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| | __NOTOC__ |
| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|30px|link=Sore throat resident survival guide]]|| <br> || <br> |
| | | [[Sore throat resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]].''' |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Pharyngitis | | | Name = Pharyngitis | |
| Image = Pharyngitis.jpg | | | Image = Pharyngitis.jpg | |
| Caption = Viral pharyngitis.<br>The [[oropharynx]] is swollen and red. | | | Caption = Viral pharyngitis.<br>The [[oropharynx]] is swollen and red. | |
| DiseasesDB = 24580 |
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| ICD10 = {{ICD10|J|02||j|00}}, {{ICD10|J|31|2|j|30}} |
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| ICD9 = {{ICD9|462}}, {{ICD9|472.1}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000655 |
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| eMedicineSubj = emerg |
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| eMedicineTopic = 419 |
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| MeshID = D010612 |
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| }} | | }} |
| | {{Pharyngitis}} |
| | {{CMG}}; {{AE}}{{VSKP}}{{DYM}} |
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| {{SI}} | | {{SK}} Sore throat; Bacterial pharyngitis; Group A streptococcal pharyngitis; Streptococcal pharyngitis; Viral pharyngitis |
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| {{CMG}}
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| {{Editor Help}}
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| :''See also [[Strep throat]].''
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| ==Definition==
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| '''Pharyngitis''' (''far-in-jī' tis'') is a [[pain and nociception|painful]] inflammation of the [[pharynx]], and is colloquially referred to as a '''sore throat'''. Infection of the tonsils, [[tonsillitis]] may occur simultaneously.
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| The major cause is [[infection]], of which about 90% are [[virus|viral]], the remainder caused by [[bacteria|bacterial]] infection and rarely ''[[Oral candidiasis|oral thrush]]'' ([[fungus|fungal]] [[candidiasis]] e.g. in babies). Some cases of pharyngitis are caused by irritation from elements such as pollutants or chemical substances.
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| ==Causes==
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| The pharynx is often the first site of infection for many contagious diseases such as the common cold. This is because viruses and bacteria often settle in this part of the body after a person inhales dust or water vapor 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.
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| ===Viral sore throats===
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| These comprise about 90% of all infectious cases and can be a feature of many different types of viral infections.
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| *[[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.
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| *[[Orthomyxoviridae]] which cause [[influenza]] - present with rapid onset high temperature, headache and generalised ache. A sore throat may be associated.
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| *[[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.
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| *[[Herpes simplex virus]] can cause multiple [[mouth ulcers]].
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| *[[Measles]]
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| *[[Common cold]]
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| ===Bacterial sore throats===
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| ====Group A streptococcal====
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| :''See also [[Strep throat]]''
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| The most common bacterial agent is [[streptococcus]]. 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, the patient may have a high temperature, headache, and aching muscles ([[myalgia]]) and joints ([[arthralgia]]).
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| It may be impossible to distinguish between viral and bacterial causes of sore throat.<ref name="pmid1565052">{{cite journal |author=Del Mar C |title=Managing sore throat: a literature review. I. Making the diagnosis |journal=Med. J. Aust. |volume=156 |issue=8 |pages=572-5 |year=1992 |pmid=1565052 |doi=}}</ref>
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| Some immune-system meditated complications may occur:
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| * [[Scarlet fever]] with its vivid [[rash]], although the milder disease seen after the 1950's suggests that the bacteria may have mutated to less virulent illness and some doctors now call this ''[[scarlatina]]'' (literally a 'little scarlet fever')
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| * Historically the most important complication was of the generalised inflammatory disorder of [[rheumatic fever]] which could later result in ''[[Rheumatic fever#Complications|Rheumatic heart disease]]'' affecting the valves of the heart. Antibiotics may reduce the incidence of this complication to under one-third.<!--
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| --><ref name="pharyngitis-cochrane">{{cite journal | author=Del Mar CB, Glasziou PP, Spinks AB. | title=Antibiotics for sore throat | journal=The [[Cochrane Library|Cochrane Database of Systematic Reviews]] | year=2004 | issue=Issue 2 | pages=Art. No.: CD000023.pub2 | id={{doi|10.1002/14651858.CD000023.pub2}} | url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html}} - Meta-analysis of published research</ref><!--
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| -->However the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.<!--
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| --><ref>{{cite journal | title=Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help | journal=CMAJ | month=September 28 | year=2004 | volume=171 | issue=7 | id={{doi|10.1503/cmaj.1041275}} | url=http://www.cmaj.ca/cgi/content/full/171/7/721}} - Canadian Medical Association Journal commentary on Cochrane analysis</ref><!--
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| --><ref>{{cite journal | title=Treatment of sore throat in light of the Cochrane verdict: is the jury still out? | journal=MJA | year=2002 | volume=177 | issue=9 | pages=512-515| url=http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html}} - Medical Journal of Australia commentary on Cochrane analysis</ref><!--
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| -->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.
