Streptococcal pharyngitis is a common disease, often occurring in winter and spring, and can be sporadic or epidemic, with a certain degree of pestilence. It is more prevalent among children and adolescents, while it is rare in infants under one year old and individuals over 50 years of age. This disease not only presents with acute inflammation in the pharynx but also affects the entire body and other organs to varying degrees.

bubble_chart Etiology

The pathogenic bacteria are mostly hemolytic streptococci and other pyogenic streptococci. Contact with carriers of hemolytic streptococci is the main cause of the disease, and the carrier rate among patients with chronic tonsillitis is very high, with about 40% being beta-hemolytic streptococci. Systemic and environmental factors can be predisposing factors, such as malnutrition, excessive fatigue, constitutional weakness, and other conditions that lower the body's resistance or immunity, making individuals more susceptible to the disease. The disease can be transmitted through droplets from coughing or sneezing, or by consuming contaminated food. Streptococci primarily harm the body through their toxins and metabolic products, such as streptolysin O and S, erythrogenic toxin, streptokinase, hyaluronidase, and several proteases. Some of these can directly damage the defense mechanisms of the tonsillar tissue, making it easier for the lesions to spread, or they can cause complications through allergic reactions.

bubble_chart Pathological Changes

After infection occurs, the mucous membrane becomes acutely congested and swollen, with increased secretion from the mucous glands, and the surface of the mucous membrane is covered with thick mucus. There is lymphocyte infiltration around the blood vessels and mucous glands beneath the mucous membrane. The lymphoid tissue of the pharyngeal wall also becomes congested and swollen, and in severe cases, white punctate exudates can be seen. The tonsils become congested and swollen, with desquamated epithelium, bacteria, metabolic products, and exudate forming small yellow-white spots in the crypt openings. If these spots coalesce, they form a pseudomembrane. The inflammation invades the parenchyma of the tonsils, causing the entire tonsil to swell, with suppuration occurring within the lymphoid follicles. The cervical lymph nodes also become swollen.

The onset is acute, initially resembling symptoms of an upper respiratory infection, followed by fear of cold, high fever, headache, general malaise, loss of appetite, and soreness in the back and limbs. Throat pain gradually intensifies, and as the inflammation spreads to different areas, corresponding symptoms may arise. Inflammation of the lateral pharyngeal bands can cause difficulty and pain in swallowing, accompanied by ear pain. Inflammation of the lymphoid tissue at the base of the tongue can result in severe burning or stabbing pain, radiating to both ears. When the Eustachian tube is affected, symptoms such as ear fullness, tinnitus, and hearing impairment may occur. If the condition spreads to the larynx, symptoms like cough, hoarseness, and difficulty breathing may appear. In children, the condition can be severe, potentially leading to convulsions. If accompanied by acute infection of the pharyngeal tonsils, symptoms such as stuffy nose, mucus discharge from the nasal cavity and posterior nasal aperture, difficulty in breastfeeding, and susceptibility to choking may occur. Examination reveals acute congestion and swelling of the pharyngeal mucosa, particularly in the lateral pharyngeal wall and behind the palatopharyngeal arch. The uvula is edematous, drooping, and flaccid. Cervical lymph nodes are swollen and tender, especially those below the mandibular angle, with noticeable tenderness upon palpation.

bubble_chart Diagnosis

The disease has an acute onset, with severe systemic and pharyngeal symptoms, and a body temperature usually ranging from 38 to 40°C. Blood tests reveal leukocytosis, predominantly with an increase in neutrophils. Diagnosis is relatively straightforward based on medical history and clinical manifestations. However, it is crucial to pay attention to the diagnosis of complications and to differentiate them from the prodromal symptoms of acute pestilence, especially in children.

