Pharyngitis

Pharyngitis
Viral pharyngitis. The oropharynx is swollen and red.
ICD-10	J02, J31.2
ICD-9	462, 472.1
DiseasesDB	24580
MedlinePlus	000655
eMedicine	emerg/419
MeSH	D010612

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See also Strep throat.

Definition

Pharyngitis (far-in-jī' tis) is a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils, tonsillitis may occur simultaneously.

The major cause is infection, of which about 90% are viral, the remainder caused by bacterial infection and rarely oral thrush (fungal candidiasis e.g. in babies). Some cases of pharyngitis are caused by irritation from elements such as pollutants or chemical substances.

Causes

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.

Viral sore throats

These comprise about 90% 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

Bacterial sore throats

Group A streptococcal

See also Strep throat

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). It may be impossible to distinguish between viral and bacterial causes of sore throat.

Some immune-system meditated complications may occur:

• 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')
• Historically the most important complication was of the generalised 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.

Complete Differential Diagnosis of Pharyngitis

• Accidents
• Adenovirus
• Allergic pharyngitis
• Allergic rhinitis
• Angina
• Bacterial tracheitis
• Behcet's Syndrome
• Blastomyces
• Cancer
• Candida albicans
• Caustic ingestions
• Cervical phlegmon
• Chemical burns
• Chemotherapy
• Chlamydia pneumoniae
• Coxsackievirus
• Coronavirus
• Corynebacterium diphtheriae
• Cryptococcus
• Cytomegalovirus
• Deep neck space infections
• Diptheria
• Drug related pharyngitis
• Environmental pollutants
• Epstien-Barr Virus
• Epiglottitis
• Erythema multiforme
• Foreign body
• Fungal Pharyngitis
• Gastroesophageal Reflux Disease
• Gonococcal Pharyngitis
• Haemophilus influenzae
• Herpes Simplex Virus
• Histoplasma
• Influenza
• Inhalants
• Kawasaki's Disease
• Klebsiella
• Laryngitis
• Leukemia
• Ludwig's angina
• Lymphadentitis
• Lymphoma
• Mononeucleosis
• Moraxella catarrhalis
• Mumps
• Mycobacterium
• Mycoplasma
• Neisseria gonorrheae
• Paracoccidioides
• Parainfluenza
• Pemphigus
• Pneumococcus
• Post nasal drip
• Rabies
• Radiation
• Reiter's syndrome
• Respiratory Syncytial Virus
• Retropharyngeal abscess
• Rhinovirus
• Rhinosporidium
• Sinusitis
• Smoke
• [Squamous cell sarcoma
• Staphylococcus aureus
• Stomatitis
• Streptococcal pharyngitis
• Thermal injury
• Thyroiditis
• Tonsillitis
• Tonsil abscess
• Tonsil carcinoma
• Toxins
• Tracheobronchitis
• Trauma
• Viral pharyngitis
• Voice abuse

Complete Differential Diagnosis of the Causes of Sore throat

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	Acetic acid, Grape seed extract, Sodium dichloroisocyanurate,
Dermatologic	No underlying causes
Drug Side Effect	Abacavir, Abatacept Injection (patient information), Acetazolamide Oral,
Ear Nose Throat	Acute viral nasopharyngitis (common cold), Angina tonsillaris, Laryngeal cancer, Laryngitis, Oropharyngeal lesion, Peritonsillar abscess, Pharyngitis, Post-nasal drip, Tonsillitis, Tonsillolith,
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Neutropenia,
Iatrogenic	Endoscopy, Invisalign, Nasogastric intubation, Uvulopalatopharyngoplasty,
Infectious Disease	Anthrax, Arcanobacterium, Coxsackie A virus, Coxsackie B , Cytomegalovirus, Diphtheria, Duke's disease, Ebola, Enterovirus, Epstein-Barr Virus, Fusobacterium, Gonococcal Infections, Group A streptococcal infection, Hantavirus pulmonary syndrome, Herpangina, Herpesviridae, Human parainfluenza viruses, Infectious mononucleosis, Influenza, Lassa Fever, Lemierre's syndrome, Mumps, Poliovirus, Q Fever, Rhinovirus, Scarlet fever, Severe acute respiratory syndrome, Strep throat, Syphillis, Tularemia,
Musculoskeletal / Ortho	No underlying causes
Neurologic	Encephalitis lethargica,
Nutritional / Metabolic	Ariboflavinosis,
Obstetric/Gynecologic	No underlying causes
Oncologic	Laryngeal cancer,
Opthalmologic	No underlying causes
Overdose / Toxicity	Cocaine, Hydrogen sulfide, Methotrexate (patient information), Peginterferon alfa-2a (patient information),
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Hay fever, Kikuchi-Fujimoto disease,
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Chronic Fatigue Syndrome,

Treatment

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.

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.

Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.Analgesics are among the most effective, but there are many simple measures that can also be used.

Symptomatic treatments

• Analgesics such as NSAIDs can help reduce the pain associated with a sore throat.
• Throat lozenges (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
• Warm tea (true or Tisane) or soup can help temporarily alleviate the pain of a sore throat.
• Cold beverages, popsicles and ice cubes numb the nerves of the throat somewhat, alleviating the pain for a brief time.
• Mouthwash (when gargled) reduces the pain but only for a brief time.
• Drinking heavy amounts of liquid reduces the pain for a short time.
• Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
• Yogurt has been shown to help alleviate the pain temporarily by coating the affected area. Milk also has the same effect.
• Gargling with warm saline solution may help reduce mucus. While it is a popular household remedy, there is little evidence that it provides any long-term benefit.

Remedial and preventive treatments

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.

• The use of antibiotics is a helpful remedial treatment when a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect.
• Honey has long been used for treating sore throats due to its antiseptic properties.
• Swallowing a couple teaspoons of raw lemon or lime juice several times a day may help destroy microorganisms in bacteria-related throat infections. Research also shows that lemon juice may destroy some viruses such as HIV. . 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).

References

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