sore throat

Definition

Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza. Sore throat may be caused by either viral or bacterial infections or environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent.

Sore throats can be either acute or chronic. Acute sore throats are the more common. They appear suddenly and last from three to about seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

— Tish Davidson

Definition

Sore throat, also called pharyngitis, is a painful inflammation of the back of the throat. It is a symptom of many conditions, but most often is associated with colds or influenza. Sore throat may be caused by either viral or bacterial infections or by environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) and influenza are more frequent.

Sore throats can be either acute or chronic. Acute sore throats are the more common. They may appear suddenly and last approximately three to about seven days. A chronic sore throat that is still present after three weeks may be a symptom of an unresolved underlying condition or disease, such as a sinus infection or mononucleosis.

Causes & Symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever, or swollen lymph glands. Proper treatment depends on identifying the cause.

Viral Sore Throat

Viruses cause 90–95% of all sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis). Cold symptoms usually accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, fever, and swollen lymph nodes in the neck. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection may include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age 10 and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is usually accompanied by a fever usually between 102–104°F (38.9–40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may easily become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

Another common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection may spread to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30–50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common in young adults. It is estimated that by the age of 35–40, 80–95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing.

Bacterial Sore Throat

From 5–10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat, or GABHS pharyngitis. The acronym stands for "Group A beta-hemolytic streptococci." Anyone can get strep throat, but it is most common in school age children. Since three is a low risk of strep throat invading and damaging heart valves (rheumatic fever), it is important to see a doctor who may prescribe antibiotics to eliminate the risk.

Pharyngeal gonorrhea, a sexually transmitted bacterial disease, causes a severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious Sore Throat

Not all sore throats are caused by infection. Post-nasal drip from allergies and airborne irritants can cause sore throat. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to diagnose its cause without seeing a doctor and having laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats develop into serious diseases. It is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throats are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

One test that doctors are using more often in diagnosing a sore throat is the rapid antigen test. While a throat culture may require 2 days for the laboratory to identify the causative organism, a rapid antigen test gives results in a few hours.

If mononucleosis is suspected, the doctor may do a Monospot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test in inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient, viral sore throat is best left to run its course without drug treatment. Antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Treatment uses antiviral plants and herbs and vitamins to boost immunity and speed recovery.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eycalyptus globulus), sage (Salvia officinalis), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and turmeric (Curcuma longa) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri) internally for infection, or drinking ginger (Zingiber officinale) or slippery elm (Ulmus fulva) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, or Phytolacca, yellow jasmine (Gelsemium), or mercury (Mercurius).
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment. In the case of chronic sore throat in a child, the doctor may recommend a tonsillectomy (surgical removal of the tonsils).

Home Care for Sore Throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• Gargling with warm double strength tea or warm salt water made by adding one teaspoon of salt to 8 oz of water.
• Drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat. Sucking on popsicles is a good way to get fluids into children.
• Eating soft, nutritious foods like noodle soup and avoiding spicy foods.
• Refraining from smoking.
• Resting until the fever is gone, then resuming strenuous activities gradually.
• A room humidifier may make sore throat sufferers more comfortable.
• Antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Allopathic Treatment

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. Stopping the antibiotic early can lead to a return of the sore throat. Sometimes a single injection of long-acting penicillin G is given instead of 10 days of oral treatment. These medications generally cost under $15.

Because mononucleosis is caused by a virus, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports, and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) are the prescribed treatments. Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

Aspirin should not be given to children because of its association with increased risk for Reye's Syndrome, a serious disease.

Expected Results

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long lasting symptoms. Adults may take up to six months to recover. In all age groups fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever, kidney damage, or rheumatic fever. Scarlet fever causes a rash, and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• Washing hands with warm water and soap frequently.
• Maintaining a balanced life with adequate sleep, nutrition, and personal fulfillment.
• Avoiding close contact with someone who has a sore throat.
• Not sharing food and eating utensils with anyone.
• Not smoking.
• Optimizing the functioning of the immune system by exercising and eating such immune-boosting foods as carrots, yams, shiitake mushrooms, etc.
• Avoiding sources of air pollution.

Resources

Book

Berkow, Robert. The Merck Manual of Diagnosis and Therapy Rahway, NJ: Merck Research Laboratories, 1992.