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| * [[Glomerulonephritis|Post-streptococcal glomerulonephritis]] is an inflammation of the kidney. It is disputed whether antibiotics might reduce<!--
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| --><ref>{{cite journal | author = Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, Porowski T | title = [The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] | journal = Wiad Lek | volume = 54 | issue = 1-2 | pages = 56-63 | year = 2001 | id = PMID 11344703}}</ref><!--
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| --> the small risk of this or not.<!--
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| --><ref name="pharyngitis-cochrane" />
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| * Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening [[septicaemia]] ([[Lemierre's syndrome]])
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| ====Diphtheria==== | | ==[[Pharyngitis overview|Overview]]== |
| [[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. | |
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| == Complete Differential Diagnosis of Pharyngitis == | | ==[[Pharyngitis historical perspective|Historical Perspective]]== |
| *Accidents
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| *[[Adenovirus]]
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| *[[pharyngitis|Allergic pharyngitis]]
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| *[[Allergic rhinitis]]
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| *[[Angina]]
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| *[[tracheitis|Bacterial tracheitis]]
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| *[[Behcet's Syndrome]]
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| *[[Blastomyces]]
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| *[[Cancer]]
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| *[[Candida albicans]]
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| *Caustic ingestions
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| *Cervical phlegmon
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| *Chemical burns
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| *Chemotherapy
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| *[[Chlamydia pneumoniae]]
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| *[[Coxsackievirus]]
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| *[[Coronavirus]]
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| *[[Corynebacterium diphtheriae]]
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| *[[Cryptococcus]]
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| *[[Cytomegalovirus]]
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| *Deep neck space infections
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| *[[Diptheria]]
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| *Drug related pharyngitis
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| *Environmental pollutants
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| *[[Epstien-Barr Virus]]
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| *[[Epiglottitis]]
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| *[[Erythema multiforme]]
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| *Foreign body
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| *[[Fungal Pharyngitis]]
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| *[[Gastroesophageal Reflux Disease]]
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| *[[Gonococcal Pharyngitis]]
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| *[[Haemophilus influenzae]]
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| *[[Herpes Simplex Virus]]
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| *[[Histoplasma]]
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| *[[Influenza]]
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| *Inhalants
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| *[[Kawasaki's Disease]]
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| *[[Klebsiella]]
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| *[[Laryngitis]]
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| *[[Leukemia]]
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| *[[Ludwig's angina]]
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| *[[Lymphadentitis]]
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| *[[Lymphoma]]
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| *[[Mononeucleosis]]
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| *[[Moraxella catarrhalis]]
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| *[[Mumps]]
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| *[[Mycobacterium]]
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| *[[Mycoplasma]]
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| *[[Neisseria gonorrheae]]
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| *Paracoccidioides
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| *Parainfluenza
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| *[[Pemphigus]]
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| *[[Pneumococcus]]
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| *Post nasal drip
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| *[[Rabies]]
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| *Radiation
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| *[[Reiter's syndrome]]
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| *[[Respiratory Syncytial Virus]]
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| *Retropharyngeal abscess
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| *[[Rhinovirus]]
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| *Rhinosporidium
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| *[[Sinusitis]]
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| *[[Smoke]]
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| *[Squamous cell sarcoma
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| *[[Staphylococcus aureus]]
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| *[[Stomatitis]]
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| *[[pharyngitis|Streptococcal pharyngitis]]
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| *Thermal injury
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| *[[Thyroiditis]]
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| *[[Tonsillitis]]
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| *Tonsil abscess
