Pharyngitis Disease

DESCRIPTION

Inflammation of the pharynx most commonly caused by acute infection. Group A streptococcus is a focus of diagnosis due to its potential for preventable rheumatic sequelae. Chronic low grade symptoms usually related to reflux disease or vocal abuse.

System(s) affected: Gastrointestinal
Genetics: Individuals with a positive family history of rheumatic fever have a higher risk of rheumatic sequelae following an untreated group A beta hemolytic streptococcal infection
Incidence/Prevalence in USA:
- Estimated 30 million cases diagnosed yearly
- 11% of all school-age children visit a physician annually with pharyngitis
- 12–25% of sore throats seen by physicians
- Incidence of rheumatic fever is decreasing, with an estimate of 64 cases per 100,000
Predominant age:
- Pharyngitis occurs in all age groups
- Streptococcal infection has the greatest incidence from 5 to 18 years of age
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Sore throat
Enlarged tonsils
Pharyngeal erythema
Tonsillar exudates
Soft palate petechiae
Cervical adenopathy
Absence of cough, hoarseness, or lower respiratory symptoms
Fever (> 102.5°F [39.1°C] suggests Streptococcus)
Scarlet fever rash: punctate erythematous macules with reddened flexor creases and circumoral pallor (streptococcal pharyngitis)
Gray pseudomembrane found in diphtheria and occasionally in mononucleosis
Characteristic erythematous-based clear vesicles in herpes stomatitis
Anorexia
Chills
Malaise
Headache
Conjunctivitis, more commonly with adenovirus infections

CAUSES

Acute – bacterial:
- Group A beta-hemolytic streptococci
- Neisseria gonorrhoeae
- Corynebacterium diphtheriae (diphtheria)
- Haemophilus influenzae
- Moraxella (Branhamella) catarrhalis
- Group C and G streptococcus (rarely)
Acute – viral:
- Rhinovirus
- Adenovirus
- Parainfluenza virus
- Coxsackievirus
- Coronavirus
- Echovirus
- Herpes simplex virus
- Epstein–Barr virus (mononucleosis)
- Cytomegalovirus
Chronic
- More likely non-infectious
- Irritation from post-nasal discharge of chronic allergic rhinitis or reflux
- Chemical irritation or smoking
- Neoplasms and vasculitides

RISK FACTORS

Group A beta-hemolytic streptococcal epidemics occur
Age (young are more susceptible)
Family history
Close quarters, such as in new military recruits
Immunosuppression
Fatigue
Smoking
Excess alcohol consumption
Oral sex
Diabetes mellitus
Recent illness

LABORATORY

Blood agar throat culture from swab. Bacitracin disc sensitivity of hemolytic colonies suggests group A streptococci.
Rapid screening for streptococci can be done from throat swab with antigen agglutination kits. A 5–10% false-negative rate leads some to suggest routine backup of all negatives with blood agar culture.
Leukocytosis (if bacterial)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Culture of pathogens to identify causes

SPECIAL TESTS

Special tests usually done only if history is suggestive
Screening for gonococcal infection requires a warm Thayer–Martin plate
Viruses can be cultured in special media
Monospot test for Epstein–Barr virus
Gram stain can be suggestive
Streptococcal isolates can be immunologically typed

IMAGING

N/A

DIAGNOSTIC PROCEDURES

History and physical probably only 50% accurate. Laboratory required unless in epidemic setting.

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Salt water gargles
Acetaminophen
Dyclonine lozenges
Cool-mist humidifier

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated

DIET

No restrictions. Encourage extra fluids.

PATIENT EDUCATION

Important to complete a 10-day course of antibiotics regardless of symptom response
Patients are presumed to be non-infectious after 24 hours of antibiotic coverage

PREVENTION/AVOIDANCE

Avoid contact with infected people

POSSIBLE COMPLICATIONS

Rheumatic fever
Post-streptococcal glomerulonephritis
Peritonsillar abscess
Systemic infection
Otitis media
Mastoiditis
Septicemia
Rhinitis
Sinusitis
Pneumonia

EXPECTED COURSE AND PROGNOSIS

Streptococcal pharyngeal infection runs a 5–7 day course with a peak of fever at 2–3 days
Symptoms will resolve spontaneously without treatment, but rheumatic complications are still possible
Suppurative complications such as peritonsillar abscess require surgical intervention

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Unless clinical presentation is unusual, treatment is based on presence or absence of group A streptococci

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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