Pharyngitis

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Pharyngitis is a type of inflammation caused by an upper respiratory tract infection. It may be classified as acute or chronic. Acute pharyngitis may be catarrhal, purulent, or ulcerative, depending on the causative agent and the immune capacity of the affected individual. Chronic pharyngitis may be catarrhal, hypertrophic, or atrophic.{{citation needed|date=August 2020}}

Tonsillitis is a subtype of pharyngitis.{{cite web|title=Tonsillitis|url=https://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069|access-date=4 August 2016|url-status=live|archive-url=https://web.archive.org/web/20160325080921/http://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069|archive-date=25 March 2016|df=dmy-all}} If the inflammation includes both the tonsils and other parts of the throat, it may be called pharyngotonsillitis or tonsillopharyngitis.{{cite journal |vauthors=Rafei K, Lichenstein R | title = Airway Infectious Disease Emergencies | journal = Pediatric Clinics of North America | volume = 53 | issue = 2 | pages = 215–242 | year = 2006 | pmid = 16574523 | doi = 10.1016/j.pcl.2005.10.001 }} Another subclassification is nasopharyngitis (the common cold).{{cite web |url=https://www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069 |title=www.nlm.nih.gov |url-status=live |archive-url=https://web.archive.org/web/20151117014738/http://www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069 |archive-date=17 November 2015 |df=dmy-all }}

Clergyman's sore throat or clergyman's throat is an archaic term formerly used for chronic pharyngitis associated with overuse of the voice as in public speaking. It was sometimes called dysphonia clericorum or chronic folliculitis sore throat.{{Cite journal |last=Broadwater |first=Kimberly |date=2021 |title=Clergyman's Sore Throat |url=https://muse.jhu.edu/article/803425 |journal=Journal of Singing |volume=78 |issue=1 |pages=113–117 |doi=10.53830/CNLB1302 |s2cid=239663449 |issn=2769-4046}}

Most cases are due to an infectious organism acquired from close contact with an infected individual.{{citation needed|date=August 2020}}

File:Mononucleosis.JPG pharyngitis in a person with infectious mononucleosis]]

These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.{{cite web |url=http://emedicine.medscape.com/article/764304-overview |title=Pharyngitis |author=Acerra JR |work=eMedicine |access-date=28 April 2010 |url-status=live |archive-url=https://web.archive.org/web/20100317130804/http://emedicine.medscape.com/article/764304-overview |archive-date=17 March 2010 |df=dmy-all }}

• Adenovirus is 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 it is painful.
• The family Orthomyxoviridae which cause influenza are present with rapid onset high temperature, headache, and generalized ache. A sore throat may be associated.
• Infectious mononucleosis ("glandular fever") is caused by the Epstein–Barr virus. This may cause significant lymph-node 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: rhinovirus, coronavirus, respiratory syncytial virus, and parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often pain.

A number of different bacteria can infect the human throat. The most common is group A streptococcus (Streptococcus pyogenes), but others include Streptococcus pneumoniae, Haemophilus influenzae, Bordetella pertussis, Bacillus anthracis, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Fusobacterium necrophorum.{{cite journal | author = Bisno AL | title = Acute pharyngitis | journal = N Engl J Med | volume = 344 | issue = 3 | pages = 205–11 | date = January 2001 | pmid = 11172144 | doi = 10.1056/NEJM200101183440308 }}

{{Main|Streptococcal pharyngitis}}File:Pos strep.JPG

Streptococcal pharyngitis or strep throat is caused by a group A beta-hemolytic streptococcus (GAS).{{cite journal | author = Baltimore RS | title = Re-evaluation of antibiotic treatment of streptococcal pharyngitis | journal = Curr. Opin. Pediatr. | volume = 22 | issue = 1 | pages = 77–82 | date = February 2010 | pmid = 19996970 | doi = 10.1097/MOP.0b013e32833502e7 | s2cid = 13141765 }} It is the most common bacterial cause of cases of pharyngitis (15–30%). Common symptoms include fever, sore throat, and large lymph nodes. It is a contagious infection, spread by close contact with an infected individual. A definitive diagnosis is made based on the results of a throat culture. Antibiotics are useful to both prevent complications (such as rheumatic fever) and speed recovery.{{cite journal | author = Choby BA | title = Diagnosis and treatment of streptococcal pharyngitis | journal = Am Fam Physician | volume = 79 | issue = 5 | pages = 383–90 | date = March 2009 | pmid = 19275067 | url = http://www.aafp.org/afp/2009/0301/p383.html | url-status = live | archive-url = https://web.archive.org/web/20150208124744/http://www.aafp.org/afp/2009/0301/p383.html | archive-date = 8 February 2015 | df = dmy-all }}