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| *Tonsil carcinoma
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| *Toxins
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| *[[Tracheobronchitis]]
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| *[[Trauma]]
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| *[[pharyngitis|Viral pharyngitis]]
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| *Voice abuse
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| ===Complete Differential Diagnosis of the Causes of Sore throat=== | | ==[[Pharyngitis classification|Classification]]== |
| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"|
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| [[Acetic acid]], | |
| [[Grape seed extract]],
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| | ==[[Pharyngitis pathophysiology|Pathophysiology]]== |
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| | ==[[Pharyngitis causes|Causes]]== |
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| | ==[[Pharyngitis differential diagnosis|Differentiating Pharyngitis from other Diseases]]== |
| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Abacavir]],
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| [[Abatacept Injection (patient information)]],
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| [[Acetazolamide Oral]],
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| | ==[[Pharyngitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Pharyngitis risk factors|Risk Factors]]== |
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| | ==[[Pharyngitis screening|Screening]]== |
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| | ==[[Pharyngitis natural history, complications and prognosis|Natural History, Complications,and Prognosis]]== |
| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| [[Acute viral nasopharyngitis (common cold)]],
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| [[Angina tonsillaris]],
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| [[Laryngeal cancer]],
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| [[Laryngitis]],
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| | | ==Diagnosis== |
| |-
| | [[Pharyngitis diagnostic study of choice|Diagnostic Study of Choice]] | [[Pharyngitis history and symptoms|History and Symptoms]] | [[Pharyngitis physical examination|Physical Examination]] | [[Pharyngitis laboratory findings|Laboratory Findings]] | [[Pharyngitis electrocardiogram|Electrocardiogram]] | [[Pharyngitis chest x ray|Chest X Ray]] | [[Pharyngitis CT findings|CT]] | [[Pharyngitis ultrasound findings|Ultrasound]] | [[Pharyngitis other diagnostic studies|Other Diagnostic Studies]] |
| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Endoscopy]],
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| [[Invisalign]], | |
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Anthrax]],
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| [[Arcanobacterium]], | |
| [[Coxsackie A virus]], | |
| [[Coxsackie B ]], | |
| [[Cytomegalovirus]],
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| [[Diphtheria]],
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| [[Duke's disease]],
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| [[Ebola]],
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| [[Enterovirus]],
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| [[Epstein-Barr Virus]],
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| [[Fusobacterium]],
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| [[Gonococcal Infections]],
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| [[Group A streptococcal infection]],
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| [[Hantavirus pulmonary syndrome]],
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| [[Herpangina]],
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| [[Herpesviridae]],
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| [[Human parainfluenza viruses]],
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| [[Infectious mononucleosis]],
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| [[Influenza]],
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| [[Lassa Fever]],
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| [[Lemierre's syndrome]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Encephalitis lethargica]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Ariboflavinosis]], | |
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Laryngeal cancer]],
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| | |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"|
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| [[Cocaine]],
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| [[Hydrogen sulfide]],
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| | |
| | |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Hay fever]],
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| [[Kikuchi-Fujimoto disease]],
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| | |
| | |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue" | |
| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Chronic Fatigue Syndrome]],
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| | |
| |-
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| |}
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| ==Treatment== | | ==Treatment== |
| | [[Pharyngitis medical therapy|Medical Therapy]] | [[Pharyngitis surgery|Surgery]] | [[Pharyngitis primary prevention|Primary Prevention]] | [[Pharyngitis secondary prevention|Secondary Prevention]] | [[Pharyngitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pharyngitis future or investigational therapies|Future or Investigational Therapies]] |
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| There are three types of treatment: '''symptomatic''', '''remedial''' and '''preventive'''. Symptomatic treatments are aimed at reducing pain and symptoms. Remedial treatments attempt to cure pharyngitis by reducing its spread and speeding up the healing process. Preventive treatments attempt to block the start of an infection.
| | ==Case Studies== |
| | |
| Remedial treatments are mostly effective for bacterial infections such as streptococcal infections. For viral infections, even with treatment, most cases of pharyngitis will still settle spontaneously within a few days. Hence the most popular method of treatment is symptomatic. Many preventive treatments are also remedial, thus those two treatments will be listed in the same section.
