Pharyngitis, tonsillitis, peritonsillar abscess and deep neck infection

Overview & Definition

Picture the six-year-old who comes in with a sore throat, a fever, and tonsils coated in white exudate. The parent expects an antibiotic. The fellowship task is to resist reflex treatment, because most sore throats in children are viral — and the one bacterial cause that matters, group A streptococcus, needs to be confirmed by a test, not guessed from the appearance of the throat. This single discipline — score, swab, then treat — is the hinge on which the entire topic turns. [1] [3]

Acute pharyngitis is inflammation of the pharynx, and acute tonsillitis is inflammation of the palatine tonsils; in practice the two overlap and are often described together as acute pharyngotonsillitis. The great majority of cases are viral, caused by rhinovirus, coronavirus, adenovirus, coxsackievirus, Epstein-Barr virus and many others. Group A beta-haemolytic streptococcus (Streptococcus pyogenes) is the single most important bacterial pathogen, accounting for roughly twenty to thirty per cent of sore throats in children over three years, and is the only common cause for which antibiotic treatment is recommended — both to shorten symptoms and to prevent acute rheumatic fever. [1] [6]

What makes this a fellowship topic rather than a routine prescription is that sore throat sits on a continuum with serious deep space infections. A simple tonsillitis can progress to a peritonsillar abscess (quinsy), infection can track into the retropharyngeal or parapharyngeal spaces to form a deep neck abscess, and the same organisms — GAS, mixed oral flora, Fusobacterium necrophorum — can produce Lemierre syndrome (septic jugular thrombophlebitis) or descend into the mediastinum. Recognising where on this spectrum a child sits — routine, urgent, or emergency — is the clinical skill that earns marks and saves lives. [9] [10]