Periodicals

Larkin, Marilynn. "A Single, Rapid Test Suffices for Pharyngitis Diagnosis in High-Risk Patients." Lancet 358 (December 8, 2001): 1969.

National Institute of Allergy and Infectious Diseases. Infectious Mononucleosis Fact Sheethttp://www.niaid.nih.gov/factsheets/infmono.htm (September 1997).

[Article by: Kathleen Wright; Rebecca J. Frey, PhD]

Definition

Sore throat is a painful inflammation of the mucous membranes lining the pharynx.

Description

Sore throat is also called pharyngitis. It is a symptom of many conditions, but is most often associated with colds or influenza. Sore throat may be caused by either viral or bacterial infections or environmental conditions. Most sore throats heal without complications, but they should not be ignored, as some develop into serious illnesses.

Sore throats can be either acute or chronic. Acute sore throats are more common than chronic sore throats. They appear suddenly and last from three to about seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Transmission

The way in which a sore throat is transmitted depends on the agent causing the sore throat. Viral and bacterial sore throats are usually passed in the same way as the common cold: sneezing, coughing, sharing drinking glasses or silverware, or in any other way germ particles can easily move from one person to another. Some sore throats are caused by environmental factors or allergies. These sore throats cannot be passed from one person to another.

Demographics

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent.

About 10 percent of children who go to the doctor each year have pharyngitis. Forty percent of the time that children are taken to the doctor with a sore throat, the sore throat is diagnosed as viral. An antibiotic cannot help to cure a virus; a virus has to be left to run its course.

In about 30 percent of the cases for which children are taken to the doctor, bacteria are found to be responsible for the sore throat. Many of these bacterial sore throats are cases of strep throat. Sore throats caused by bacteria can be successfully treated with antibiotics. In about 40 percent of these cases of pharyngitis, it is never clear what caused the sore throat. In these cases it is possible that the virus or bacteria was not identified, or that other factors such as environment or post-nasal drip may have been responsible.

Causes and Symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever, or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral Sore Throat

Viruses cause most sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis). Cold symptoms usually accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that causes sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age 10 and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the coxsackie virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever, usually between 102–104°F (38.9–40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, children with herpangina may vomit, have abdominal pain, and generally feel very ill.

One other common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection spreads to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30–50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common. It is estimated that by the age of 35–40, 80–95 percent of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test.

Bacterial Sore Throat

Fewer sore throats are caused by bacteria than are caused by viruses. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat. Anyone can get strep throat, but it is most common in school age children.

Noninfectious Sore Throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as breathing secondhand smoke, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. Children who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

When to Call the Doctor

If the child has had a sore throat and fever for more than 24 hours, a doctor should be contacted so a strep test can be performed. Identifying and treating strep throat within about a week is vital to preventing rheumatic fever. If the child has had a sore throat, even without fever, for more than 48 hours, the doctor should be consulted. If the child has trouble swallowing or breathing, or is drooling excessively (in small children), emergency medical attention should be sought immediately.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throat are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The strep test is inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. Viral sore throats are best left to run their course without drug treatment, because antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication, although other antibiotics are also effective if the child is allergic to penicillin. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. If it is unlikely that the parent will be able to ensure that the child will take the full course of antibiotics, a one-time injection of antibiotics can be administered instead. Cessation of the antibiotic early can lead to a return of the sore throat.

Because a virus causes mononucleosis, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports, and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) will help the illness pass. Nearly 90 percent of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home Care for Sore Throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• taking acetaminophen or ibuprofen for pain (aspirin should not be given to children because of its association with increased risk for Reye's syndrome, a serious disease)
• gargling with warm double strength tea or warm salt water made by adding 1 tsp of salt to 8 oz (237 ml) of water
• drinking plenty of fluids, but avoiding acid juices such as orange juice, which can irritate the throat (sucking on popsicles is a good way to get fluids into children)
• eating soft, nutritious foods like noodle soup and avoiding spicy foods
• resting until the fever is gone, then resuming strenuous activities gradually
• using a room humidifier to make sore throat sufferers more comfortable
• using antiseptic lozenges and sprays with caution, as they may aggravate the sore throat rather than improve it

Alternative Treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of the essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eucalyptus globulus), sage (Salvia officinalis), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and tumeric (Curcuma longa) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri) internally for infection or drinking ginger (Zingiber officinale) or slippery elm (Ulmus fulva) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, Phytolacca, or yellow jasmine (Gelsemium).

