Pharyngitis: Difference between revisions
added |
|||
| Line 107: | Line 107: | ||
* [[Steroid]]s (such as [[dexamethasone]]) have been found to be useful for severe pharyngitis.<ref>{{cite journal |vauthors=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P | title = Corticosteroids for pain relief in sore throat: systematic review and meta-analysis | journal = BMJ | volume = 339 | issue = | pages = b2976 | year = 2009 | pmid = 19661138 | pmc = 2722696 | doi = 10.1136/bmj.b2976 | url = }}</ref><ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=740 |title=Do steroids reduce symptoms in acute pharyngitis? |publisher=BestBets.org |accessdate=2009-01-14}}</ref> |
* [[Steroid]]s (such as [[dexamethasone]]) have been found to be useful for severe pharyngitis.<ref>{{cite journal |vauthors=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P | title = Corticosteroids for pain relief in sore throat: systematic review and meta-analysis | journal = BMJ | volume = 339 | issue = | pages = b2976 | year = 2009 | pmid = 19661138 | pmc = 2722696 | doi = 10.1136/bmj.b2976 | url = }}</ref><ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=740 |title=Do steroids reduce symptoms in acute pharyngitis? |publisher=BestBets.org |accessdate=2009-01-14}}</ref> |
||
* Viscous [[lidocaine]] relieves pain by numbing the mucus membranes.<ref>{{cite web |url=http://www.medicinenet.com/lidocaine_viscous/article.htm |title=LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions. |work= |accessdate=}}</ref> |
* Viscous [[lidocaine]] relieves pain by numbing the mucus membranes.<ref>{{cite web |url=http://www.medicinenet.com/lidocaine_viscous/article.htm |title=LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions. |work= |accessdate=}}</ref> |
||
* [[Antibiotic]]s are useful if a bacterial infection is the cause of the sore throat. |
* [[Antibiotic]]s are useful if a bacterial infection is the cause of the sore throat.<ref>{{cite journal|last1=Kocher|first1=JJ|last2=Selby|first2=TD|title=Antibiotics for sore throat.|journal=American family physician|date=1 July 2014|volume=90|issue=1|pages=23-4|pmid=25077497}}</ref><ref>{{cite journal|last1=Spinks|first1=A|last2=Glasziou|first2=PP|last3=Del Mar|first3=CB|title=Antibiotics for sore throat.|journal=The Cochrane database of systematic reviews|date=5 November 2013|issue=11|pages=CD000023|pmid=24190439}}</ref> For viral infections, antibiotics have no effect. In the United States they are used in 25% of people before a bacterial infection has been detected.<ref>{{cite journal|last1=Urkin|first1=J|last2=Allenbogen|first2=M|last3=Friger|first3=M|last4=Vinker|first4=S|last5=Reuveni|first5=H|last6=Elahayani|first6=A|title=Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases.|journal=Acta paediatrica (Oslo, Norway : 1992)|date=November 2013|volume=102|issue=11|pages=1075-80|pmid=23879261}}</ref> |
||
* Oral analgesic solutions, the active ingredient usually being [[phenol]], but also less commonly [[benzocaine]], [[cetylpyridinium chloride]] and/or [[menthol]]. [[Chloraseptic]] and [[Cēpacol]] are two examples of brands of these kinds of analgesics. |
* Oral analgesic solutions, the active ingredient usually being [[phenol]], but also less commonly [[benzocaine]], [[cetylpyridinium chloride]] and/or [[menthol]]. [[Chloraseptic]] and [[Cēpacol]] are two examples of brands of these kinds of analgesics. |
||
Revision as of 21:20, 4 August 2016
| Pharyngitis | |
|---|---|
| Other names | acute sore throat |
| Pronunciation | |
| Specialty | Otorhinolaryngology  |
Pharyngitis is the inflammation of the pharynx, the region in the back of the throat.[1] In most cases it is painful, and it is the most common cause of a sore throat.[2] Pharyngitis can result in very large tonsils, which cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough or fever. Pharyngitis can be long-lasting or quickly developing and temporary.
Most acute cases are caused by viral infections (40–80%), with the remainder caused by bacterial infections, fungal infections, or irritants such as pollutants or chemical substances.[2][3] It is typically a type of respiratory tract infection.[4]
Treatment of viral causes mainly involve efforts to help with the pain. Bacterial or fungal causes may be treated with antibiotics and anti-fungal medication respectively. It is unclear if steroids are useful in acute pharyngitis.[5]
On the average, children experience sore throats about five times a year, adults twice a year.[6] The word comes from the Greek word pharynx meaning "throat" and the suffix -itis meaning "inflammation."
