Acute pharyngitis
Classification and external resources
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

Pharyngitis (pronounced /ˌfærɪnˈdʒaɪtɪs/) is an inflammation of the throat or pharynx.^[1] In most cases it is painful and the initial infection can extend for a lengthy time period, and is often referred to as a sore throat.

Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic. The remainder of this article is about the acute form.

Acute pharyngitis can result in very large tonsils which cause trouble swallowing and breathing. Some cases are accompanied by a cough or fever.

Most acute 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.^[2]

Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and anti-fungals respectively.

Contents 1 Classification 2 Causes 2.1 Viral pharyngitis 2.2 Bacterial pharyngitis 2.2.1 Streptococcal pharyngitis 2.2.2 Diphtheria 2.3 Other causes 2.3.1 Candida albicans 2.3.2 Fusobacterium necrophorum 2.3.3 Serious causes 3 Treatment 3.1 Symptomatic treatments 3.2 Remedial treatments 3.3 Alternative treatments 4 External links 5 References

[edit] Classification

Acute pharyngitis is one type of upper respiratory tract infection.^{[citation needed]}

[edit] Causes

The pharynx is a common site of infection. After a person is directly exposed to the causing agent, such as viruses or bacteria, the latter will often settle in this part of the body. Examples of direct contact include inhaling dust or water vapour containing the microorganism.^{[citation needed]}

[edit] Viral pharyngitis

These comprise about 40-60% of all infectious cases and can be a feature of many different types of viral infections.^[2]

• 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

[edit] 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.^[3]

[edit] Streptococcal pharyngitis

The most common bacterial agent is streptococcus. It causes about 15-30% of cases of pharyngitis.^[3] 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.^[4]

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 mediated 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")^{[citation needed]}
• 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.^[5] However, the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.^[6][7] 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.^[5][8]
• Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening septicaemia (Lemierre's syndrome)^{[citation needed]}

[edit] 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.^{[citation needed]}

[edit] Other causes

[edit] Candida albicans

Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.^{[citation needed]}

[edit] 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's syndrome can develop.^{[citation needed]}

[edit] Serious causes

A few other causes are rare but potentially fatal and include parapharyngeal space infections: peritonsillar abscess ("quinsy"), submandibular space infection (Ludwig's angina) and epiglottitis.^[9]

[edit] Treatment

Treatment can be divided into symptomatic and remedial. Symptomatic treatments attempt to reduce pain and discomfort. Remedial treatments attempt to cure pharyngitis or prevent long term complications such as rheumatic fever.

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.

[edit] Symptomatic treatments

• Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat.^[10]
• *Steroids ( such as dexamethasone ) have been found to be useful for severe pharyngitis.^[11][12]
• Viscous lidocaine relieves pain by numbing the mucus membranes of the throat.^[13]

[edit] 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.^[5]
• Antiviral drugs are not used except in cases when the patient's immune system is compromised.^{[citation needed]}

[edit] Alternative treatments

Alternative medicines are promoted and used for the treatment of sore throats.^[14] Alternative treatments are however poorly supported by evidence, and UpToDate, an evidence-based peer-reviewed resource, recommends that they not be used to treat pharyngitis.^[15] The Mayo Foundation specifies that herbal treatments, such as marshmallow root, eucalyptus, and chamomile have limited evidence to support their use.^[14]

[edit] External links

• Remedies Sore Throat

[edit] References

v • d • e Pathology of respiratory system (J, 460-519), respiratory diseases Upper RT (including URTIs, Common cold) Head sinuses: Sinusitis nose: Rhinitis (Vasomotor rhinitis, Atrophic rhinitis, Hay fever) · Nasal polyp · Rhinorrhea · nasal septum (Nasal septum deviation, Nasal septum perforation, Nasal septal hematoma) tonsil: Tonsillitis · Adenoid hypertrophy · Peritonsillar abscess Neck pharynx: Pharyngitis (Strep throat) larynx: Laryngitis · Croup · Laryngospasm · vocal folds: Vocal fold nodule · epiglottis: Epiglottitis trachea: Tracheitis · Tracheal stenosis Retropharyngeal abscess Lower RT/lung disease (including LRTIs) Bronchial/ obstructive acute: Acute bronchitis chronic: COPD (Chronic bronchitis, Emphysema, Diffuse panbronchiolitis) · Asthma (Status asthmaticus) · Bronchiectasis unspecified: Bronchitis · Bronchiolitis (Bronchiolitis obliterans) Interstitial/ restrictive External agents/ occupational lung disease Pneumoconiosis (Asbestosis, Baritosis, Bauxite fibrosis, Berylliosis, Caplan's syndrome, Chalicosis, Coalworker's pneumoconiosis, Siderosis, Silicosis, Byssinosis) Hypersensitivity pneumonitis (Bagassosis, Bird fancier's lung, Farmer's lung) Other ARDS · Pulmonary edema · Löffler's syndrome/Eosinophilic pneumonia · Respiratory hypersensitivity (Allergic bronchopulmonary aspergillosis) Hamman-Rich syndrome · Idiopathic pulmonary fibrosis · Sarcoidosis Obstructive or restrictive Pneumonia/ pneumonitis By pathogen Viral · Bacterial (Pneumococcal, Klebsiella) / Atypical bacterial (Mycoplasma, Legionnaires' disease, Chlamydiae) · Fungal (Pneumocystis) · Parasitic · noninfectious (Chemical/Mendelson's syndrome, Aspiration/Lipid) By vector/route Community-acquired · Healthcare-associated · Hospital-acquired By distribution Broncho- · Lobar IIP UIP · DIP · BOOP-COP · NSIP · RB Other Atelectasis · circulatory (Pulmonary hypertension, Pulmonary embolism) · Lung abscess Pleural cavity/ mediastinum Pleural disease Pleuritis/pleurisy Pneumothorax/Hemopneumothorax (Tension pneumothorax) Pleural effusion: Hemothorax · Hydrothorax · Chylothorax · Empyema/pyothorax · Malignant Fibrothorax Mediastinal disease Mediastinitis · Mediastinal emphysema Other/general Respiratory failure · Influenza · SARS · Idiopathic pulmonary haemosiderosis · Pulmonary alveolar proteinosis respiratory system navs: anat nose,larynx/lower+thoracic cavity/physio/dev, noncongen/congen/tumors, symptoms+signs/eponymous, proc

v • d • e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

v • d • e Common cold Viruses Rhinovirus - Coronavirus - Human parainfluenza viruses - Human respiratory syncytial virus - Adenovirus - Enterovirus - Metapneumovirus Symptoms Pharyngitis - Rhinorrhea - Nasal congestion - Sneezing - Cough - Muscle aches - Fatigue - Malaise - Headache - Weakness - Loss of appetite Complications Acute bronchitis - Bronchiolitis - Croup - Pneumonia - Sinusitis - Otitis media - Strep throat Antiviral drugs Pleconaril (experimental)