It is necessary to rest in bed, drink plenty of boiled water, and consume easily digestible food. For those with high fever, severe sore throat, and intense body aches, appropriate use of antipyretic and analgesic agents such as aspirin, orally, 0.5g each time, 2 to 3 times a day, is recommended. Isolation treatment should be noted to prevent pestilence to others. Gargle with compound formula borax solution or saline solution for the throat; using a solution containing antibiotics for gargling or local spraying is more effective. In the initial stage [first stage] of the illness, applying 1% iodine glycerin, 10% mild silver protein, or 1-2% silver nitrate to the pharyngeal wall can help reduce inflammation. For swollen and painful cervical lymph nodes, hot compress or physical therapy is advisable to reduce inflammation. Systemic medication is very important. Currently, it is believed that sulfonamides Yaodui have no significant effect on the treatment of acute pharyngitis and tonsillitis caused by hemolytic streptococcus. Penicillin has a good therapeutic effect on hemolytic streptococcus infections, making it the drug of choice for treating this disease. Depending on the condition, intramuscular or intravenous administration is used, with the injection dose and duration adjusted according to the condition. For those allergic to penicillin or with resistance to medicinal properties, cephalosporins and other drugs can be chosen for treatment. Additionally, Chinese patent drugs such as Coptis Rhizome Injection, Bovine Bezoar Pill for Detoxification, etc., also have certain effects.

bubble_chart Prognosis

The prognosis is generally good, and recovery usually occurs within 7 to 10 days if no complications arise. Therefore, early diagnosis and management of complications are crucial, as their occurrence is not influenced by chemotherapy or antibiotic therapy. Once complications develop, they can progress to chronic heart valve disease, which may impair long-term health.

Strengthen health education, exercise the body, and enhance resistance to diseases. For those who frequently suffer from pharyngitis and tonsillitis that are difficult to cure, a tonsillectomy may be considered. Patients should be promptly isolated and treated to avoid mutual pestilence.

bubble_chart Complications

Patients without complications usually recover gradually within a week. However, once complications occur, they can cause significant harm to the body. The mechanisms of these complications can be divided into the following three categories:

(1) Direct spread: Infection spreads from the pharynx to nearby tissues, leading to conditions such as peritonsillitis, peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, acute lymphadenitis, acute sinusitis, acute otitis media, acute laryngitis, tracheitis, bronchitis, and pneumonia.

(2) Hematogenous dissemination: Infection spreads through the bloodstream to other parts of the body, potentially causing acute arthritis, acute osteomyelitis, sepsis, peritonitis, meningitis, etc.

(3) Advanced stage complications: These include wind-dampness heat, arthritis, nephritis, myocarditis, etc. These non-suppurative advanced stage complications are referred to as "post-streptococcal infection syndromes." It is currently believed that these complications are not caused by direct invasion of tissues by streptococci, but rather by a hypersensitive reaction of the tissues to the bacteria or their metabolic products following a pharyngeal infection.

bubble_chart Differentiation

It should be differentiated from the following diseases:

(1) Scarlet fever pharyngitis - Also caused by hemolytic streptococcus infection, with fever and systemic rash. The pharyngeal manifestations are difficult to distinguish, but the rash is distinctive. From the second day of onset, red spotted rashes appear and rapidly spread from the neck to the trunk and limbs, with facial flushing and perioral pallor. Initially, there is a "strawberry tongue," and 3-4 days after onset, it becomes a "raspberry tongue." During the stage of convalescence, the rash subsides, and significant desquamation may occur.

(2) Ulceromembranous angina (Vincent's angina) - Both pharyngeal and systemic symptoms are mild, with ulceration on one side of the tonsil or pharynx. Ulcers may occur on the oral mucosa and gums, and Vincent's spirochetes and fusiform bacilli can be detected in smears.

(3) Pharyngeal diphtheria - Mild congestion of the pharyngeal mucosa, with the formation of gray-white pseudomembranes covering the pharyngeal wall and tonsils, which are densely adherent and not easily wiped off. If forcibly removed, bleeding is seen. Diphtheria bacilli can be detected in pharyngeal mucosa cultures and smears.

(4) Adenovirus catarrhal pharyngitis - Often accompanied by conjunctivitis, known as pharyngoconjunctival fever, with no bacterial growth in cultures and relatively mild clinical symptoms.

(5) Agranulocytosis - The pharyngeal mucosa appears purplish-red, with ulcers often present on the tonsil surface. The general condition is poor, and there is no suppuration around the tonsils. Differentiation can be made based on history and blood tests.