Pharyngitis
Encyclopedia
Pharyngitis is an inflammation
of the throat
or pharynx
. In most cases it is quite painful, and is the most common cause of 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
. Pharyngitis can result in very large tonsils which cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough
or fever
, for example, if caused by a systemic infection.
Most acute cases are caused by viral
infections (40–80%), with the remainder caused by bacteria
l infections, fungal
infections, or irritants such as pollutant
s or chemical substance
s. Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and anti-fungal respectively.
. It may be classified as acute or chronic. An acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the immune capacity of the affected individual. Chronic pharyngitis is the most common otolaringologic disease and may be catarrhal, hypertrophic or atrophic.
If the inflammation includes tonsillitis
, it is called pharyngotonsillitis. Another sub classification is nasopharyngitis (the common cold).
These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.
Bacterial
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
.
Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus (GAS). 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 and speed recovery.
Fusobacterium necrophorum
are normal inhabitants of the oropharyngeal flora. Occasionally however it can create a peritonsillar abscess
. In 1 out of 400 untreated cases Lemierre's syndrome
occurs.
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.
A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess
("quinsy"), submandibular space infection (Ludwig's angina), and epiglottitis
.
Fungal
Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush
.
and antipsychotic
s.
, an evidence-based peer-reviewed resource, recommends that they not be used to treat pharyngitis.
and is diagnosed in more than 1.9 million people a year in the United States.
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the throat
Throat
In vertebrate anatomy, the throat is the anterior part of the neck, in front of the vertebral column. It consists of the pharynx and larynx...
or pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
. In most cases it is quite painful, and is the most common cause of a sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
.
Like many types of inflammation, pharyngitis can be acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....
– characterized by a rapid onset and typically a relatively short course – or chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
. Pharyngitis can result in very large tonsils which cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
or fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, for example, if caused by a systemic infection.
Most acute cases are caused by viral
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
infections (40–80%), with the remainder caused by bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l infections, fungal
Fungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...
infections, or irritants such as pollutant
Pollutant
A pollutant is a waste material that pollutes air, water or soil, and is the cause of pollution.Three factors determine the severity of a pollutant: its chemical nature, its concentration and its persistence. Some pollutants are biodegradable and therefore will not persist in the environment in the...
s or chemical substance
Chemical substance
In chemistry, a chemical substance is a form of matter that has constant chemical composition and characteristic properties. It cannot be separated into components by physical separation methods, i.e. without breaking chemical bonds. They can be solids, liquids or gases.Chemical substances are...
s. Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and anti-fungal respectively.
Classification
Pharyngitis is a type of inflammation, most commonly caused by an upper respiratory tract infectionUpper respiratory tract infection
Upper respiratory tract infections are the illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx...
. It may be classified as acute or chronic. An acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the immune capacity of the affected individual. Chronic pharyngitis is the most common otolaringologic disease and may be catarrhal, hypertrophic or atrophic.
If the inflammation includes tonsillitis
Tonsillitis
Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics...
, it is called pharyngotonsillitis. Another sub classification is nasopharyngitis (the common cold).
Cause
The majority of cases are due to an infectious organism acquired from close contact with an infected individual.Infectious
ViralThese comprise about 40–80% 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 nodeLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
enlargement is modest and the throat often does not appear red, although it is very painful. - OrthomyxoviridaeOrthomyxoviridaeThe Orthomyxoviridae are a family of RNA viruses that includes five genera: Influenzavirus A, Influenzavirus B, Influenzavirus C, Isavirus and Thogotovirus. A sixth has recently been described...
which cause influenzaInfluenzaInfluenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
– present with rapid onset high temperature, headache and generalised ache. A sore throat may be associated. - Infectious mononucleosisInfectious mononucleosisInfectious mononucleosis is an infectious, widespread viral...
("glandular fever") caused by the Epstein-Barr virusEpstein-Barr virusThe Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
. 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 virusHerpes simplex virusHerpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
can cause multiple mouth ulcers. - MeaslesMeaslesMeasles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
- Common coldCommon coldThe common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
: rhinovirusRhinovirusHuman rhinoviruses are the most common viral infective agents in humans and are the predominant cause of the common cold. Rhinovirus infection proliferates in temperatures between 33–35 °C , and this may be why it occurs primarily in the nose...
, coronavirusCoronavirusCoronaviruses are species in the genera of virus belonging to the subfamily Coronavirinae in the family Coronaviridae. Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. The genomic size of coronaviruses ranges from approximately 16 to 31...
, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme pain.
Bacterial
A number of different bacteria can infect the human throat. The most common is Group A streptococcus, however others include Corynebacterium diphtheriae
Corynebacterium diphtheriae
Corynebacterium diphtheriae is a pathogenic bacterium that causes diphtheria. It is also known as the Klebs-Löffler bacillus, because it was discovered in 1884 by German bacteriologists Edwin Klebs and Friedrich Löffler .-Classification:Four subspecies are recognized: C. diphtheriae mitis, C....
