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Pharyngitis (Sore throat) causes, treatment and FAQs

What is pharyngitis? Pharyngitis (Sore throat) is inflammation of the pharynx (back of throat). It is one of the most common reasons for doctor visits.
acute-pharyngitis

Pharyngitis is more common in winter than in summer.
It can be caused by viral or bacterial infections and its treatment is determined according to its cause.

What are the causes of Pharyngitis?

Pharyngitis can be specific or non-specific according to its cause, which may be:
  • Viruses: the most common cause of pharyngitis and they don't respond to antibiotic treatment. Many viruses cause pharyngitis, such as Adenovirus (common cold), influenza virus and Ebstein Bar virus.
  • Bacteria: less common but they respond to antibiotic treatment. Group A beta hemolytic Streptococcus (strep throat) is the most common bacterial cause of pharyngitis, it mainly affects children age 3 to 14 years.. Other less common bacterial causes include Nisseria gonorrhea, chlamydia, and corynebacterium.

Risk factors:

  • Frequent cold an flu bouts
  • Negtive somking (secondhand smoke)
  • Healthcare workers are at higher risk for pharyngitis
  • Frequent sinusitis

What are the symptoms of Pharyngitis?

Symptoms of pharyngitis start to occur 2-5 days after catching the infection.
Symptoms vary according to the cause and underlying body condition:
  • Sore throat: it is the commonest symptom, the patient may also experience dryness or scratching in his throat. Sore throat is severe in cases of Diphteria (does not exist nowadays).
  • Cough
  • Sneezing and runny nose (from common cold)
  • General symptoms: low grade fever, headache, malaise, anorexia & may be vomiting.
  • Dysphasia (difficulty in swallowing) occurs with bacterial infection (Strep throat).
  • Loss of appetite
  • Muscle aches (Myalgia)
  • Bad taste in the mouth

Signs of Pharyngitis

Doctor's examination may reveal the following signs:
  • Swollen lymph nodes
  • Red pharynx with white or gray patches
  • In case of Diphteria: False membrane over the tonsil which is unilateral, yellow white or dirty gray, Thick & firm, adherent & leaves a bleeding surface on removal & reforms rapidly.It often exceeds limits of the tonsils

How long is pharyngitis contagious?

Pharyngitis infectiousness depends on its cuase, it is as follows:
  • If it is Viral pharyngitis, the patient will stay contagiuos until the fever runs its course.
  • If it is Bacterial pharyngitis, the patient stays contagious till spending at least 24 hours after taking the first antibiotic dose.

How long does pharyngitis last?

Pharyngitis resulting from common cold virus usually lasts for a week (less than 10 days) with peak symptoms at 3-5 days.

Bacterial pharyngitis responds to antibiotic treatment and it resolves earlier (usually about 3 days) with proper antibiotc dose.

Sore throats caused by mononucleosis,  may last for a month.

Investigations needed to confirm pharyngitis diagnosis:
  • Throat swab for culture and sensitivity: Doctors usually requests this test if he suspects bacterial pharyngitis (strep throat)
  • Complete blood count (CBC)
  • Ebstein bar virus titre

Treatment of Pharyngitis

In viral pharyngitis, some home remedies can help improve and recover symptoms, with the following measures:

  • Avoid dehydration by drinking plenty of fluids
  • Drinking warm soup and warm broth
  • Gargling with warm salt water
  • Taking antipyretics to control fever and pain such as paracetamol PO
  • Taking Lozenges to relieve throat pain and scratching.
  • Have some rest 

Antibiotic treatment of Bacterial Pharyngitis

Bacterial Pharyngitis needs a 7-10 day course of antibiotic. You should take the full course even after improvement to prevent recurrence of the disease.