Classification
Pharyngitis is a type of inflammation, most commonly caused by an upper respiratory tract infection. It may be classified as acute or chronic. An acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the immune capacity of the affected individual. Chronic pharyngitis is the most common otolaringologic disease and may be catarrhal, hypertrophic or atrophic.
If the inflammation includes tonsillitis, it may be called pharyngotonsillitis.[7] Another sub classification is nasopharyngitis (the common cold).[8]
Cause
The majority of cases are due to an infectious organism acquired from close contact with an infected individual.
Viral
These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.[2][3]
- Adenovirus – the most common of the viral causes. Typically the degree of neck lymph node enlargement is modest and the throat often does not appear red, although it is painful.
- Orthomyxoviridae which cause influenza – present with rapid onset high temperature, headache and generalized ache. A sore throat may be associated.
- Infectious mononucleosis ("glandular fever") caused by the Epstein–Barr virus. This may cause significant lymph gland swelling and an exudative tonsillitis with marked redness and swelling of the throat. The heterophile test can be used if this is suspected.
- Herpes simplex virus can cause multiple mouth ulcers.
- Measles
- Common cold: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often pain.
Bacterial
A number of different bacteria can infect the human throat. The most common is Group A streptococcus, but others include Streptococcus pneumoniae, Haemophilus influenzae, Bordetella pertussis, Bacillus anthracis, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.[9]
- Streptococcal pharyngitis
Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus (GAS).[10] It is the most common bacterial cause of cases of pharyngitis (15–30%).[9] Common symptoms include fever, sore throat, and large lymph nodes. It is a contagious infection, spread by close contact with an infected individual. A definitive diagnosis is made based on the results of a throat culture. Antibiotics are useful to both prevent complications and speed recovery.[11]
- Fusobacterium necrophorum
Fusobacterium necrophorum is a normal inhabitant of the oropharyngeal flora and can occasionally create a peritonsillar abscess. In 1 out of 400 untreated cases, Lemierre's syndrome occurs.[12]
- Diphtheria
Diphtheria is a potentially life-threatening upper respiratory infection caused by Corynebacterium diphtheriae which has been largely eradicated in developed nations since the introduction of childhood vaccination programs, but is still reported in the Third World and increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but recovery is generally slow.[citation needed]
- Others
A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess ("quinsy"), submandibular space infection (Ludwig's angina), and epiglottitis.[13][14][15]
Fungal
Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.[citation needed]
Non-infectious
Pharyngitis may also be caused by mechanical, chemical or thermal irritation, for example cold air or acid reflux. Some medications may produce pharyngitis such as pramipexole and antipsychotics.[16][17]
Diagnostic approach
| Points | Probability of Strep | Management |
|---|---|---|
| 1 or less | <10% | No antibiotic or culture needed |
| 2 | 11–17% | Antibiotic based on culture or RADT |
| 3 | 28–35% | |
| 4 or 5 | 52% | Empiric antibiotics |
It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone.[18] Thus often a throat swab is done to rule out a bacterial cause.[19]
The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.[11]
One point is given for each of the criteria:[11]
- Absence of a cough
- Swollen and tender cervical lymph nodes
- Temperature >38.0 °C (100.4 °F)
- Tonsillar exudate or swelling
- Age less than 15 (a point is subtracted if age >44)
The McIsaac criteria adds to the Centor:[20]
- Age less than 15: add one point
- Age greater than 45: subtract one point
The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing.[18] Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.[18]
Management
The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, fungal, and herpes simplex infections.
Medications
- Analgesics such as NSAIDs and acetaminophen (paracetamol) can help reduce the pain associated with a sore throat. Aspirin may be used in adults but is not recommended in children due to the risk of Reye syndrome.[21]
- Steroids (such as dexamethasone) have been found to be useful for severe pharyngitis.[22][23]
- Viscous lidocaine relieves pain by numbing the mucus membranes.[24]
- Antibiotics are useful if a bacterial infection is the cause of the sore throat.[25][26] For viral infections, antibiotics have no effect. In the United States they are used in 25% of people before a bacterial infection has been detected.[27]
- Oral analgesic solutions, the active ingredient usually being phenol, but also less commonly benzocaine, cetylpyridinium chloride and/or menthol. Chloraseptic and Cēpacol are two examples of brands of these kinds of analgesics.