, Neisseria gonorrhoeae
Neisseria gonorrhoeae
Neisseria gonorrhoeae, also known as gonococci , or gonococcus , is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.N...
, Chlamydophila pneumoniae
Chlamydophila pneumoniae
Chlamydophila pneumoniae is a species of Chlamydophila, an obligate intracellular bacteria that infects humans and is a major cause of pneumonia....
, and Mycoplasma pneumoniae
Mycoplasma pneumoniae
Mycoplasma pneumoniae is a very small bacterium in the class Mollicutes.It causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia, and is related to cold agglutinin disease.-Cell wall/Treatment:...
.
- Streptococcal pharyngiti
Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus (GAS). It is the most common bacterial cause of cases of pharyngitis (15–30%). Common symptoms include fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
, 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 and speed recovery.
- Fusobacterium necrophoru
Fusobacterium necrophorum
Fusobacterium necrophorum
Fusobacterium necrophorum is the species of Fusobacterium that is responsible for Lemierre's syndrome, and appears to be responsible for 10% of all acute sore throats, 21% of all recurring sore throats, and 23% of peritonsillar abscesses with the remainder being caused by Group A streptococci or...
are normal inhabitants of the oropharyngeal flora. Occasionally however it can create a peritonsillar abscess
Peritonsillar abscess
Peritonsillar abscess , also called a quinsy or abbreviated as PTA is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil .-Symptoms and signs:...
. In 1 out of 400 untreated cases Lemierre's syndrome
Lemierre's syndrome
Lemierre's syndrome is a form of thrombophlebitis usually caused by the bacterium Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium and usually affects young, healthy adults...
occurs.
- Diphtheri
Diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
is a potentially life threatening upper respiratory infection caused by Corynebacterium diphtheriae
Corynebacterium diphtheriae
Corynebacterium diphtheriae is a pathogenic bacterium that causes diphtheria. It is also known as the Klebs-Löffler bacillus, because it was discovered in 1884 by German bacteriologists Edwin Klebs and Friedrich Löffler .-Classification:Four subspecies are recognized: C. diphtheriae mitis, C....
which has been largely eradicated in developed nations since the introduction of childhood vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
programs, but is still reported in the Third World
Third World
The term Third World arose during the Cold War to define countries that remained non-aligned with either capitalism and NATO , or communism and the Soviet Union...
and increasingly in some areas in Eastern Europe
Eastern Europe
Eastern Europe is the eastern part of Europe. The term has widely disparate geopolitical, geographical, cultural and socioeconomic readings, which makes it highly context-dependent and even volatile, and there are "almost as many definitions of Eastern Europe as there are scholars of the region"...
. Antibiotics are effective in the early stages, but recovery is generally slow.
- Other
A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess
Peritonsillar abscess
Peritonsillar abscess , also called a quinsy or abbreviated as PTA is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil .-Symptoms and signs:...
("quinsy"), submandibular space infection (Ludwig's angina), and epiglottitis
Epiglottitis
Epiglottitis is an inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea . Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency...
.
Fungal
Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush
Oral candidiasis
Oral candidiasis is an infection of yeast fungi of the genus Candida on the mucous membranes of the mouth. It is frequently caused by Candida albicans, or less commonly by Candida glabrata or Candida tropicalis...
.
Non-infectious
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 pramipexolePramipexole
Pramipexole is a non-ergoline dopamine agonist indicated for treating early-stage Parkinson's disease and restless legs syndrome...
and antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
s.
Diagnostic approach
It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone. Thus often a throat swab is done to rule out a bacterial cause.Management
The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, fungal, and herpes simplex infections.Medications
- Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat.
- SteroidSteroidA steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s (such as dexamethasoneDexamethasoneDexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant...
) have been found to be useful for severe pharyngitis. - Viscous lidocaineLidocaineLidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
relieves pain by numbing the mucus membranes. - AntibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s are useful if group A streptococcus is the cause of the sore throat. For viral infections, antibiotics have no effect.
Alternative
Alternative medicines are promoted and used for the treatment of sore throats. They are however poorly supported by evidence, and UpToDateUpToDate
UpToDate is an evidence based, peer reviewed medical information resource published by a medical company called UpToDate, Inc. It is available both via the Internet and offline on personal computers or a PDA. An update is published every four months....
, an evidence-based peer-reviewed resource, recommends that they not be used to treat pharyngitis.
Epidemiology
Acute pharyngitis is the most common cause of a sore throatSore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
and is diagnosed in more than 1.9 million people a year in the United States.