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Pharyngitis Diagnosis/Pharyngitis or Strep throat, also called streptococcal sore throat, is an infection of the throat and tonsils caused by Streptococcal bacteria. Typical symptoms are sore throat, chills, fever, and swollen lymph nodes in the neck. Strep throat is cured by antibiotic treatment. If left untreated, strep throat can cause serious heart and kidney complications.Persisting or recurrent sore throat can indicate a number of conditions, most of which are very curable. Acute pharyngitis is a sore throat that appears and can last up to a month before fully resolved. It is usually the result of infection – viral, bacterial, or rarely fungal (candida yeast). Acute pharyngitis might be tested to make
Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat. Since infections can affect any part of the mucosa, it is often arbitrary whether an acute upper respiratory tract infection is called “sore throat” (“pharyngitis” or “tonsillitis”), “common cold”, “sinusitis”, “otitis media”, or “bronchitis”
Types of Pharyngitis
Pharyngitis is a type of inflammation caused by an upper respiratory tract infection. It may be classified as
- Acute pharyngitis may be catarrhal, purulent, or ulcerative, depending on the causative agent and the immune capacity of the affected individual.
- Chronic pharyngitis may be catarrhal, hypertrophic, or atrophic.
Tonsillitis is a subtype of pharyngitis.[rx] If the inflammation includes both the tonsils and other parts of the throat, it may be called pharyngotonsillitis.[rx] Another subclassification is nasopharyngitis (the common cold).[rx]
Causes of Pharyngitis
The most important bacterial cause of a throat infection is group A β-hemolytic streptococcus (GABHS), which is responsible for about one-third of sore throats in children aged 5 to 15 years. In adults and in younger children, only 10% of sore throats are caused by GABHS. Carriers of GABHS do not need treatment.
- Viruses are responsible for 85% to 95% of adult sore throats.
- Viruses cause 70% of sore throats in children aged 5 to 16.
- Viruses cause 95% of sore throats in children younger than 5 years.
- The most common bacterial cause of sore throat is GABHS.
- At least 30% of GABHS cultured in primary care are due to carriers who are not sick and are at very low risk of infecting other people.
Infectious causes of Pharyngitis
- Herpes simplex virus (HSV)1 and 2
- Influenza A and B
- Parainfluenza virus
- Epstein-Barr virus (EBV)
- Cytomegalovirus (CMV)
- Human herpesvirus (HHV) 6
- Group C beta-hemolytic streptococci
- Neisseria gonorrhoeae
- Corynebacterium diphtheriae
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Fusobacterium necrophorum
Noninfectious causes of sore throat
- Persistent cough
- Postnasal drip
- Gastroesophageal reflux disease (GERD)
- Acute thyroiditis
Others causes are describe bellow
- Toxins/Irritants – Various substances such a cigarette smoke, air pollution, and noxious airborne chemicals can lead to a pharyngitis. Medical conditions such as postnasal drip, allergies, cough, gastroesophageal reflux disease (GERD), and tumors can cause a pharyngitis. The intentional or unintentional ingestion of certain substances (for example, bleach) can cause a sore throat.
- Trauma/Injury – Any direct injury to the throat or neck area can lead to a sore throat. Sometimes, a foreign body (for example, a bone or piece of food) can cause a sore throat/ pharyngitis. Excessive yelling or screaming can irritate the throat and larynx, also leading to a sore throat.
- Strep throat /pharyngitis and other bacterial infections – Bacterial infections can also cause sore throats /pharyngitis. The most common one is strep throat, an infection of the throat and tonsils caused by group A Streptococcus bacteria. Strep throat causes nearly 40 percent of sore throat cases in children . Tonsillitis, and sexually transmitted infections like gonorrhea and chlamydia can also cause a pharyngitis.
- Allergies – When the immune system reacts to allergy triggers like pollen, grass, and pet dander, it releases chemicals that cause symptoms like nasal congestion, watery eyes, sneezing, and throat irritation. Excess mucus in the nose can drip down the back of the throat. This is called postnasal drip and can irritate the throat.
- Irritants – Outdoor air pollution can cause ongoing throat irritation. Indoor pollution — tobacco smoke or chemicals — also can cause a chronic sore throat/pharyngitis. Chewing tobacco, drinking alcohol and eating spicy foods also can irritate your throat.
