Pharyngitis

2008/9 Schools Wikipedia Selection. Related subjects: Health and medicine

Pharyngitis Classification and external resources
Viral pharyngitis. The oropharynx is swollen and red.
ICD- 10	J 02., J 31.2
ICD- 9	462, 472.1
DiseasesDB	24580
MedlinePlus	000655
eMedicine	emerg/419
MeSH	D010612

Pharyngitis (IPA:  [ˌfarɪnˈdʒʌɪtɪs]) is, in most cases, a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils ( tonsillitis) and/or larynx ( laryngitis) may occur simultaneously.

About 90% of cases are caused by viral infection, with the remainder caused by bacterial infection and, in rare cases, 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 infectious 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 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 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 virus: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus

Bacterial sore throats

Group A streptococcal

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 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.

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.
• Cayenne pepper is said to provide effective short term relief when mixed with water and gargled.
• Throat sprays such as Cepacol and Chloraseptic.
• 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 herbal) or soup can help temporarily alleviate the pain of a sore throat.
• 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.
• Gargling with warm saline solution may help reduce mucus and the pain.