Clinical Signs Highly Indicative of Pharyngitis and Epiglottitis
The most definitive clinical signs of pharyngitis include sudden-onset sore throat, pain on swallowing, fever (101°F-104°F), tonsillopharyngeal erythema with or without exudates, soft palate petechiae, beefy red swollen uvula, and tender enlarged anterior cervical nodes; while epiglottitis is characterized by severe dysphagia, muffled voice, stridor, and patients sitting in an erect position to maintain airway patency. 1, 2
Pharyngitis: Key Clinical Signs
Highly Suggestive Signs of Bacterial Pharyngitis (GAS)
- Sudden-onset sore throat 1
- Pain on swallowing 1
- Fever of varying degree (usually 101°F-104°F) 1
- Tonsillopharyngeal erythema with or without exudates 1
- Soft palate petechiae ("doughnut" lesions) 1
- Beefy red swollen uvula 1
- Tender, enlarged anterior cervical lymph nodes 1
- Scarlatiniform rash (in cases of scarlet fever) 1
- Headache, nausea, vomiting, and abdominal pain (especially in children) 1
Signs Suggesting Viral Pharyngitis
- Conjunctivitis 1
- Coryza (nasal discharge) 1
- Hoarseness 1
- Cough 1
- Diarrhea 1
- Characteristic viral exanthems or enanthems 1
Epiglottitis: Key Clinical Signs
Highly Suggestive Signs of Epiglottitis
- Severe dysphagia (difficulty swallowing) 2, 3
- Muffled or "hot potato" voice 2, 4
- Stridor (strongest predictor of need for airway intervention, RR 6.2) 2, 3
- Patient sitting in an erect position (strong predictor of need for airway intervention, RR 4.8) 3
- Drooling or pooling of secretions 2, 4
- Respiratory distress 2, 5
- Fever (though may not be present in older adults) 2, 5
- Visible swollen, cherry-red epiglottis on examination 2, 4
Important Clinical Considerations
Diagnostic Challenges
- No single clinical sign is specific enough to diagnose GAS pharyngitis without microbiological confirmation 1
- Clinical scoring systems (like modified Centor criteria) can help identify patients with low probability of GAS pharyngitis 1
- Visualization of the epiglottis is key to diagnosing epiglottitis, but should be performed with caution and with airway management equipment ready 2
Age-Related Differences
- GAS pharyngitis is primarily a disease of children 5-15 years of age, but can occur at any age 1
- Clinical findings of pharyngitis in children under 3 years can be different and less specific (e.g., excoriated nares, purulent nasal discharge) 1
- Epiglottitis in adults often presents more subacutely than in children 2, 5
- Elderly patients with epiglottitis may have less dramatic presentations with fewer classic signs 5
Warning Signs Requiring Urgent Attention
- For epiglottitis: stridor, sitting erect, respiratory distress, and drooling are critical signs requiring immediate airway management consideration 2, 3
- Difficulty swallowing, neck tenderness or swelling may indicate complications like peritonsillar abscess or other deep space infections 1