- Muscle strain – You can strain muscles in your throat by yelling, such as at a sporting event; talking loudly; or talking for long periods without rest.
- Dry air – Dry air can suck moisture from the mouth and throat, and leave them feeling dry and scratchy. The air is most likely dry in the winter months when the heater is running.
- Smoke, chemicals, and other irritants – Many different chemicals and other substances in the environment irritate the throat, including ,cigarette and other tobacco smoke, air pollution, cleaning products and other chemicals
- Injury – Any injury, such as a hit or cut to the neck, can cause pain in the throat. Getting a piece of food stuck in your throat can also irritate it.Repeated use strains the vocal cords and muscles in the throat. You can get a sore throat after yelling, talking loudly, or singing for a long period of time. Sore throats are a common complaint among fitness instructors and teachers, who often have to yell .
- Gastroesophageal reflux disease (GERD) – Gastroesophageal reflux disease (GERD) is a condition in which acid from the stomach backs up into the esophagus – the tube that carries food from the mouth to the stomach.The acid burns the esophagus and throat, causing symptoms like heartburn and acid reflux – the regurgitation of acid into your throat.
- Tumor – A tumor of the throat, voice box, or tongue is a less common cause of a sore throat. When a sore throat/pharyngitis is a sign of cancer, it doesn’t go away after a few days.
- Snoring – is frequently associated with sore throat, and the two have risk factors such as smoking [rx] in common, although the direction of causality is not always clear. A high frequency of sore throat is a risk factor for habitual snoring in children [rx] and sore throat was reported by over half of those snoring children who were subsequently diagnosed with obstructive sleep apnoea [rx]. Sore throat may also be associated with obstructive sleep apnoea in adults [rx]. Sleep apnoea is a key factor for the manifestation of secondary hypertension.
- Tracheal intubation – and laryngeal mask airways are common causes of sore throat in people undergoing general anaesthesia [rx–rx]. The reported incidence of postoperative sore throat varies widely, but is generally higher for tracheal intubation than for laryngeal mask airway [rx]. For patients undergoing tracheal intubation, an incidence of around 28–45.5 % [rx, rx]— and as high as 70 % [rx]— has been reported. For laryngeal mask airway, the incidence is lower—in the region of 3.5–21.4 %.
- Shouting – and voice loading may cause sore throat, as reported by people in professions that require use (and overuse) of their voice for their work. For example, aerobics instructors have reported an increased incidence of sore throat unrelated to illness since beginning instructing [rx] and the frequency of aerobics classes has been shown to significantly correlate with sore throat symptoms in instructors [rx]. Sore throat is also reported by school teachers [rx]. Furthermore, sore throat can occur as a secondary consequence of functional dysphonia [rx] as well as vice versa.
- Drug-induced – sore throat is a notable adverse effect of some medications, including angiotensin-converting enzyme (ACE) inhibitors [rx] and chemotherapy agents. Sore throat is also a common problem in asthmatics taking inhaled corticosteroids [rx–rx], although these data may be in part confounded by a potential steroid-induced increased susceptibility to infection, including mycoses. In fact, people taking a wide variety of other drugs frequently report sore throat as an adverse effect, but in many cases the symptom will be coincidental (that is, probably infectious sore throat and at a similar rate to placebo).
- Concomitant illness – can directly result in sore throat. For example, Kawasaki disease (a mucocutaneous vasculitis) typically causes pharyngitis in both adults and children [rx]. Furthermore, chronic pharyngitis is a common manifestation of gastroesophageal reflux disorder [rx], with this presentation now termed laryngopharyngeal reflux disorder [rx].
- Ambient air pollution – is a common cause of sore throat. The factors implicated include ozone, nitrogen oxides, and fine dust. Urban living and traffic fumes are frequently associated with sore throat. In children in Hong Kong, sore throat decreased when fuel sulphur levels were reduced [rx]
- Occupational or hazard-associated irritants – that have been reported to cause sore throat include particulates, fumes, chemicals, and odours. Laryngitis has also been reported [rx].