Alternative
Alternative medicines are promoted and used for the treatment of sore throats.[28] However, they are poorly supported by evidence.[28]
Epidemiology
Acute pharyngitis is the most common cause of a sore throat and, together with cough, it is diagnosed in more than 1.9 million people a year in the United States.[2]
References
- ^ "Pharyngitis". ClinicalKey.
- ^ a b c d Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, Pennsylvania: Mosby/Elsevier. Chapter 30. ISBN 978-0-323-05472-0.
- ^ a b Acerra JR. "Pharyngitis". eMedicine. Retrieved 28 April 2010.
- ^ "Pharyngitis". National Library of Medicine. Retrieved 4 August 2016.
- ^ Principi, N; Bianchini, S; Baggi, E; Esposito, S (February 2013). "No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media". European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 32 (2): 151–60. PMID 22993127.
- ^ Tamparo, Carol (2011). Fifth Edition: Diseases of the Human Body. Philadelphia, PA: F.A. Davis Company. p. 356. ISBN 978-0-8036-2505-1.
- ^ Rafei K, Lichenstein R (2006). "Airway Infectious Disease Emergencies". Pediatric Clinics of North America. 53 (2): 215–242. doi:10.1016/j.pcl.2005.10.001. PMID 16574523.
- ^ "www.nlm.nih.gov".
- ^ a b Bisno AL (January 2001). "Acute pharyngitis". N Engl J Med. 344 (3): 205–11. doi:10.1056/NEJM200101183440308. PMID 11172144.
- ^ Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970.
- ^ a b c Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician. 79 (5): 383–90. PMID 19275067.
- ^ Centor RM (1 December 2009). "Expand the pharyngitis paradigm for adolescents and young adults". Ann Intern Med. 151 (11): 812–5. doi:10.1059/0003-4819-151-11-200912010-00011. PMID 19949147.
- ^ "UpToDate Inc". (registration required)
- ^ Reynolds SC, Chow AW (September–October 2009). "Severe soft tissue infections of the head and neck: a primer for critical care physicians". Lung. 187 (5): 271–9. doi:10.1007/s00408-009-9153-7. PMID 19653038.
- ^ Bansal A, Miskoff J, Lis RJ (January 2003). "Otolaryngologic critical care". Crit Care Clin. 19 (1): 55–72. doi:10.1016/S0749-0704(02)00062-3. PMID 12688577.
- ^ "Mirapex product insert" (PDF). Boehringer Ingelheim. 2009. Retrieved 30 June 2010.
- ^ "Mosby's Medical Dictionary, 8th edition". Elsevier. 2009. Retrieved 30 June 2010.
- ^ a b c Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C (9 September 2012). "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 55 (10): e86–102. doi:10.1093/cid/cis629. PMID 22965026.
- ^ Del Mar C (1992). "Managing sore throat: a literature review. I. Making the diagnosis". Med J Aust. 156 (8): 572–5. PMID 1565052.
- ^ 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. 172. doi:10.1001/archinternmed.2012.950. PMID 22566485.
- ^ Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Current Opinion in Pediatrics. 22 (Curr. Opin. Pediatr. 22 (1)): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970.
- ^ 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. doi:10.1136/bmj.b2976. PMC 2722696. PMID 19661138.
- ^ "Do steroids reduce symptoms in acute pharyngitis?". BestBets.org. Retrieved 14 January 2009.
- ^ "LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions".
- ^ Kocher, JJ; Selby, TD (1 July 2014). "Antibiotics for sore throat". American family physician. 90 (1): 23–4. PMID 25077497.
- ^ Spinks, A; Glasziou, PP; Del Mar, CB (5 November 2013). "Antibiotics for sore throat". The Cochrane database of systematic reviews (11): CD000023. PMID 24190439.
- ^ Urkin, J; Allenbogen, M; Friger, M; Vinker, S; Reuveni, H; Elahayani, A (November 2013). "Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases". Acta paediatrica (Oslo, Norway : 1992). 102 (11): 1075–80. PMID 23879261.
- ^ a b "Sore throat: Self-care". Mayo Clinic. Retrieved 17 September 2007.
