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| ==Overview== | | ==Overview== |
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| | [[Pharyngitis]] can be classified based on the duration as [[acute pharyngitis]] or chronic pharyngitis. Additionally, pharyngitis may be classified broadly according to the causative agent as [[infectious]] or [[non-infectious]]. |
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| ==Classification== | | ==Classification== |
| Pharngitis can be classified according to the causative agent.
| | [[Pharyngitis]] is a type of [[inflammation]], most commonly caused by an [[upper respiratory tract infection]]. It may be classified as acute or chronic. |
| | * [[Acute pharyngitis]] may be [[catarrh]]al, [[purulent]] or [[ulcerative]], depending on the causative [[agent]] and the [[immune]] capacity of the affected individual. |
| | * [[Chronic pharyngitis]] may be [[catarrhal]], [[hypertrophic]] or [[atrophic]]. |
| | Pharyngitis can be classified according to the causative agent.<ref name="pmid22338589">Murray RC, Chennupati SK (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22338589 Chronic streptococcal and non-streptococcal pharyngitis.] ''Infect Disord Drug Targets'' 12 (4):281-5. PMID: [https://pubmed.gov/22338589 22338589]</ref><ref name="pmid12841012">Chazan B, Shaabi M, Bishara E, Colodner R, Raz R (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12841012 Clinical predictors of streptococcal pharyngitis in adults.] ''Isr Med Assoc J'' 5 (6):413-5. PMID: [https://pubmed.gov/12841012 12841012]</ref> |
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| {| class="wikitable" | | {| class="wikitable" |
| |- | | |- |
| !Classification of pharyngitis | | ! colspan="2" |Classification of pharyngitis |
| !
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| |- | | |- |
| |Catarrhal pharyngitis | | ! style="width: 50%;" |Infectious pharyngitis |
| |Viral pharyngitis | | ! style="width: 50%;" |Non infectious pharyngitis |
| |- | | |- |
| |Exudative pharyngitis | | | valign = top | |
| |* Purulent exudative (e.g. Group A streptococcus)
| | *[[Catarrhal]] pharyngitis |
| |* Viral infections (e.g. Adenovirus, EBV)
| | ** [[Viral pharyngitis]] |
| |-
| | * [[Exudative]] pharyngitis |
| |Membranous pharyngitis
| | ** [[Purulent]] exudative (e.g. [[Group A streptococcus]]) |
| |Diphtheria
| | ** Viral infections (e.g. [[Adenovirus]], [[EBV]]) |
| |-
| | *Membranous pharyngitis |
| |Pseudomembranous pharyngitis
| | ** [[Diphtheria]] |
| |* EBV * Lysteriosis * Syphilis * Leukemia * Oropharyngeal candidiasis
| | *[[Pseudomembranous]] pharyngitis |
| |-
| | ** [[EBV]] |
| |Herpetic pharyngitis
| | ** [[Listeriosis]] |
| |* HSV *Enterovirus
| | ** [[Syphilis]] |
| | | ** Oropharyngeal [[candidiasis]] |
| | *[[Herpetic]] pharyngitis |
| | ** [[HSV]] |
| | ** [[Enterovirus]] |
| | | valign = top | |
| | * [[Gastroesophageal reflux disease]] (GERD) |
| | * Periodic [[fever]], [[aphthous ulcers]], pharyngitis and [[adenitis]] (PFAPA) syndrome |
| | * [[Kawasaki disease]] |
| | * [[Systemic lupus erythematosis]] |
| | * [[Stevens-Johnson syndrome]] |
| | * [[Leukemia]] |
| | * [[Radiation injury|Radiation]] damage |
| | * [[Burnt]] paryngitis |
| |} | | |} |
| ===Viral sore throats===
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| These comprise about 90% of all infectious cases and can be a feature of many different types of viral infections.
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| *[[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 is very painful.
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| *[[Orthomyxoviridae]] which cause [[influenza]] - present with rapid onset high temperature, headache and generalized ache. A sore throat may be associated.
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| *[[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.
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| *[[Herpes simplex virus]] can cause multiple [[mouth ulcers]].