Antibiotic should be prescribed by a doctor according to age and condition of the patient.
Most doctors prescribe the following antibiotic courses:

a. InjectionBenzathine benzylpenicillin
 Age Antibiotic prescription and dose
 Children under 30 kg (or under 10 years) Benzathine benzylpenicillin Intra-muscular (IM) 600 000 IU single dose
 Children 30 kg and over (or 10 years and over) and adults Benzathine benzylpenicillin IM 1.2 Million IU single dose

b. Oral antibiotic:
Phenoxymethylpenicillin (penicillin V) is usually prescribed Per Oral for 10 days, according to age as follows:
 Age Dose
 Children under 1 year Penicillin V 125 mg 2 times daily
 Children 1 to < 6 years Penicillin V 250 mg 2 times daily
 Children 6 to < 12 years Penicillin V 500 mg 2 times daily
 Children 12 years and over and adults Penicillin V 1 gram 2 times daily

Treatment of patients who are allergic to penicillin  

Macrolides, such as azithromycin, are prescribed for patients with pharyngitis who have allergy to penicillin.

 Children Azithromycin 20 mg/kg once daily (max. 500 mg daily) for 3 days 
 Adults Azithromycin 500 mg once daily for 3 days

How to prevent Pharyngitis?

There are some advices that help prevention of pharyngitis:
  • Avoid contact with active pharyngitis patients
  • Wash your hands frequently, especially before and after eating and after coghing or sneezing
  • If soap and water are not available, use alcohol sanitizers
  • Avoid smoking and secondhand smoke

Which foods help with pharyngitis?

In general, you should focs on foods that are soft and easy to swallow to decrease dysphagia.
Also warm foods and fluids help soothe the throat.

Here is a list of some foods that you are advised to eat when you have sore throat that is caused by pharyngitis:

  • Warm meals such as pasta, cooked cereal, macaroni and cheese
  • Gelatin desserts, yogurts, fruit or vegetable smoothies
  • Mashed potatoes, milk, broth and cream-based soups

What foods and drinks should be avoided in pharyngitis?

Any food that could irritate the pharyngeal wall (throat) or is difficult to swallow should be avoided, such as spicy seasonings and sauces, crusty bread, crackers, coffee, sodas, alcohol, dry snack foods, such as potato chips, pretzels, or popcorn, acidic fruits, such as oranges, lemons, lime, tomatoes, and grapefruits.

What is granular pharyngitis?

  • Granular pharyngitis results from chronic irritation to the wall of the pharynx.
  • The most common cause for granular pharyngitis (nowadays) is laryngopharyngeal reflux disorder.
  • Chronic granular pharyngitis is common in smokers, alcoholics and patients with chronic rhinosinusitis and Reflux oesophagitis.
  • Symptoms of granular pharyngitis include burning sore throat, especially when the patient is fatigued, a dry hacking cough, and occasional hoarseness due to the thick tenacious secretions which consist of collections of mucus in clumps.
  • Other symptoms include desire to clear the throat (hawking), dysphagia (difficulty in swallowing) and foreign body sensation in lower part of throat.

How to treat chronic Granular pharyngitis?

  • Avoid predisposing factors
  • Normal saline nasal and postnasal wash, once or twice a day.
  • Anti-reflux drugs such as Omeprazole
  • Antibiotics such as Penicillins

Answers to Frequently Asked Questions "FAQs"

What is viral pharyngitis?
This is pharyngitis caused by a virus, most commonly "adenovirus" and it represents the majority of pharyngitis cases.
Viral pharyngitis doesn't respond to antibiotics, so it takes longer to resolve by some home remedies.

What domain does streptococcus pharyngitis belong to?
Streptococcal pharyngitis is caused by bacteria called Group A Streptococcus (GAS), it responds to antibiotic treatment (espicially Penicillins) as described above.

How do you get bacterial pharyngitis?
Pharyngitis is transmitted by "Droplet" infection (large particles) as in Rhinoviruses and Aerosol (small particles) as in Influenza virus, so you may get infected by one of the following:

  • If a patient with pharyngitis sneezes or coughs near you and you breathe in those droplets
  • If you touch or hold contaminated objects then you touch your mouth or nose
  • If you stay in a place where many people gather can spread the infection from the patient to many contacts
How treat/ get rid of pharyngitis?
You should visit an E.N.T doctor if you have severe symptoms of pharyngitis.
Viral pharyngitis can be treated by simple home measures as described above, while bacterial pharyngitis needs antibiotics as detailed in the table above.

