Symptoms usually vary depending on whether it is a viral or bacterial infection. They may also vary from mild to severe.

In case of viral pharyngitis, the symptoms include the following:

• Sore throat
• Redness of eye
• Cough and hoarseness
• Abdominal pain
• Runny nose

Patients suffering from bacterial pharyngitis usually present with the following features:

• Fever
• Body ache
• Generalized body sickness
• Enlarged tonsils with white spots
• Swollen, tender lymph nodes in front of the neck
• Edema, erythema and lymphoid hyperplasia may also be present.

Children usually present with diarrhea, loss of appetite, conjunctivitis, cough, and fever as high as 105 F [5]. In severe cases, there may be dysphagia for fluids and even for saliva [6].

Patients with fungal infections present with oral thrush in most of the cases.

• Cervical Lymphadenopathy

  Assess hydration status fever oral/pharyngeal ulcers (coxsackie virus) tonsillar exudates tender anterior cervical lymphadenopathy hepatosplenomegaly (EBV) scarlet-fever type rash - blanching, sandpaper-like rash, usually more prominent in skin creases [rch.org.au]

  Posterior cervical lymphadenopathy is common in patients with infectious mononucleosis, and its absence makes the diagnosis much less likely. [aafp.org]

  One of the most commonly used scoring system is the Centor Score, assigning points for tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough and history of fever. [rhdaction.org]

• Fever

  Temperature: Fever is usually absent or low-grade in viral pharyngitis, but fever is not reliable to differentiate viral or bacterial etiologies. [web.archive.org]

  fever in these settings. [doi.org]

  Nonsuppurative complications include rheumatic fever and poststreptococcal glomerulonephritis. Figure 35-2 Scarlatiniform rash in scarlet fever. This 7-year-old boy has a typical sandpaper rash with his strep throat and fever. [accessmedicine.mhmedical.com]

• Chills

  In addition to a sore, dry, or scratchy throat, a cold or flu may cause: sneezing runny nose headache cough fatigue body aches chills fever (a low-grade fever with a cold and higher-grade fever with the flu) In addition to a sore throat, the symptoms [healthline.com]

  A 27-year-old woman complains of 2 days of sore throat, fever, and chills. She is unable to swallow anything other than liquids because of severe odynophagia. She denies any congestion or cough. [accessmedicine.mhmedical.com]

• Pharyngitis

  […] chronic pharyngitis chronic pharyngitis and nasopharyngitis chronic sore throat pharyngeal disease inflamed throat throatitis Sore Throat throat inflammation edit English pharyngitis type of upper respiratory tract infection Persistent sore throat Pharyngeal [wikidata.org]

  Airway obstruction is also of utmost importance for the ED physician treating pharyngitis. Pathophysiology With infectious pharyngitis, bacteria or viruses may directly invade the pharyngeal mucosa, causing a local inflammatory response. [web.archive.org]

  Prevalence estimates for GAS+ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level. [ncbi.nlm.nih.gov]

• Sore Throat

  From Wikidata Jump to navigation Jump to search type of upper respiratory tract infection Persistent sore throat Pharyngeal disorder Pharyngitis - acute Sore throat - chronic acute pharyngitis acute sore throat acute sore throat NOS chronic pharyn/nasopharyngitis [wikidata.org]

  Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat Comparison 2. [doi.org]

  RESULTS: A total of 101 patients with sore throat were tested with 26 (25.7%) positive for GAS. One hundred and forty-seven patients without sore throat were tested with one positive POC test result (specificity 99%; 95% CI 96-100). [ncbi.nlm.nih.gov]

  […] right away if you have a sore throat and trouble breathing. [nlm.nih.gov]

• Cough

  Patients often have a cough. Occasional outbreaks have been reported. M pneumoniae in young adults presents with headache, pharyngitis, and lower respiratory symptoms. [web.archive.org]

  Hallmarked by acute onset of sore throat; the absence of cough, nasal congestion and discharge suggests a bacterial aetiology. Rapid antigen detection tests allow immediate point-of-care assessment of group A Streptococcus (GAS) pharyngitis. [bestpractice.bmj.com]

  Cough and rhinorrhea are generally absent. [cdemcurriculum.com]

  There is the urge to clear the throat, cough and harke. Often, the symptoms are worst in the morning. [healthanddisease.com]

  […] spaces Using correct coughing and sneezing technique, such as coughing or sneezing into a tissue and disposing it, or into the inner side of the upper arm Do not share food or drinks with infected individuals Regularly clean the sleeping and living areas [dovemed.com]

• Stridor

  Symptoms include a “barking” cough, stridor, hoarseness, and potentially dyspnea. Anteroposterior radiography may show subglottic narrowing (steeple sign). A peritonsillar abscess may lead to similar symptoms as retropharyngeal abscess. [aafp.org]

  However, a child who appears seriously ill or has stridor or any other respiratory symptoms should not be transported to the x-ray suite. [msdmanuals.com]