- Temperature and humidity – affect mucus membranes, and have been linked with sore throat symptoms. Heated air causes nasal pain [rx] and working regularly in a cold environment causes rhinitis and sore throat as well as changes in lung function [rx]. Humidity is also important, with the overall intensity of sick building syndrome symptoms increasing when indoor air is not humidified [rx].
Gastroesophageal reflux disease
Exposure to second-hand smoke
Autoimmune disorders (Behcet Syndrome, Kawasaki, etc)
Colds, the flu, and other viral infections – Viruses cause about 90 percent of sore throats . Among the viruses that cause sore throats are:
- The common cold
- Influenza — the flu
- Mononucleosis, an infectious disease that’s transmitted through saliva
- Measles, an illness that causes a rash and fever
- Chickenpox, an infection that causes a fever and an itchy, bumpy rash
- Mumps, an infection that causes swelling of the salivary glands in the neck
Because most cases of sore throat are caused by an infection, individuals may commonly experience any of the additional following signs and symptoms
- Headache, nausea and vomiting, malaise, dysphagia, and abdominal pain might be present.
- Cough and rhinorrhea are usually absent.
- Edema and erythema of the tonsils and pharynx are usually present.
- Anterior neck glands might be enlarged and tender.
- A non-adherent pharyngeal exudate might be present
- Fever and/or chills
- Nausea and/or vomiting
- Body aches
- Pain or a scratchy sensation in the throat
- Pain that worsens with swallowing or talking
- Difficulty swallowing
- Sore, swollen glands in your neck or jaw
- Swollen, red tonsils
- White patches or pus on your tonsils
- Hoarse or muffled voice
- Runny nose or nasal congestion
- Neck stiffness
- Swollen glands
- Painful joints
- Shortness of breath
- Dark urine, skin rash, or chest pain (may occur three to four weeks later)
- Lack of appetite
- Redness and/or swelling of the tonsils and back of the throat
- White patchy areas on the tonsils (exudate)
- Swollen and/or tender lymph nodes in the neck
- A muffled or hoarse voice
Diagnosis of Pharyngitis
Score 1 point for the presence of each of the following features:
- Temperature greater than 38°C
- Absence of cough
- Presence of enlarged or tender glands
- Presence of tonsillar exudates
- Age younger than 15 y
- Score 0 or 1 – No antibiotic treatment
- Score 2 or 3 – Do throat swab and culture
- Score 4 or 5 – Treat with antibiotic or do a throat swab
History and physical examination are the most important tools in diagnosis. When epiglottitis or occasionally croup is suspected, neck X-rays may be helpful. A blood count and antibody test may be helpful when mononucleosis is suspected to confirm the diagnosis.
The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on five clinical criteria, it indicates the probability of a streptococcal infection.[rx] One point is given for each of the criteria:[rx]
- Absence of a cough
- Swollen and tender cervical lymph nodes
- Temperature more than 38.0 °C (100.4 °F)
- Tonsillar exudate or swelling
- Age less than 15 (a point is subtracted if age is more than 44)
The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate following positive testing.[rx] Testing is not needed in children under three, as both groups, A strep and rheumatic fever are rare, except if they have a sibling with the disease.[rx]
- Latex fixation test – This test was developed in the 1980s and is largely obsolete. It employs latex beads covered with antigens that will visibly agglutinate around GAS antibodies if these are present.
- Optical immunoassay – This newer and more expensive test involves mixing the sample with labeled antibodies and then with a special substrate on a film that changes color to signal the presence or absence of GAS antigen.
- Lateral flow test – This is currently the most widely used RST. The sample is applied to a strip of nitrocellulose film and, if GAS antigens are present, these will migrate along the film to form a visible line of antigen bound to labeled antibodies. (The technique which we used). The sensitivity of this test ranges from 80 to 97 % depending on experience and methodology while the specificity is 97 %. [rx].
- Throat culture of Sore Throat – This may indicate a more serious infection. The doctor will examine your child and may perform a throat culture to determine the nature of the infection. To do this, he will touch the back of the throat and tonsils with a cotton-tipped applicator and then smear the tip onto a special culture dish that allows strep bacteria to grow if they are present. The culture dish usually is examined twenty-four hours later for the presence of the bacteria.
- Rapid Strep Test Sore Throat – Most pediatric offices perform rapid strep tests that provide findings within minutes. If the rapid strep test is negative, your doctor may confirm the result with a culture. A negative test means that the infection is presumed to be due to a virus. In that case, antibiotics (which are antibacterial) will not help and need not be prescribed. Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.
