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Common Viral Causes of Pharyngitis in India (in order of frequency):
1. Adenovirus – most common
• Often associated with fever, sore throat, pharyngeal erythema, and sometimes pharyngoconjunctival fever (sore throat + conjunctivitis).
2. Rhinovirus
• Usually causes mild pharyngitis along with common cold symptoms.
3. Coronavirus (non-SARS types)
• Common in seasonal outbreaks.
4. Epstein–Barr Virus (EBV)
• Causes infectious mononucleosis; presents with sore throat, lymphadenopathy, and splenomegaly.
5. Influenza virus
• Prominent during outbreaks; associated with fever, myalgia, and sore throat.
6. Parainfluenza virus
• More common in children; can also cause croup.
7. Enteroviruses (e.g., Coxsackie A, Echoviruses)
• Cause herpangina and hand-foot-mouth disease.

Key Point:
• In India, viral causes account for 50–70% of acute pharyngitis cases.
• Among these, adenovirus is the leading culprit, especially during seasonal outbreaks in children and young adults.

The most common bacterial cause of pharyngitis in India is Group A β-hemolytic Streptococcus (GAS), also known as Streptococcus pyogenes.

Bacterial Causes of Pharyngitis in India (in order of frequency)

1. Streptococcus pyogenes (GAS) → Most common
• Responsible for 15–30% of pharyngitis cases in children and 5–10% in adults.
• Clinical clues:
• Sudden onset sore throat
• Fever
• Tender anterior cervical lymphadenopathy
• Tonsillar exudates
• Absence of cough
• Importance: Untreated infections can lead to rheumatic fever and post-streptococcal glomerulonephritis.

2. Group C & G Streptococci
• Less common but can mimic GAS pharyngitis.

3. Arcanobacterium haemolyticum
• Seen mostly in adolescents; causes a scarlatiniform rash.

4. Neisseria gonorrhoeae
• Rare in India, associated with orogenital contact.

5. Corynebacterium diphtheriae
• Sporadic cases still occur in India, especially in unvaccinated populations.
• Presents with pseudomembrane over tonsils and pharynx.

6. Mycoplasma pneumoniae & Chlamydophila pneumoniae
• Cause atypical pharyngitis, often associated with lower respiratory tract involvement.
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