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Pharyngitis
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Pharyngitis is an inflammation of the throat or pharynx. In most cases it is painful, and thus is often referred to as a sore throat. Inflammation of the tonsils (tonsillitis) and/or larynx (laryngitis) occur simultaneously, which can make eating difficult or painful. It can result in very large tonsils which cause trouble swallowing and breathing. Some are accompanied by a cough or fever.
Most cases are caused by viral infections (40%-60%), with the remainder caused by bacterial infections, fungal infections, or irritants such as pollutants or chemical substances.
Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and antifungals respectively.
e pharyngitis is one type of upper respiratory tract infections
Chronic pharyngitis
Causes
The pharynx is a common site of infection.
Discussion
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Encyclopedia
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is painful, and thus is often referred to as a sore throat. Inflammation of the tonsils (tonsillitis) and/or larynx (laryngitis) occur simultaneously, which can make eating difficult or painful. It can result in very large tonsils which cause trouble swallowing and breathing. Some are accompanied by a cough or fever.
Most cases are caused by viral infections (40%-60%), with the remainder caused by bacterial infections, fungal infections, or irritants such as pollutants or chemical substances.
Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and antifungals respectively.
Classification
Acute pharyngitis is one type of upper respiratory tract infections
Chronic pharyngitis
Causes
The pharynx is a common site of infection. This is because viruses and bacteria often settle in this part of the body after a person inhales dust or water vapour containing the microorganism. Infection can also arise when a person touches their nose or mouth after having touched an object shared with another person with the disease. The foreign invader reproduces rapidly after settling on the body tissue.
Viral pharyngitis
These comprise about 40-60% of all infectious cases and can be a feature of many different types of viral infections.
- Adenovirus - the most common of the viral causes. Typically the degree of neck lymph node enlargement is modest and the throat often does not appear red, although is very painful.
- Orthomyxoviridae which cause influenza - present with rapid onset high temperature, headache and generalised ache. A sore throat may be associated.
- Infectious mononucleosis ("glandular fever") caused by the Epstein-Barr virus. This may cause significant lymph gland swelling and an exudative tonsillitis with marked redness and swelling of the throat. The heterophile test can be used if this is suspected.
- Herpes simplex virus can cause multiple mouth ulcers.
- Measles
- Common cold virus: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme pain.
- Primary HIV
Bacterial pharyngitis
A number of different bacteria can infect the human throat. The most common is Group A streptococcus, however others include, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.
Streptococcal pharyngitis
The most common bacterial agent is streptococcus. It causes about 15-30% of cases of pharyngitis. Unlike adenovirus, there tends to be greater generalized symptoms and more signs to find. Typically enlarged and tender lymph glands, with bright red, inflamed, and swollen throat of sudden onset with severe pain (often the patient finds it painful to talk or swallow), the patient may have a high temperature, headache, and aching muscles (myalgia) and joints (arthralgia). White or yellow spots on the back of the throat may be present on exam. These spots may also appear on the tonsils when those glands are involved.
It may be impossible to distinguish between viral and bacterial causes of sore throat.
Coughing is usually absent in strep throat though a dry, nonproductive cough (similar to how a person clears his or her voice) may appear in some patients; in addition coughing may appear when there is co-infection with a virus. A stuffy nose is also considered uncommon and is more likely due to a virus instead of the strep bacteria.
Some immune-system meditated complications may occur:
- Scarlet fever with its vivid rash, although the milder disease seen after the 1950s suggests that the bacteria may have mutated to less virulent illness and some doctors now call this scarlatina (literally a "little scarlet fever")
- Historically the most important complication was of the generalized inflammatory disorder of rheumatic fever which could later result in Rheumatic heart disease affecting the valves of the heart. Antibiotics may reduce the incidence of this complication to under one-third.
However the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.
This may be a result of a change in the prevalence of various strains of bacteria. In underdeveloped regions, untreated streptococcal infection can still give rise to rheumatic heart disease and may be due to environmental factors, or reflect a genetic predisposition of the patient to the disease.
- Post-streptococcal glomerulonephritis is an inflammation of the kidney. It is disputed whether antibiotics might reduce the small risk of this or not.
- Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening septicaemia (Lemierre's syndrome)
Diphtheria
Diphtheria is a potentially life threatening upper respiratory infection caused by Corynebacterium diphtheriae which has been largely eradicated in developed nations since the introduction of childhood vaccination programs, but is still reported in the Third World and increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but recovery is generally slow.
Other causes
Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.
Fusobacterium necrophorum
Fusobacteria are normal inhabitants of the oropharyngeal flora. After a strep sore throat has created a peritonsillar abscess, a crater filled with pus and bacteria near the tonsils, Lemierre syndrome can develop.
Treatment
Treatment can be divided into symptomatic and remedial. Symptomatic treatments attempt to reduce pain and discomfort. Remedial treatments attempt to cure pharyngitis.
Remedial treatments are effective for bacterial infections and fungal infection. No specific treatment for viral infections have been found to be effective and most cases will settle within a few days.
Symptomatic treatments
- Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat.
- Steroids: A single dose of dexamethasone reduces symptoms. This can either be given by mouth or intra-muscularly.
- Viscous lidocaine relieves pain by numbing the mucus membranes of the throat.
Remedial treatments
- Antibiotics are useful if a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect. These infections are treated by controlling or relieving symptoms until the virus runs its course.
- Antiviral drugs do not decrease the length of illness and are not used except in cases when the patient's immune system is compromised.
Alternative treatments
Many alternative treatments are promoted and used in sore throats. They are however poorly supported by evidence and Uptodate recommends that they not be used to treat pharyngitis. Some include gargling with a warm salt solution, eucalyptus, and chamomile.
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