Pharyngitis

What is Pharyngitis?

Pharyngitis is a condition where the mucus linings of the throat get inflamed. Typically, it’s caused by an infection, which could be either bacterial or viral. However, there are other uncommon causes like allergies, physical injuries, cancer, acid reflux, and exposure to harmful substances.

What Causes Pharyngitis?

When people have a sore throat, also known as pharyngitis, typically 50% to 80% of the cases are caused by viruses such as the common cold, the flu, adenoviruses, coronaviruses, and parainfluenza. Other, less frequent, viral causes can include herpes, Epstein-Barr virus, HIV, and coxsackievirus. The severity of the condition may increase in cases that start with a viral infection and then develop into a bacterial one.

The most frequent bacterial cause of a sore throat is a type called Group A beta-hemolytic streptococci, leading to 5% to 36% of sore throats. Other less common bacterial causes include Group B and C streptococci, Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Candida, Neisseria meningitidis, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Fusobacterium necrophorum, and Corynebacterium diphtheriae. Environmental allergies and exposure to certain chemicals may also result in a sore throat.

Symptoms of a sore throat can also be a part of more serious illnesses. These can include a peritonsillar abscess, retropharyngeal abscess, inflammation of the epiglottis (epiglottitis), and Kawasaki disease, a rare condition that primarily affects children and involves inflammation of the blood vessels.

Risk Factors and Frequency for Pharyngitis

In 2010, there were many emergency room visits relating to pharyngitis, with a large portion of them being for young patients. It’s worth noting that while adults can also suffer from pharyngitis, it’s less common. Globally, the occurrence of pharyngitis is particularly high, especially in regions where antibiotics are commonly overused.

• In 2010, 1.814 million visits to the emergency department for pharyngitis were recorded.
• 692,000 of those were patients under the age of 15.
• Pharyngitis most commonly affects children under the age of 5.
• Adults can get pharyngitis, but it’s less frequent.
• High rates of pharyngitis are found worldwide, particularly in areas with over-prescription of antibiotics.

Signs and Symptoms of Pharyngitis

When a person goes to the doctor, they might ask about signs that the person might have uncomplicated pharyngitis, also known as an irritated or inflamed throat, while also ruling out other serious conditions. Common signs for this are things like a fever, white spots on the tonsils, painful swelling in the neck, redness in the throat, and ear pain. This kind of simple throat infection, whether from a bacteria or virus, usually clears up on its own within 5 to 7 days. It’s not a condition that gets worse over time, affects both sides of the throat, and doesn’t cause locked jaw or difficulty in breathing.

If the infection is viral, a person might also experience additional symptoms like coughing, runny nose, red eyes, headaches, and a rash. In contrast, bacterial throat infection due to the Group A Streptococcus bacteria usually starts suddenly, and it doesn’t have any signs associated with a common cold like a cough or runny nose. Instead, it’s linked with a fever, white spots on the tonsils, and swelling of the neck lymph nodes. Another kind of throat infection caused by the Epstein-Barr virus, known as infectious mononucleosis, can lead to symptoms like fever, enlarged tonsils, an increase in lymphocytes, unusual lymphocytes, headache, muscle pain and fatigue. It can cause both front and back neck swelling and may result in enlarged liver or spleen. People infected with infectious mononucleosis can experience fatigue and swelling of lymph nodes for up to 3 weeks. If a person has a rash after taking amoxicillin for Group A Streptococcus infection, it might be a sign of mononucleosis.

Other illnesses can also show signs in the throat. For instance, a retropharyngeal abscess, which is a deep tissue infection at the back of the throat, has symptoms like neck stiffness and pain when moving the neck. Epiglottitis, a severe and life-threatening condition which affects the windpipe, is often indicated by symptoms of stridor, a harsh vibrating noise when breathing. Lemierre’s syndrome, caused by the bacterium F. necrophorum, happens as a result of a throat infection spreading and causing blood clot in the internal jugular vein. If the patient has engaged in oral sexual contact, doctors might consider N. gonorrhoeae infection. Acute retroviral syndrome due to HIV might present with fever and non-exudative pharyngitis, which is a sore throat without any fluid or pus.

Testing for Pharyngitis

Certain rules and guidelines have been established to better diagnose and treat Group A beta-hemolytic streptococcal sore throat (also known as strep throat). One of the most widely used ones, especially for adults, is the Centor Score.

The Centor Criteria awards 1 point for each of the following:
1. Pus on the tonsils
2. Tender lymph nodes on the front left side of your neck
3. A history of fever
4. No cough present

This criteria is most valuable for individuals aged 5 to 15 years old, but not suitable for children under 3 years old.

Depending on the total score obtained from the criteria, the following actions are recommended:

* 0-1: No need for further tests or antibiotics
* 2-3: A quick antigen test (a test to detect certain proteins) is suggested
* 4: Start antibiotics without further tests

Counting white blood cells, usually used to indicate an infection, doesn’t really help tell apart a viral from a bacterial throat infection. However, an increase in certain types of white blood cells might indicate a different condition, called infectious mononucleosis.

The quick antigen tests are specific to Group A beta-hemolytic streptococci (the bacteria causing strep throat), but their quality varies. If positive, treatment should start. If negative, especially in children, a throat swab should be done to culture bacteria and guide treatment.