Nutritional Concerns

Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements. Although it may hurt to swallow, it is very important that the child does not become dehydrated. Sucking on popsicles or drinking warm broth can help. If the child shows any signs of dehydration he or she should be taken to the doctor.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children, the symptoms may last only a week, but in adolescents the symptoms usually last longer. In all age groups, fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the individual should seek emergency medical care immediately.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever, kidney damage, or rheumatic fever. Scarlet fever causes a rash and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until they have taken antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• washing hands well and frequently
• avoiding close contact with someone who has a sore throat
• not sharing food and eating utensils with anyone
• staying out of polluted air

Parental Concerns

Viral sore throats usually resolve themselves fairly quickly although they may be very uncomfortable. If the child has a fever and sore throat for more than 24 hours it may be a sign of a bacterial infection and the child should be taken to the doctor. Prompt treatment with antibiotics for strep throat is important because it can prevent rheumatic fever, a serious disease that can cause damage to the heart.

See also Common cold.

Resources

Periodicals

"Coughs, Colds, and Sore Throat." Practice Nurse v.26, i.2 (July 25, 2003): 38.

Dinelli, D.L. "Sore Throat and Difficulty Breathing." American Family Physician 63, no. 11 (June 1, 2001): 2255.

"Sore Throat." The Journal of the American Medical Association 291, no. 13 (April 7, 2004): 1664.

Vincent, Miriam T., Celestin, Nadhia, Hussain, Aneela N. "Pharyngitis." American Family Physician 69, no. 6 (March 15, 2004): 1465.

[Article by: Tish Davidson, A.M.]

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

"Sore throat" redirects here. For other uses, see Sore throat (disambiguation).

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

Classification

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

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]}

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

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]

Streptococcal pharyngitis

Main article: 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]}

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]}

Other causes

Candida albicans

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

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]}

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]

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.

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]

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]}

Alternative treatments

See also: Alternative treatments used for the common cold

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]

External links

• Remedies Sore Throat

References

1. ^ pharyngitis at Dorland's Medical Dictionary
2. ^ ^{a b} "eMedicine - Pharyngitis : Article by John R Acerra". http://www.emedicine.com/emerg/TOPIC419.HTM. 
3. ^ ^{a b} Bisno AL (January 2001). "Acute pharyngitis". N. Engl. J. Med. 344 (3): 205–11. PMID 11172144. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11172144&promo=ONFLNS19. 
4. ^ Del Mar C (1992). "Managing sore throat: a literature review. I. Making the diagnosis". Med. J. Aust. 156 (8): 572–5. PMID 1565052. 
5. ^ ^{a b c} Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html.  - Meta-analysis of published research
6. ^ Ohlsson A, Clark K (2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ 171 (7): 721. doi:10.1503/cmaj.1041275. PMID 15451830. http://www.cmaj.ca/cgi/content/full/171/7/721. 
7. ^ Danchin MH, Curtis N, Nolan TM, Carapetis JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". Med. J. Aust. 177 (9): 512–5. PMID 12405896. http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html. 
8. ^ Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]" (in Polish). Wiad. Lek. 54 (1-2): 56–63. PMID 11344703. 
9. ^ "UpToDate Inc.". http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result. 
10. ^ Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract 50 (459): 817–20. PMID 11127175. PMC 1313826. http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=50&issue=459&spage=817&aulast=Thomas. 
11. ^ PMID 19661138
12. ^ "BestBets: Do Steroids Reduce Symptoms in Acute Pharyngitis". BestBets.org. http://www.bestbets.org/bets/bet.php?id=740. Retrieved 2009-01-14. 
13. ^ http://www.medicinenet.com/lidocaine_viscous/article.htm
14. ^ ^{a b} "Sore throat: Self-care - MayoClinic.com". http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10. Retrieved 2007-09-17. 
15. ^ "UpToDate Inc.". Uptodate. http://www.uptodate.com/online/content/topic.do?topicKey=c_health/6691. 

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)

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)