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|
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| Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.<!--
| | [[Pharyngitis case study one|Case #1]] |
| --><ref name="Thomas">{{cite journal | author= Thomas M, Del Mar CB, Glasziou P. | title=How effective are treatments other than antibiotics for acute sore throat? | journal=Br J GP| year=2000 | volume=50 | issue=459 | pages=817-820| id = PMID 11127175 | url=http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1313826&blobtype=pdf | format=PDF}}</ref><!-- -->Analgesics are among the most effective, but there are many simple measures that can also be used.
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|
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| ===Symptomatic treatments=== | | ==Related Chapters== |
| | *[[Strep throat]] |
| | *[[Gonococcal pharyngitis]] |
| | *[[Infectious mononucleosis]] |
| | *[[Viral pharyngitis]] |
|
| |
|
| * Analgesics such as [[NSAIDs]] can help reduce the pain associated with a sore throat.<ref name="Thomas"/>
| |
| * [[Throat lozenge]]s ([[cough medicine]]) are often used for short-term pain relief.
| |
| * Avoid foods and liquids highly acidic in nature, as they will provoke temporary periods of intense pain
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| * Warm tea ([[tea|true]] or Tisane) or soup can help temporarily alleviate the pain of a sore throat.
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| * Cold beverages, popsicles and ice cubes numb the nerves of the throat somewhat, alleviating the pain for a brief time.
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| * Mouthwash (when gargled) reduces the pain but only for a brief time.
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| * Drinking heavy amounts of liquid reduces the pain for a short time.
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| * Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
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| * Yogurt has been shown to help alleviate the pain temporarily by coating the affected area. Milk also has the same effect.
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| * [[Gargling]] with warm saline solution may help reduce mucus. <ref>{{cite web |url=http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10 |title=Sore throat: Self-care - MayoClinic.com |accessdate=2007-09-17 |format= |work=}}</ref> While it is a popular household remedy, there is little evidence that it provides any long-term benefit.
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| ===Remedial and preventive treatments===
| | {{WH}} |
| Performing remedial treatments early when your throat begins to feel scratchy may help the infection from spreading to the rest of the throat and back of the mouth, which can result in difficulty in swallowing. Treatment should begin the first or second day of your illness, however if you have a cold or the flu, the infection may still continue to spread to other areas such as the ears through the eustachian tube (causing an earache) and to the lungs through the trachea (causing a cough). Healthy people who will be in frequent contact with someone with Pharyngitis may also try the measures below, of which some can be also be preventive, to help inhibit the start of an infection.
| | {{WS}} |
| * The use of [[antibiotic]]s is a helpful remedial treatment when a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect.<ref name="pharyngitis-cochrane" />
| |
| * Honey has long been used for treating sore throats due to its [[antiseptic]] properties.<ref>{{cite journal |author=Ramoutsaki I, Papadakis C, Ramoutsakis I, Helidonis E |title=Therapeutic methods used for otolaryngological problems during the Byzantine period |journal=Ann. Otol. Rhinol. Laryngol. |volume=111 |issue=6 |pages=553-7 |year=2002 |pmid=12090712}}</ref>
| |
| * Swallowing a couple teaspoons of raw lemon or lime juice several times a day may help destroy microorganisms in bacteria-related throat infections. <ref>[http://www.freepatentsonline.com/EP1331947.html]</ref> Research also shows that lemon juice may destroy some viruses such as HIV. <ref>[http://www.abc.net.au/news/stories/2004/07/12/1152319.htm]</ref><ref>[http://www.aids.net.au/aids-lemons.pdf]</ref>. This remedy should be started during the first or second day of sickness as citric acid can irritate your throat tissues after the Pharyngitis becomes too widespread. If this is the case, you may try a diluted solution of lemon, honey and tea (or lemon with hot water). <ref>[http://www.cnn.com/HEALTH/library/DS/00526.html]</ref>
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| ==References==
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| {{Reflist|2}}
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| {{Respiratory pathology}}
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| {{SIB}}
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| [[Category:Infectious Diseases]]
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| [[Category:Inflammations]]
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| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
| [[Category:Pulmonology]] | | [[Category:Emergency mdicine]] |
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| | [[Category:Immunology]] |
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