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  Pharyngitis

Pharynx is the medical term for throat. Inflammation of the throat is termed as phayrngitis. Viral infection comprises 90% of pharyngitis while the rest is caused by bacteria and in rare cases, oral thrush (oral candidiasis). Among the bacterial causes, the streptococcal group is the most common etiologic agent. In some cases of pharyngitis, irritations from environmental exposure to agents such as pollutants, chemicals, or smoke are the culprit. Majority of pharyngitis cases occurs as part of a viral upper respiratory tract infection (URTI). It may also be symptom in a number of diseases namely: diphtheria caused by Corynebacterium diphtheriae, infectious mononucleosis caused by Epstein-Barr virus and acute HIV infection.

Pharyngitis Inflammation of the pharynx
Pharyngitis


Viral upper respiratory tract infection that produces postnasal drip namely the coryza (common cold) and seasonal or perennial allergies are the most common causes of sore throat (pharyngitis). As mentioned above, 90% of all infectious cases of pharyngitis is viral in origin and some of the viral groups involved are the following: Adenovirus, the most common of the viral causes which manifests typically as moderate degree of cervical lymphadenopathy (lymph node enlargement along the neck area) and a very painful but a non-erythematous (not reddish) throat; Orthomyxoviridae, the group causing influenza which clinically present as rapid onset high grade fever with accompanying headache and generalized body aches aside from sore throat; Epstein-Barr virus causing infectious mononucleosis which clinically manifests as significant swelling of lymph gland and tonsils with exudates(pus) and a markedly red and swollen throat; this type of viral infection is positive for the heterophile test ; Herpes simplex virus causing mouth ulcers and the Rubeola (measles) group.

Among the bacterial causes of pharyngitis, the Group A Streptococcus is the most common bacterial agent. Unlike the viral causes, there is a tendency to find more generalized symptoms and signs. Typical signs and symptoms with “strep throat” include the following: enlarged and tender neck lymph nodes, with bright red and swollen throat, high temperature, headache, myalgia (muscle aches) and arthralgia (joint pains). Repeated bouts of untreated strep throat may lead to complications namely: acute rheumatic fever that may lead to heart problem known as rheumatic heart disease; scarlet fever; quinsy or peritonsillar abscess (a long standing infection of the tonsils and its connective tissues) and acute post-streptococcal glomerulonephritis (APSGN), a kidney disease. The tonsils may likewise grow excessively known as “kissing tonsils” or hypertrophied tonsils even without infection which can possibly lead to obstructive sleep apnea (OSA). Other bacterial causes include organisms such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Neisseria gonorrhea.

The prevalence rate of sore throat increases during winter or cold months when the viral respiratory disease incidence is highest. The incidence rate of sore throat is highest among children between the ages of 5 and 18 and rare cases occur in children younger than 3 years old. Infection is transmitted by direct person-to-person contact.

Several risk factors are associated with pharyngitis which includes coughing, inhalation of pollutants, seasonal allergies, smoking and second-hand or passive smoking.

Basically, same with the aforementioned findings, upon physical examination the throat often appears red, swollen and may have white spots known as purulent exudate (pus) accompanied by enlarged, swollen tonsils with firmly adherent whitish or grayish exudates. These findings are accompanied commonly by fever, cough, itchy throat, dysphagia (difficulty in swallowing) and odynophagia (painful swallowing). The cervical lymph nodes may become swollen and tender on palpation. Severe pharyngitis associated with Corynebacterium diphtheriae and infectious mononucleosis can lead to airway obstruction and may even progress to infection of the lower respiratory tract as well.

Diagnosis is made clinically usually by examining the throat, observation of its gross appearance, and palpating the neck for swollen lymph nodes. Because viral and bacterial pharyngitis may have similar gross findings or appearance, a throat culture is often necessary to detect if bacteria is present. The throat culture is obtained by throat swab (using an applicator stick with cotton on its tip). The sample is sent to a laboratory for throat swab culture and analysis. Another diagnostic procedure is a rapid strep test but the results of this test are not very reliable and a negative result must be confirmed by culture to rule out a false negative result. This rapid strep test may be performed and analyzed in the physician's clinic set-up and the results are usually available in about 15 minutes.

Sore throat associated with viral URI is a self-limiting condition and usually resolves spontaneously without medication. Warm salt-water gargling and taking acetaminophen may relieve pain and reduce the swelling and inflammation. However, bacterial pharyngitis is treated with antibiotics to kill the bacteria and prevent progression of the condition and avoid complications. For chronically infected tonsils, a tonsillectomy (surgical removal of the tonsils) may need to be performed.

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