The degree of sorethroat varies from extremely severe to no significant discomfort. The neck lymph nodes become very large and are usually very tender. Fevers may last up to 4 days with severely affected children remaining sick for up to 2 weeks. The tonsil appearance is as variable as in viral tonsillitis. Runny nose, cough, and hoarseness are rarely present.
Complications are common which is why treatment with antibiotics is so important.
The Group A Streptococcus bacteria can cause two types of complications, infectious and non-infectious. The infectious complications are due to the direct spread of the bacteria while non-infectious complications are due to the release of harmful substances by the bacteria or by the bacteria causing changes in the immune system. Local complications also include the bacteria entering into the blood vessels which now allows more serious infections such as bone infections, meningitis and pneumonia. The differentiation between viral tonsillitis and Strep tonsillitis is important to prevent these possible complications. The history may give important clues but a swab of the back of the throat for a culture is a critical part of the evaluation.