Fusobacterium necrophorum is a normal inhabitant of the oropharyngeal flora and can occasionally create a peritonsillar abscess. In one out of 400 untreated cases, Lemierre's syndrome occurs.{{cite journal | author = Centor RM | title = Expand the pharyngitis paradigm for adolescents and young adults | journal = Ann Intern Med | volume = 151 | issue = 11 | pages = 812–5 | date = 1 December 2009 | pmid = 19949147 | doi = 10.7326/0003-4819-151-11-200912010-00011 | citeseerx = 10.1.1.669.7473 | s2cid = 207535809 }}

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|date=April 2009}}

A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess ("quinsy abscess"), submandibular space infection (Ludwig's angina), and epiglottitis.{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result |title=UpToDate Inc. |url-status=live |archive-url=https://web.archive.org/web/20090627030426/http://www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result |archive-date=27 June 2009 |df=dmy-all }} (registration required){{cite journal |vauthors=Reynolds SC, Chow AW | title = Severe soft tissue infections of the head and neck: a primer for critical care physicians | journal = Lung | volume = 187 | issue = 5 | pages = 271–9 | date = Sep–Oct 2009 | pmid = 19653038 | doi = 10.1007/s00408-009-9153-7 | s2cid = 9009912 }}{{cite journal |vauthors=Bansal A, Miskoff J, Lis RJ | title = Otolaryngologic critical care | journal = Crit Care Clin | volume = 19 | issue = 1 | pages = 55–72 | date = January 2003 | pmid = 12688577 | doi = 10.1016/S0749-0704(02)00062-3 }}

Some cases of pharyngitis are caused by fungal infection, such as Candida albicans, causing oral thrush.{{cite web |last1=Harvard Medical School |title=Sore Throat (Pharyngitis) |url=https://www.health.harvard.edu/a_to_z/sore-throat-pharyngitis-a-to-z |website=Harvard Health Publishing Harvard Medical School |publisher=Harvard Health Publishing |access-date=3 December 2019}}

Pharyngitis may also be caused by mechanical, chemical, or thermal irritation, for example cold air or acid reflux. Some medications may produce pharyngitis, such as pramipexole and antipsychotics.{{cite web |url=http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Mirapex/Mirapex.pdf |title=Mirapex product insert |year=2009 |publisher=Boehringer Ingelheim |access-date=30 June 2010 |url-status=live |archive-url=https://web.archive.org/web/20100614020208/http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf |archive-date=14 June 2010 |df=dmy-all }}{{cite web |url=http://medical-dictionary.thefreedictionary.com/olanzapine |title=Mosby's Medical Dictionary, 8th edition |year=2009 |publisher=Elsevier |access-date=30 June 2010}}

File:Throat Culture.png

Differentiating a viral and a bacterial cause of a sore throat based on symptoms alone is difficult. Thus, a throat swab often is done to rule out a bacterial cause.{{cite journal | author = Del Mar C | title = Managing sore throat: a literature review. I. Making the diagnosis | journal = Medical Journal of Australia | volume = 156 | issue = 8 | pages = 572–5 | year = 1992 | pmid = 1565052 | doi = 10.5694/j.1326-5377.1992.tb121422.x}}

The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on five clinical criteria, it indicates the probability of a streptococcal infection.

One point is given for each of the criteria:

• Absence of a cough
• Swollen and tender cervical lymph nodes
• Temperature more than {{convert|38.0|C|F}}
• Tonsillar exudate or swelling
• Age less than 15 (a point is subtracted if age is more than 44)

The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three, as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.{{cite journal |vauthors=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C | title = Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. | journal = Clinical Infectious Diseases | volume = 55 | issue = 10 | pages = e86–102 | date = 9 September 2012 | pmid = 22965026 | doi = 10.1093/cid/cis629 | pmc = 7108032 | doi-access = free }}

The majority of the time, treatment is symptomatic. Specific treatments are effective for bacterial, fungal, and herpes simplex infections.