  […] cervical lymphadenopathy hepatosplenomegaly (EBV) scarlet-fever type rash - blanching, sandpaper-like rash, usually more prominent in skin creases, flushed face/cheeks with peri-oral pallor (GAS) Red flags unwell/toxic appearance respiratory distress stridor [rch.org.au]

  Uncomplicated infectious pharyngitis, both viral and bacterial, typically is self-limited to 5 to 7 days, is not progressive, is bilateral, does not have trismus, and does not have evidence of airway obstruction (stridor). [ncbi.nlm.nih.gov]

  If stridor is present, consider a foreign body or epiglottitis. If the patient is drooling, the patient may be in severe pain, or consider a foreign body or epiglottitis. If the voice is abnormal, consider several processes. [cdemcurriculum.com]

• Throat Irritation

  Breathing through your mouth — often because of chronic nasal congestion — also can cause a dry, sore throat. Irritants. Outdoor air pollution can cause ongoing throat irritation. [mayoclinic.org]

  Habitual throat clearing or coughing could also lead to irritation of the posterior pharynx. A person who strains their voice when yelling or speaking for long periods of time may complain of a sore throat. [antimicrobe.org]

• Dysphagia

  […] beta-lactams Azithromycin PO Children: 12mg/kg once daily (max 500mg) Adults: 500mg once daily 5 days ** second line therapy for improved compliance Management of suppurative complications Disease Management Peritonsillar abscess (Quinsy) Odynophagia/Dysphagia [rch.org.au]

  […] in patients with retropharyngeal abscess can be as high as 50 percent. 2 The retropharyngeal space is a potential area of infection, but normally regresses by six years of age. 3 In adults, retropharyngeal abscess commonly causes sore throat, fever, dysphagia [aafp.org]

  An 83-year-old man with well-controlled diabetes mellitus and hypertension was admitted due to dyspnea, odynophagia, and dysphagia. [ncbi.nlm.nih.gov]

  PHARYNGITISPHARYNGITIS • HISTORYHISTORY – Classic symptoms →Classic symptoms → Fever, throat pain, dysphagiaFever, throat pain, dysphagia VIRAL →VIRAL → Most likely concurrent URI symptoms ofMost likely concurrent URI symptoms of rhinorrhearhinorrhea [de.slideshare.net]

  – Features common to all types of pharyngitis: throat pain and dysphagia (difficulty swallowing), with or without fever. – Specific features, depending on the cause: Common forms: • Erythematous (red throat) or exudative (red throat and whitish exudate [medicalguidelines.msf.org]

• Tonsillar Exudate

  On examination, she has bilateral tonsillar erythema and exudate ( Figure 35-1 ). Her anterior cervical lymph nodes are tender. [accessmedicine.mhmedical.com]

  PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for [ncbi.nlm.nih.gov]

• Exudative Pharyngitis

  On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. [ncbi.nlm.nih.gov]

  Erythematous or exudative pharyngitis may also be associated with gonococcal or primary HIV infection. [medicalguidelines.msf.org]

  Exudative - group A streptococcus is the most common bacterial cause of exudative and nonexudative pharyngitis. Beta-hemolytic streptococci in groups C and G have also been associated with exudative pharyngitis and tonsillitis. [healthcentral.com]

  In addition to exudative pharyngitis, it is often accompanied by disseminated lymphadenopathy and splenomegaly. [empendium.com]

  […] antibiotics muddy the data A meta-analysis of 8 RCTs enrolling 743 patients (369 children and 374 adults) found that oral and intramuscular steroids reduce duration and intensity of pain in moderate to severe pharyngitis and exudative pharyngitis. 3 [mdedge.com]

• Palatal Petechiae

  Tonsillopharyngeal/palatal petechiae are seen in GAS infections and infectious mononucleosis. [web.archive.org]

  Odynophagia, palatal petechiae, and season of the year (autumn and winter) were positively associated with SP (p = 0.007, p < 0.001 and p = 0.03 respectively). [scielo.conicyt.cl]

  It is much more likely to have pharyngeal and tonsillar inflammation (mucosal erythema and edema), palatal petechiae, well-demarcated pharyngeal/tonsillar exudates ( Figure. Streptococcal pharyngitis. ), and associated cervical lymphadenopathy. [empendium.com]

  On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis [cdc.gov]

• Erythema

  On examination, she has bilateral tonsillar erythema and exudate ( Figure 35-1 ). Her anterior cervical lymph nodes are tender. [accessmedicine.mhmedical.com]

  PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for [ncbi.nlm.nih.gov]

  HIV-1: This is associated with pharyngeal edema and erythema, common aphthous ulcers, and a rarity of exudates. Fever, myalgia, and lymphadenopathy also are found. [web.archive.org]

  Pharyngeal abscess and tonsillopharyngitis both may cause pharyngeal erythema, exudate, or both. [msdmanuals.com]

• Otalgia

  Six clinical symptom scores, such as the severity of itchy throat, hoarseness, pain, odynophagia, cough and otalgia were evaluated in chronic pharyngitis patients after the oral intake of PCG. [ncbi.nlm.nih.gov]

  dysphagia→ sore throat, fever, otalgia, dysphagia • Physical ExamPhysical Exam → whitish plaques, enlarged/tender→ whitish plaques, enlarged/tender cervical adenopathycervical adenopathy • EtiologyEtiology → GAS, EBV – less commonly HSV→ GAS, EBV – [de.slideshare.net]

