PHARYNGITIS - Disease Management

Pharyngitis is an inflammation of the pharynx. which frequently results in a sore throat and

may be caused by a variety of microorganisms. Chronic pharyngitis is a chronic inflammation of

the pharyngeal mucous membrane and submucous Lymphoid tissues. In infectious pharyngitis, bacteria

or viruses may directly invade the pharyngeal mucosa, causing a local inflammatory response.

Causes

• Virus
• Adenovirus
• Arcanobacterium (Corynebacterium) haemolyticus
• Coxsackieviruses A and B
• Herpes Simplex virus
• HIV
• Influenza virus
• Mononucleosis
• Respiratory Syncytial virus
• Rhinovirus
• Bacteria
• Arcanobacteriumn
• Chlamydia pneumoniae
• Corynebacterium
• Group Ab Streptococcus
• Group C, G, and F Streptococci
• Mycoplasma pneumonia
• Neisseria gonorrhoeae
• Other causes of pharyngitis
• Oral thrush is due to candidal species (immunocompromised patients).
• Dry air, allergy/postnasal drip, chemical injury, gastroesophageal reflux disease (GERD), smoking, neoplasia, and endotracheal intubation.

Riak Factors

• Colder months-during respiratory disease season.
• Infected family member

Signs and Symptoms

• Sore throat
• Strep throat may be accompanied by fever, headache, swollen lymph nodes in the neck
• Viral pharyngitis may be associated with rhinorrhea and postnasal discharge
• Difficulty in swallowing and breathing

DIAGNOSIS

Differential Diagnosis

• Candidiasis
• Diphtheria
• Epiglottitis (adult)
• Gonorrhea
• Herpes Simplex
• Mononucleosis
• Pediatrics
• Croup or Laryngotracheobronchitis (pediatrics)
• Epiglottitis Pediatrics
• Hand-Foot-and-Mouth Disease (pediatrics)
• Pharyngitis (pediatrics)
• Scarlet Fever
• Peritonsillar abscess
• Pharyngitis Pneumonia
• Mycoplasma Retropharyngeal Abscess
• Rheumatic Fever

Investigation

• GABHS rapid antigen detection test
• Throat culture
• Antistreptolysin-O (ASO)
• Mono spot
• Peripheral smear
• Fluorescent monoclonal antibody test
• .Lateral neck film
• Chest X-ray

TREATMENT

Goal

• Decrease the duration of the illness and infective period
• Provide symptomatic relief
• Decrease the incidence of relapses and complications.

Non-Pharmacological Treatment

Viral infections are managed with supportive measures Such as warm saline gargles, analgesics, and fluids.

Pharmacological Treatment

Antibiotic therapy

• 1st line treatment: Penicillins, erythromycin
• 2nd line treatment: Penicillins, cephalosporins, macrolides
• Gonococcal pharyngitis: Ceftriaxone plus doxycycline or azithromycin, or ciprofloxacin plus doxycycline or azithromycin

PATIENT EDUCATION

• A complete full course of antibiotic therapy
• The risk of recurrence
• Regular follow-up

Complications

• Otitis media
• Mastoiditis
• Sinusitis
• Epiglottitis
• Pneumonia

Prognosis

• Most cases of pharyngitis resolve spontaneously within 10 days.
• Treatment failures are frequent (poor compliance, antibiotic resistance, untreated close contacts, carrier states, and antibiotic-related or co-pathogenic suppression of host immunity and necessary flora).