• Pain medication, such as NSAIDs and acetaminophen (paracetamol), can help reduce the pain associated with a sore throat. Aspirin may be used in adults, but is not recommended in children due to the risk of Reye syndrome.{{cite journal|title=Re-evaluation of antibiotic treatment of streptococcal pharyngitis|date=February 2010|issue=Curr. Opin. Pediatr. 22 (1)|pages=77–82|doi=10.1097/MOP.0b013e32833502e7|pmid=19996970|volume=22|author=Baltimore RS|journal=Current Opinion in Pediatrics|s2cid=13141765}}
• Steroids (such as dexamethasone) may be useful for severe pharyngitis.{{cite journal |vauthors=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P | title = Corticosteroids for pain relief in sore throat: systematic review and meta-analysis | journal = BMJ | volume = 339 | pages = b2976 | year = 2009 | pmid = 19661138 | pmc = 2722696 | doi = 10.1136/bmj.b2976 }} Their general use, however, is poorly supported.
• Viscous lidocaine relieves pain by numbing the mucous membranes.{{cite web |url=http://www.medicinenet.com/lidocaine_viscous/article.htm |title=LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions. |url-status=live |archive-url=https://web.archive.org/web/20100408065631/http://www.medicinenet.com/lidocaine_viscous/article.htm |archive-date=8 April 2010 |df=dmy-all }}
• Antibiotics are useful if a bacterial infection is the cause of the sore throat.{{cite journal|last1=Kocher|first1=JJ|last2=Selby|first2=TD|title=Antibiotics for sore throat.|journal=American Family Physician|date=1 July 2014|volume=90|issue=1|pages=23–4|pmid=25077497}}{{Cite journal |last1=Spinks |first1=Anneliese |last2=Glasziou |first2=Paul P. |last3=Del Mar |first3=Chris B. |date=2021-12-09 |title=Antibiotics for treatment of sore throat in children and adults |url= |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD000023 |doi=10.1002/14651858.CD000023.pub5 |issn=1469-493X |pmc=8655103 |pmid=34881426}} For viral infections, antibiotics have no effect. In the United States, they are used in 25% of people before a bacterial infection has been detected.{{cite journal|last1=Urkin|first1=J|last2=Allenbogen|first2=M|last3=Friger|first3=M|last4=Vinker|first4=S|last5=Reuveni|first5=H|last6=Elahayani|first6=A|title=Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases.|journal=Acta Paediatrica|date=November 2013|volume=102|issue=11|pages=1075–80|pmid=23879261|doi=10.1111/apa.12364|s2cid=24465793}}
• Oral analgesic solutions, the active ingredient is usually phenol, but also less commonly benzocaine, cetylpyridinium chloride, and/or menthol. Chloraseptic and Cepacol are two examples of brands of these kinds of analgesics.{{citation needed|date=August 2020}}

{{see also|Alternative treatments used for the common cold}}

Gargling salt water is often suggested, but there is no evidence to support or discourage this practice. Alternative medicines are promoted and used for the treatment of sore throats. However, they are poorly supported by evidence.{{cite web |url=http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10 |title=Sore throat: Self-care |publisher=Mayo Clinic |access-date=17 September 2007 |url-status=live |archive-url=https://web.archive.org/web/20070929153814/http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION%3D10 |archive-date=29 September 2007 |df=dmy-all }}

Acute pharyngitis is the most common cause of a sore throat and, together with cough, it is diagnosed in more than 1.9 million people a year in the United States.

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{{Medical resources

| DiseasesDB = 24580

| ICD11 = {{ICD11|CA02}}, {{ICD11|CA09.2}}

| ICD10 = {{ICD10|J|02||j|00}}, {{ICD10|J|31|2|j|30}}

| ICD9 = {{ICD9|462}}, {{ICD9|472.1}}

| ICDO =

| OMIM =

| MedlinePlus = 000655

| eMedicineSubj = emerg

| eMedicineTopic = 419

| MeshID = D010612

}}

{{Respiratory pathology}}

{{Common cold}}

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{{Use dmy dates|date=April 2018}}

Category:Infectious diseases

Category:Inflammations

Category:Upper respiratory tract diseases

Category:Gastrointestinal tract disorders

Category:Wikipedia medicine articles ready to translate

Category:Pharynx

Category:Wikipedia emergency medicine articles ready to translate

Category:Otorhinolaryngology