Tonsillopharyngitis - Acute

Definition

Acute tonsillopharyngitis is an inflammation of the pharynx and tonsils, usually of infectious origin (viral or bacterial), characterized by sore throat, fever, dysphagia, and erythema of the pharyngeal mucosa.

Epidemiology

• Common in children and adolescents, peak incidence 5–15 years
• Viral causes more common than bacterial in all age groups
• Bacterial tonsillopharyngitis (Streptococcus pyogenes) more frequent in school-aged children
• Accounts for millions of outpatient visits worldwide annually
• Seasonal variation: more common in winter and early spring

Etiology

• Viral: rhinovirus, adenovirus, influenza, parainfluenza, Epstein-Barr virus (mononucleosis)
• Bacterial: Group A Streptococcus (GAS) most common, also Staphylococcus aureus, Streptococcus groups C/G
• Other less common bacteria: Mycoplasma pneumoniae, Chlamydophila pneumoniae
• Environmental factors: exposure to infected contacts
• Immune status may influence susceptibility

Pathophysiology

• Pathogen invasion of pharyngeal or tonsillar mucosa
• Activation of local immune response causing inflammation
• Vasodilation and increased vascular permeability leading to erythema and edema
• Recruitment of neutrophils and lymphocytes to infected site
• Formation of exudates in bacterial cases
• Pain and dysphagia due to inflammatory mediators
• Systemic symptoms (fever, malaise) via cytokine release