Group A Streptococcal Pharyngitis vs Peritonsillar Abscess
Group A Streptococcal Pharyngitis and Peritonsillar Abscess are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Group A Streptococcal Pharyngitis vs Peritonsillar Abscess at a glance
- Group A Streptococcal Pharyngitis: GAS bacterial pharyngitis — diagnose with RADT/culture and treat with penicillin to prevent rheumatic fever.
- Peritonsillar Abscess: Pus collection between tonsil capsule and pharyngeal constrictor — requires drainage plus antibiotics.
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Side-by-side comparison
| Feature | Group A Streptococcal Pharyngitis | Peritonsillar Abscess |
|---|---|---|
| At a glance | GAS bacterial pharyngitis — diagnose with RADT/culture and treat with penicillin to prevent rheumatic fever. | Pus collection between tonsil capsule and pharyngeal constrictor — requires drainage plus antibiotics. |
| Classic presentation | Modified Centor (McIsaac) score components: fever >38, tonsillar exudate, tender anterior cervical adenopathy, absence of cough, age 3-14 (+1) or 15-44 (0) or… | Triad: severe unilateral sore throat + trismus + muffled 'hot potato' voice with uvular deviation.; Severe unilateral sore throat, often worsening over 2-5… |
| Workup / key labs | IDSA 2012: confirm GAS pharyngitis with positive RADT or throat culture in symptomatic patients with clinical features suggestive of GAS (Centor ≥2-3); do not… | CBC, CMP, blood cultures if febrile or toxic appearing; Throat culture (low yield; treatment is empiric); Heterophile (Monospot) or EBV serology if… |
| Imaging | Not required for uncomplicated GAS pharyngitis; Lateral neck XR or CT if epiglottitis, retropharyngeal abscess, or deep neck infection suspected | Clinical diagnosis often sufficient; Intraoral ultrasound — distinguishes abscess from cellulitis, guides drainage; CT neck with IV contrast — for atypical… |
| First-line treatment | Penicillin V 500 mg PO BID-TID × 10 days (adults) OR amoxicillin 50 mg/kg/day (max 1000 mg) once daily × 10 days (children) — narrow-spectrum, low cost, no… | Drainage — needle aspiration OR incision and drainage by trained clinician (ENT, emergency medicine, or experienced primary care); Empiric antibiotics… |
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