There are no proven methods for prevention of colds other than good hand washing and avoiding contact with infected persons. No significant effect of vitamin C or Echinacea for prevention of the common cold has been confirmed.
Many infectious agents can cause pharyngitis (Table 103-1).Group A streptococci (Streptococcus pyogenes) are gram-positive, nonmotile cocci that are facultative anaerobes. Onsheep blood agar, the colonies are small (1 to 2 mm in diameter)and have a surrounding zone of β (clear) hemolysis. Other bacterial organisms less often associated with pharyngitis include group C streptococcus (also β-hemolytic), Arcanobacterium haemolyticum (β-hemolytic, gram-positive rod), and Francisella tularensis (gram-negative coccobacillus and cause of tularemia). Chlamydophila pneumoniae, strain TWAR, is associated with lower respiratory disease but also causes sore throat.Mycoplasma pneumoniae is associated with atypical pneumoniaand may cause mild pharyngitis without distinguishing clinical manifestations. Other bacteria, including Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae,are cultured frequently from the throats of children with pharyngitis, but their role in causing pharyngitis is unclear.
Many viruses cause acute pharyngitis. Some viruses, such as adenoviruses, are more likely than others to cause pharyngitis as a prominent symptom, whereas other viruses, such as rhinoviruses, are more likely to cause pharyngitis as a minor part of an illness that primarily features other symptoms, such as rhinorrhea or cough. Epstein-Barr virus, enteroviruses (herpangina), herpes simplex virus, and primary human immunodeficiency virus (HIV) infection also produce pharyngitis.
Sore throat is the primary symptom in approximately one third of upper respiratory tract illnesses. Streptococcal pharyngitis is relatively uncommon before 2 to 3 years of age, but the incidence increases in young school-age children and then declines in late adolescence and adulthood. Streptococcal pharyngitis occurs throughout the year in temperate climates, with a peak during the winter and early spring. The illness often spreads to siblings and classmates. Viral infections generally spread via close contact with an infected person and peak during winter and spring.
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Pharyngeal inflammation causes cough, sore throat, dysphagia, and fever. If involvement of the tonsils is prominent, the term tonsillitis or tonsillopharyngitis is often used.
Adapted from Hayden GF, Hendley JO, Gwaltney JM Jr: Management of the ambulatory patient with a sore throat, Curr Clin Top Infect Dis 9:62–75, 1988.
The onset of streptococcal pharyngitis is often rapid and associated with prominent sore throat and moderate to high fever. Headache, nausea, vomiting, and abdominal pain are frequent. In a typical, florid case, the pharynx is distinctly red. The tonsils are enlarged and covered with a yellow, blood-tinged exudate. There may be petechiae or doughnut-shapedlesions on the soft palate and posterior pharynx. The uvula may be red, stippled, and swollen. Anterior cervical lymph nodes are enlarged and tender to touch. Many children, however, present with only mild pharyngeal erythema without tonsillar exudate or cervical lymphadenitis. Conjunctivitis, cough, coryza, hoarseness, or ulcerations suggest a viral etiology. The diagnosis of streptococcal pharyngitis cannot be made on clinical features alone.