characterized by punctate, erythematous, blanchable, sandpaper-like exanthematic rash. Rash distribute in the neck, groin, and axillae, and is accentuate specifically in the body folds and creases. Other findings include pharynx and tonsils appears erythematous and covered with exudates and toungue appears as bright red with white coating, also known as strawberry tongue.
Prognosis
Most cases of pharyngitis go away on their own without complications.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Bisno AL (2001) Acute pharyngitis. N Engl J Med 344 (3):205-11. DOI:10.1056/NEJM200101183440308 PMID: 11172144
- ↑ 2.0 2.1 Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ St Sauver JL, Weaver AL, Orvidas LJ, Jacobson RM, Jacobsen SJ (2006) Population-based prevalence of repeated group A beta-hemolytic streptococcal pharyngitis episodes. Mayo Clin Proc 81 (9):1172-6. PMID: 16970213
- ↑ Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al. (2012) Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 55 (10):1279-82. DOI:10.1093/cid/cis847 PMID: 23091044
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
- ↑ Cohen, J (2010). Infectious diseases. Edinburgh: Mosby/Elsevier. ISBN 978-0323045797.
- ↑ 7.0 7.1 7.2 7.3 Murray RC, Chennupati SK (2012). "Chronic streptococcal and non-streptococcal pharyngitis". Infect Disord Drug Targets. 12 (4): 281–5. PMID 22338589.