About 10% of people present to primary healthcare services with sore throat each year. The causative organisms of sore throat may be bacteria (most commonly Streptococcus) or viruses (typically rhinovirus), but it is difficult to distinguish bacterial from viral infections clinically.
Treatment of Pharyngitis
You can take medicines to relieve the pain of a sore throat, or to treat the underlying cause.
- NSAIDs – may reduce the pain of sore throat at 24 hours or less, and at 2−5 days. NSAIDs are associated with gastrointestinal and renal adverse effects. Pain relievers, such as acetaminophen and ibuprofen and naproxen – to relieve the aches and pains of a cold and sore throat. (Aspirin should not be given to children because of its link to Reye’s syndrome, a disorder that can cause brain damage and death.)
- Paracetamol – seems to effectively reduce the pain of acute infective sore throat after a single dose, or regular doses over 2 days.
- Antibiotics – can reduce the proportion of people with symptoms associated with sore throat at 3 days. Reduction in symptoms seems greater for people with positive throat swabs for Streptococcus than for people with negative swabs. Antibiotics are generally associated with adverse effects such as nausea, rash, vaginitis, and headache, and widespread usage may lead to bacterial resistance. It may also reduce suppurative and non-suppurative complications of group A beta haemolytic streptococcal pharyngitis, although non-suppurative complications are rare in industrialised countries.
- Corticosteroids – added to antibiotics may reduce the severity of pain from sore throat in children and adults compared with antibiotics alone. Most studies used a single dose of corticosteroid. However, data from other disorders suggest that long term use of corticosteroids is associated with serious adverse effects. Super-colonisation with Streptococcus isolated from healthy individuals apparently resistant to infections from Streptococcus may reduce recurrence of sore throat, although there is currently no evidence to suggest it may treat symptoms of acute sore throat.
- Phenoxymethyl penicillin – is taken orally and is the most commonly prescribed antibiotic for strep throat.
- Amoxicillin – is a useful oral penicillin alternative as it can be given with food, which may help people to remember to take all of their doses.
- Benzathine benzylpenicillin or procaine penicillin – is given as a single intramuscular injection and may be used in patients who are unable to take penicillin orally or are unlikely to complete the 10-day oral course.
- Erythromycin ethyl succinate – is a suitable oral antibiotic alternative for people who are allergic to penicillin.
- Sore throat sprays – and lozenges to soothe your throat and numb the throat pain temporarily. (Lozenges should not be given to young children.)
- Decongestant nasal sprays – to relieve a sore throat caused by postnasal drip – nasal drainage that runs down your throat. (Be sure to stop using nasal decongestant sprays after three days, or you may have an increase in congestion when you stop them.)
- You can also use one or more of these treatments – which work directly on the pain of a sore throat
- A sore throat spray that contains a numbing antiseptic like phenol, or a cooling ingredient like menthol or eucalyptus
- Throat lozenges
- Cough syrup
Medications that reduce stomach acid can help with a sore throat caused by GERD. These include
- Antacids such as Tums, Rolaids, Maalox, and Mylanta to neutralize stomach acid.
- H2 blockers such as cimetidine, famotidine, and ranitidine to reduce stomach acid production.
- Proton pump inhibitors (PPIs) such as lansoprazole and omeprazole to block acid production.
- Low-dose corticosteroids can also help with the pain of a sore throat, without causing any serious side effects
- Throat sprays can help numb the throat, which helps to stop the pain associated with both strep throat and sore throats.
- Tea with honey has been shown to relieve throat irritation, and hot water from a mild tea can do the same.
- Suck on lozenges, ice chips (do not give lozenges to young children),
- Drink lots of liquids,
- Gargling may ease the pain,
- Get plenty of rest,
- Use a clean humidifier or mist vaporizer,
- Avoid smoking, secondhand and thirdhand smoke, and
Some herbs, including slippery elm, marshmallow root, and licorice root, are sold as sore throat remedies. There’s not much evidence this work, but an herbal tea called Throat Coat that contains all three did relieve throat pain in one study.