What is acute pharyngitis?
Acute pharyngitis is an inflammatory syndrome that occurs in the pharynx and/or the tonsilsand it is caused by several different groups of microorganisms. 
"Acute" means sudden onset.

It can be part of a generalized upper respiratory tract infection or a specific infection localized to the pharynx.

How to cure viral pharyngitis?
  • Viral pharyngitis can be treated by home rest and over-the-counter analgesics and antipyretics such as Paracetamol or Ibubrufen.
  • Lozenges are helpful to relieve sore throat and scratching.
  • In addition, drinking plenty of fluids espicially warm fluids helps cure.
What is the difference between pharyngitis and laryngitis?
Pharyngitis is inflammation of the bach of pharynx (back of throat) and its main symptom is sore throat, while laryngitis is inflammation of the tissues of the larynx (voice box) and its main symptom is hoarseness of voice.

What is chronic pharyngitis?
Chronic pharyngitis (persistent sore throat) differs from acute pharyngitis in that it lasts for a considerably longer time and does not respond to treatments for acute pharyngitis.

What is "gas" pharyngitis?
GAS pharyngitis refers to bacterial pharyngitis that is caused by Group A Streptococcus, a Gram positive bacterium that is often found in the throat and on other parts of the body such as skin.

GAS usually causes mild illnesses such as strep throat or impetigo, but it can also -rarely- cause severe or even life threatening diseases.

How long does it take for viral pharyngitis to go away?
Mostly, Viral pharyngitis resolves within a week, maximum 10 days.
Home rest and following the above mentioned measures can make it last shorter.

Why does otitis media result in pharyngitis?
Otitis media (middle ear infection) may cause pharyngitis because the Eustachian tube connects the middle ear cavity to the back of the pharynx (back of throat). So, if the middle ear is infected (Otitis media), bacteria can travel down the Eustachian tube and enter into the pharynx where it causes pharyngitis.

How to diagnose pharyngitis?
To reach a diagnosis in a case of pharyngitis, your doctor takes a full medical history of your case, then starts examination to see the signs of pharyngitis that are mentioned in details above.

Your doctor may also request some investigations to confirm diagnosis or to exclude bacterial pharyngitis, such as throat swab culture and complete blood count.

Group a β-hemolytic streptococcal (gabhs) pharyngitis is most common in which age group?
Most commonly between 3 and 10 years old as in Tonsillitis.

What is th most common cause of pharyngitis?
Viruses espicially Rhinovirus (common cold) and adenovirus are the most common causes of pharyngitis and sore throat.

Can you cough mucus when you have pharyngitis?
Yes, if accompanied with respiratory tract infection.

When is pharyngitis common?
Pharyngitis is more common in winter espicially in cold countries, as it is linked to common cold bouts.

How much rest is needed for pharyngitis?
  • In Sore throats caused by viruses, it usually takes a week (less than 10 days) to recover completely
  • In Sore throats caused by mononucleosis  (Ebstein-Bar virus), it may last for a month. Antibiotics are not effective, but corticosteroids can decrease the course of the disease.
  • In Sore throats caused by bacteria , Antibiotics can shorten the duration of a sore throat quickly.

When can a child with acute streptococcal pharyngitis return to school?
 Streptococcal pharyngitis is caused by bacteria, so it responds to antibiotic treatment and the child can improve and become non-contagious 24 hours after taking the first dose of antibiotic, and he can go back to school the next day.

What is myalgia pharyngitis?
Myalgia means muscle pain and it occurs in patients with acute pharyngitis espicially in cases caused by influenza virus or streptococcus bacteria.

It is part of the body's general manifestation of pharyngitis.

Which symptom indicates that a patient's pharyngitis is most likely bacterial and not viral?
Presence of enlarged inflamed neck lymph node, high fever or suppuration.

What is the alternative for patients with GABHS pharyngitis who are allergic to pinicillin? 
Macrolides (azithromycin) is a good choice instead of pcn for those who are allergic.

References

  • Otorhinolaryngology for medical students (Cairo university, ENT department), second edition, 2003.
  • Ozlem E. Tulunay, Laryngitis—Diagnosis and Management, Otolaryngologic Clinics of North America, Volume 41, Issue 2, 2008, Pages 437-451

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