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| *[[Measles]]
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| *[[Common cold]]
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| *INFECTIOUS MONONUCLEOSIS: Infectious mononucleosis is most common in patients 15 to 30 years of age. Patients typically present with fever, sore throat, and malaise. On examination, there is pharyngeal injection with exudates. Posterior cervical lymphadenopathy is common in patients with infectious mononucleosis, and its absence makes the diagnosis much less likely. Hepatosplenomegaly also may be present.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref>
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| ===Bacterial sore throats===
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| ====Group A streptococcal====
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| :''See also [[Strep throat]]''
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| The most common bacterial agent is [[streptococcus]]. Unlike adenovirus, there tends to be greater generalized symptoms and more signs to find. Typically enlarged and tender lymph glands, with bright red inflamed and swollen throat, the patient may have a high temperature, headache, and aching muscles ([[myalgia]]) and joints ([[arthralgia]]).
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| It may be impossible to distinguish between viral and bacterial causes of sore throat.<ref name="pmid1565052">{{cite journal |author=Del Mar C|title=Managing sore throat: a literature review. I. Making the diagnosis |journal=Med. J. Aust. |volume=156 |issue=8 |pages=572-5 |year=1992 |pmid=1565052|doi=}}</ref>
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| Some immune-system meditated complications may occur:
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| * [[Scarlet fever]] with its vivid [[rash]], although the milder disease seen after the 1950's suggests that the bacteria may have mutated to less virulent illness and some doctors now call this ''[[scarlatina]]'' (literally a 'little scarlet fever')
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| * Historically the most important complication was of the generalized inflammatory disorder of [[rheumatic fever]] which could later result in ''[[Rheumatic fever#Complications|rheumatic heart disease]]'' affecting the valves of the heart. Antibiotics may reduce the incidence of this complication to under one-third.<!--
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| --><ref name="pharyngitis-cochrane">{{cite journal | author=Del Mar CB, Glasziou PP, Spinks AB. | title=Antibiotics for sore throat | journal=The[[Cochrane Library|Cochrane Database of Systematic Reviews]] | year=2004 | issue=Issue 2 | pages=Art. No.: CD000023.pub2 |id={{doi|10.1002/14651858.CD000023.pub2}} | url=http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html}} - Meta-analysis of published research</ref><!--
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| -->However, the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.<!--
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| --><ref>{{cite journal | title=Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help | journal=CMAJ |month=September 28 | year=2004 | volume=171 | issue=7 | id={{doi|10.1503/cmaj.1041275}} | url=http://www.cmaj.ca/cgi/content/full/171/7/721}} - Canadian Medical Association Journal commentary on Cochrane analysis</ref><!--
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| --><ref>{{cite journal | title=Treatment of sore throat in light of the Cochrane verdict: is the jury still out? | journal=MJA | year=2002 | volume=177 |issue=9 | pages=512-515| url=http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html}} - Medical Journal of Australia commentary on Cochrane analysis</ref><!--
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| -->This may be a result of a change in the prevalence of various strains of bacteria. In underdeveloped regions, untreated streptococcal infection can still give rise to rheumatic heart disease and may be due to environmental factors, or reflect a genetic predisposition of the patient to the disease.
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| * [[Glomerulonephritis|Post-streptococcal glomerulonephritis]] is an inflammation of the kidney. It is disputed whether antibiotics might reduce<!--
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| --><ref>{{cite journal | author = Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, Porowski T | title = [The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] | journal = Wiad Lek | volume = 54 |issue = 1-2 | pages = 56-63 | year = 2001 | id = PMID 11344703}}</ref><!--
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| --> the small risk of this or not.<!--
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| --><ref name="pharyngitis-cochrane" />
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| * Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening [[septicaemia]] ([[Lemierre's syndrome]]).
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| ====Diphtheria====
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| [[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.
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Needs content]] | | {{WS}}{{WH}} |
| [[Category:Emergency medicine]] | | |
| [[Category:Primary care]] | | [[Category:Emergency mdicine]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Inflammations]]
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| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
| [[Category:Pulmonology]] | | [[Category:Pediatrics]] |
| | [[Category:Immunology]] |
| | [[Category:Gastroenterology]] |