- Vitamin C – Vitamin C was identified in the early part of the previous century and there was much interest in its possible effects on various infections including the common cold.[rx]rx][rx] A few controlled trials on the effect of vitamin C on the common cold were carried out already in the 1940s,[rx] but the topic became particularly popular after 1970, when Linus Pauling, a double Nobel laureate, wrote a best-selling book Vitamin C and the Common Cold.[rx][rx] According to the Cochrane review on vitamin C and the common cold, 1 g/day or more of vitamin C does not influence common cold incidence in the general community.[rx] However, in five randomized double-blind placebo-controlled trials with participants who were under heavy short-term physical stress (three of the trials were with marathon runners), vitamin C halved the incidence of colds.[rx] In the dose of 1 g/day or more, vitamin C shortened the duration of colds in adults by 8% and in children by 18%.[rx] Vitamin C also decreased the severity of colds.
- Echinacea – A systematic review by the Cochrane Collaboration, last updated in 2014, examines twenty-four randomized controlled trials studying various echinacea preparations for the prevention and treatment of the common cold. Echinacea showed no benefit over placebo for prevention.[rx] Evidence for treatment was inconsistent. Reported side effects were rare.[rx] The use of echinacea preparations is not currently recommended.[rx][rx][rx]
- Chicken soup – In the twelfth century, Moses Maimonides wrote, “Chicken soup … is recommended as an excellent food as well as medication.”[rx] Since then, there have been numerous reports in the United States that chicken soup alleviates the symptoms of the common cold. Even usually staid medical journals have published tongue-in-cheek articles on the alleged medicinal properties of chicken soup.[rx][rx][rx]
- Pelargonium sidoides extract – A 2013 Cochrane review found tentative evidence of benefit with Pelargonium sidoides for the symptoms of the common cold; however, the quality of the evidence was very poor.[rx]
- Steam inhalation – Many people believe that steam inhalation reduces cold symptoms.[rx] There is no evidence suggesting that steam inhalation is effective for treating the common cold.[rx] There have been reports of children being badly burned by accidentally spilling the water used for steam inhalation.[rx] Evidence does not support a relationship between cold temperature exposure or a “chill” (feeling of coldness) and the common cold.[rx]
- Zinc – Zinc is tentatively linked to a shorter length of symptoms.[rx]
- Avoid smoking or exposure to secondhand smoke. Tobacco smoke, whether primary or secondary, contains hundreds of toxic chemicals that can irritate the throat lining.
- If you have seasonal allergies or ongoing allergic reactions to dust, molds, or pet dander, you are more likely to develop a sore throat than people who dont have allergies.
- Avoid exposure to chemical irritants. Particulate matter in the air from the burning of fossil fuels, as well as common household chemicals, can cause throat irritation.
- If you experience chronic or frequent sinus infections you are more likely to experience a sore throat, since drainage from nose or sinus infections can cause throat infections as well.
- If you live or work in close quarters such as a child care center, classroom, office, prison, or military installation, you are at greater risk because viral and bacterial infections spread easily in environments where people are in close proximity.
- Maintain good hygiene. Do not share napkins, towels, and utensils with an infected person. Wash your hands regularly with soap or a sanitizing gel, for 10-15 seconds.
- Covering the mouth and nose with a tissue when sneezing or coughing
- Frequent and thorough washing and drying of hands
- Avoiding close physical contact
- Not sharing food, liquids, or eating or drinking utensils with an infected person
- If strep throat is confirmed, staying home for 24 hours after starting antibiotic therapy
Self-Care of a Sore Throat
If you are looking after yourself, the tips below may help relieve the symptoms:
- Gargle with warm, salty water.
- Drink hot water with honey and lemon.
- It is important to stay well hydrated so drink plenty of water. If you have an existing medical condition, check with your doctor about how much water is right for you.
- Warm or iced drinks and ice blocks may be soothing.
- Avoid foods that cause pain when you swallow. Try eating soft foods such as yoghurt, soup or ice cream.
- Rest and avoid heavy activity until symptoms go away.
- Keep the room at a comfortable temperature.
- Smoking or breathing in other people’s smoke can make symptoms worse. Try to avoid being around people who are smoking. If you are a smoker, try to cut down or quit. For advice on quitting smoking,
- Find out more about self-care tips if you have a high temperature (fever).