An 18-year-old woman presents with a 2-day history of sore throat. Which of the following constellation of symptoms and signs is most consistent with group-A streptococcal pharyngitis?
Viruses are the most common cause of pharyngitis in adults. Group-A beta- hemolytic streptococci (Spyogenes) accounts for 50% of pharyngitis cases in children but only 10% of cases in adults. Centor criteria (fever, absence of cough, tonsillar exudate, and tender anterior cervical lymphadenopathy) are widely used to identify patients at risk for group-A streptococcal pharyngitis. Patients with two or three criteria should have a positive rapid streptococcal antigen test or positive throat culture before being given antibiotics. A negative rapid streptococcal antigen test needs to be confirmed by a throat culture. Patients meeting all four Centor criteria should also have either of the previously described confirmatory tests but may be treated empirically while awaiting results. A 10-day course of oral penicillin continues to be the treatment of choice for streptococcal pharyngitis. A 5-day course of azithromycin can be used in penicillin-allergic patients.Trismus, hoarseness, and neck swelling are concerning for more serious infections such as epiglottitis. Runny nose, cough, and myalgia suggest a viral illness such as the common cold.
Fever, anorexia, dysphagia, and hoarseness
Fever, runny nose, cough, myalgia, and poor appetite
Fever, no cough, tonsillar exudates, and tender anterior cervical lymphadenopathy
Fever, cough, pharyngeal erythema, and dysphagia
Infection