Pharyngitis

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In medicine, pharyngitis is an upper respiratory tract infection that is "inflammation of the throat (pharynx)."[1]

Causes

Viral

The majority of pharyngtis is caused by viral infection.

Bacterial

Group A β-hemolytic streptococcus (streptococcus pyogenes).

Fusobacterium necrophorum may be as common as group A β-hemolytic streptococcus and can cause Lemierre syndrome.[2] Lemierre syndrome is "suppurative thrombophlebitis of the internal jugular vein, bacteremia, and metastatic infections."</ref name="pmid19949147">

Chemical and physical agents

Diagnosis

Diagnosis has been reviewed by the Rational Clinical Examination who noted the Centor criteria.[3]

Centor criteria:[4]

  • fever
  • No cough
  • Tonsilar exudate
  • Tender anterior cervical lymph nodes

The McIsaac criteria adds to the Centor:[4]

  • Age less than 15: add one point
  • Age greater than 45: subtract one point

According to the Centers for Disease Control and Prevention:

  • 0 points: do not test nor treat
  • 1 points: do not test nor treat
  • 2 points: rapid test and treat if positive
  • 3 points
    • Option 1: rapid test and treat if positive
    • Option 2: treat empirically
  • 4 points: treat empirically

Differential diagnosis

  • Angioedema [r]: Allergic skin reaction causing localized redness, swelling, and itching. [e]

Pharyngitis caused by Fusobacterium necrophorum may lead to Lemierre syndrome.[2]

Treatment

Antibiotics may be used for patients with sufficient likelihood of streptococcal infection.[5]

Losenges with amylmetacresol and 2,4-dichlorobenzyl alcohol may help.[6]

Corticosteroids, such as prednisone 60 mg by mouth for one or two days may reduce symptoms among patients with severe pharyngitis.[7][8]

References

  1. Anonymous (2015), Pharyngitis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 Centor, Robert (2009-12-01). "Expand the Pharyngitis Paradigm for Adolescents and Young Adults". Annals of Internal Medicine 151 (11): 812-815. PMID 19949147. Retrieved on 2009-12-01.
  3. Ebell MH, Smith MA, Barry HC, Ives K, Carey M (2000). "The rational clinical examination. Does this patient have strep throat?". JAMA 284 (22): 2912-8. PMID 11147989[e]
  4. 4.0 4.1 Fine AM, Nizet V, Mandl KD (2012). "Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis.". Arch Intern Med. DOI:10.1001/archinternmed.2012.950. PMID 22566485. Research Blogging.
  5. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE (2004). "Empirical validation of guidelines for the management of pharyngitis in children and adults.". JAMA 291 (13): 1587-95. DOI:10.1001/jama.291.13.1587. PMID 15069046. Research Blogging.
  6. McNally D, Simpson M, Morris C, Shephard A, Goulder M (2010). "Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised controlled trial.". Int J Clin Pract 64 (2): 194-207. DOI:10.1111/j.1742-1241.2009.02230.x. PMID 19849767. Research Blogging.
  7. Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P (2009). "Corticosteroids for pain relief in sore throat: systematic review and meta-analysis.". BMJ 339: b2976. PMID 19661138. PMC PMC2722696.
  8. Kiderman A, Yaphe J, Bregman J, Zemel T, Furst AL (March 2005). "Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice". Br J Gen Pract 55 (512): 218–21. PMID 15808038. PMC 1463093[e]