Throat cultures have been the go-to method for diagnosing strep throat, but their reliability can be influenced by several factors, such as the amount of bacteria, where the sample is taken from, and how the culture is carried out.

The monospot test, which can diagnose infectious mononucleosis, has variable reliability. Other factors like when the sample was taken and the patient’s age can also impact the test results.

If gonorrhea (a sexually transmitted infection) or candida (a fungal infection) is suspected, specific cultures can be done.

Normally, an X-ray of the chest is not needed. If there’s a concern that the airway might be affected, an X-ray of the neck should be done. A CT scan could be beneficial to find an abscess (a pocket of pus) around the tonsils.

Treatment Options for Pharyngitis

Pharyngitis, or inflammation of the throat, is often caused by Group A beta-hemolytic streptococcal bacteria. Antibiotics are generally prescribed for these patients, which can help to shorten the duration of symptoms by about a day, and also prevent a serious complication, rheumatic fever. Rheumatic fever is a rare condition that can develop from untreated strep throat, affecting about 1 in 400 people.

Antibiotics should only be used if the patient tests positive for Group A beta-hemolytic streptococci, particularly in children. This can be determined through a throat culture or a rapid antigen detection test. The standard treatment is a 10-day course of penicillin taken orally, which is known to completely eliminate the bacteria and prevent rheumatic fever.

There are several alternatives to penicillin for treating Group A beta-hemolytic streptococcal pharyngitis. These include oral amoxicillin, cephalosporins, macrolides, and clindamycin. Penicillin can also be administered through an injection. However, azithromycin and clarithromycin are not first-choice antibiotics for this condition, as there’s a risk that the bacteria could develop resistance to them. If a patient has a mild penicillin allergy, they can be treated with cephalosporins. For those with a severe penicillin allergy, azithromycin or clindamycin are appropriate options. Once the patient has been taking antibiotics for 24 hours, their condition is no longer infectious.

In some cases, a single dose of corticosteroids such as dexamethasone may be given to lessen the severity of symptoms, though there isn’t much evidence to support this treatment. Patients are also encouraged to gargle and take over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs. However, these should be used carefully in severely dehydrated patients. For those with infectious mononucleosis, or “mono”, participation in contact sports should be avoided for about a month and a half to two months to avoid risking a ruptured spleen.

What else can Pharyngitis be?

When trying to find the cause of things like a stuffy or a runny nose, a doctor could be looking for a number of different conditions. These might include:

• Conditions that block your airway
• Allergies that affect your nose (allergic rhinitis)
• Various types of nasal or neck cancers
• Acid reflux disease (GERD)
• An abscess around your tonsils (Peritonsillar abscess)
• A serious bacterial infection known as diphtheria
• Inflamed epiglottis which is a flap of tissue that sits at the base of the tongue (Epiglottitis)
• Herpes – a viral infection
• Mononucleosis also known as the “kissing disease”

Since these conditions have similar symptoms, it can be challenging to diagnose the exact cause of discomfort. Doctors would have to conduct different tests to determine the underlying issue accurately.

What to expect with Pharyngitis

In general, people with pharyngitis, an infection in the throat, typically get better on their own within 5 to 7 days, so the outlook is generally good. However, the situation is different in developing countries where over 20 million people get affected by a bacterium called group A streptococcus and can develop a disease named acute rheumatic fever, which often leads to death in young individuals.

Deaths from pharyngitis itself are pretty rare, but they can happen if the infection blocks the airways. Usually, most pharyngitis cases get better within 7 to 10 days. However, sometimes the treatment doesn’t work. This could be because the bacteria are resistant to the antibiotics, the patient isn’t taking their medicine as directed, or people close to them also got the infection and weren’t treated.

Possible Complications When Diagnosed with Pharyngitis

Bacterial pharyngitis, or a throat infection caused by bacteria, can lead to various complications including:

• Epiglottitis: inflammation of the flap at the base of the tongue
• Otitis media: an infection in the middle ear
• Mastoiditis: an infection in the mastoid bone of the skull
• Sinusitis: infection or inflammation of the sinuses
• Acute rheumatic fever: an inflammatory disease that can develop after strep throat
• Post-streptococcal glomerulonephritis: a kidney disease that can happen after strep throat
• Toxic shock syndrome: a rare life-threatening condition caused by certain types of bacterial infections

Recovery from Pharyngitis

If someone in your household has an infection caused by group A streptococci bacteria, they should be given a full 10-day course of antibiotics without any previous testing, but only if they are showing symptoms. People in the household who don’t have any symptoms don’t need treatment.

Preventing Pharyngitis

It’s important to inform patients and parents about the distinction between bacterial and viral sore throats. If a patient has been diagnosed with an infection caused by ‘group A streptococcus’ bacteria, they should make sure to finish all of their prescribed antibiotics. This is to avoid the development of a serious heart condition known as rheumatic heart disease.

On the other hand, patients with viral sore throats need to understand that antibiotics won’t help them. Instead, they can use over-the-counter medicines to relieve their symptoms. This approach will avoid overuse of antibiotics – a practice that can lead to bacteria developing resistance to these drugs.

Finally, it’s crucial for all individuals with a sore throat to practice good hygiene like regular hand-washing, getting enough rest, and staying well-hydrated. These habits promote better recovery and overall health.