  Patients appear ill and generally present with symptoms such as fever, dysphagia, otalgia, and trismus (difficulty or inability to open the mouth). Since even swallowing saliva can be painful, drooling may occur. [journals.lww.com]

• Neck Swelling

  Finally, pediatricians, internists, family physicians, and emergency department physicians should know the red flags for adolescent and young adult pharyngitis: worsening symptoms or neck swelling (especially unilateral neck swelling). [ncbi.nlm.nih.gov]

  The 2 major red flags in adolescent and young adult pharyngitis are worsening symptoms or neck swelling. If the patient has bacteremic symptoms, treat either with a combination of penicillin and metronidazole or with clindamycin alone. [doi.org]

• Headache

  They cause fever, headache, and sore throat that last for 4 to 14 days. Lymphatic tissue in the pharynx may also become involved. Read More [britannica.com]

  Symptoms of headache at day three At day three of the illness, antibiotics reduced symptoms of headache (RR 0.44; 95% CI 0.27 to 0.71) ( Analysis 3.1 ). 3. [doi.org]

  M pneumoniae in young adults presents with headache, pharyngitis, and lower respiratory symptoms. Approximately 75% of patients have a cough, which is distinctive from GAS infection. [web.archive.org]

  Take paracetamol, ibuprofen or aspirin to ease any pain and other symptoms such as a headache. Do NOT give aspirin to children under 16. [medic8.com]

  Sore throat with flu: Fatigue Body aches Chills Fever higher than 102 degrees F Sore throat with mononucleosis: Enlarged lymph nodes in neck and armpits Swollen tonsils Headache Loss of appetite Swollen spleen Liver inflammation Diagnosis of Pharyngitis [everydayhealth.com]

A complete history with thorough examination of the mouth, throat, nose, ears and lymph nodes in front of the neck is necessary. It is hard to differentiate between a viral and bacterial cause based on symptoms alone; however, Centor criteria is helpful in the diagnosis of streptococcal pharyngitis [7] [8].

The following investigations are necessary to establish the diagnosis.

• White blood cell (WBC) count will be raised with predominance of polymorphs.
• Throat culture is the primary method for the diagnosis of streptococcal pharyngitis and the most reliable means of differentiating streptococcal from viral pharyngitis.
• Non-specific tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are of very little importance [9].

The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, viral and fungal infections.

Medications

Antibiotics: The treatment of choice for streptococcal pharyngitis is oral penicillin V (250mg) given 3 times daily for 10 days. This is helpful if bacterial infection is the cause of sore throat [10]. Antibiotics have no effect for a viral infection. Non-compliant patients may be given a single intramuscular injection of benzathine penicillin G, which provides adequate penicillin levels for 10 days. The usual dose is 600,000 units for children weighing less than 25 kg and 1,200,000 units for children weighing 25 kg or more.

Penicillin-allergic patients may be given any of the several alternative antibiotics:

• Oral erythromycin (50 mg/kg/day in three divided doses for 10 days). Or
• Oral cephalosporins such as cephradin or cephalexin (50-100 mg/kg/day in three divided doses for 10 days). Or
• Oral clarithromycin (15 mg/kg/day in two divided doses for 10 days).

If the patient has had three or more documented infections within 6 months, consider daily penicillin prophylaxis during the winter season.

Analgesics: They help reduce soreness of the throat. Most effective analgesics include non-steroidal anti-inflammatory drugs and acetaminophen.

Steroids: They are helpful in severe pharyngitis. Dexamethasone is often used for this purpose.

Idocaine: It helps to relieve pain by numbing the mucous membrane.

Surgery

Surgery should be considered when the patients have frequent episodes of pharyngitis or when the persistently enlarged tonsils cause chronic upper airway obstruction.

Almost all the people with viral and bacterial streptococcal pharyngitis recover completely without complications; so the overall the prognosis is excellent. Streptococcal infection of the throat should always be treated carefully as untreated cases may develop rheumatic fever [4].

There can be infectious or non-infectious causes of pharyngitis.

Infectious

Acute pharyngitis is an oropharyngeal infection. The disease most commonly spreads via contact with infected individuals and droplet infection. The infectious agents may be bacterial, viral or fungal in nature [1].

Viral: These comprise about 40-60% of all the infectious cases. The different kinds of viruses include:

• Adenovirus: This is the most common of the viral causes of pharyngitis in the children below 3 years of age.
• Orthomyxoviridae: This can cause influenza, high grade fever, headache and generalized body ache.
• Herpes simplex virus: It is responsible for mouth ulcers.
• Other viruses include measles, rhinovirus, coronavirus and respiratory syncytial virus.

Bacterial: The different kinds of bacteria include:

• Streptococci: Group A beta-hemolytic streptococc are the most common bacterial cause of acute pharyngitis. Common symptoms include fever, sore throat and large lymph nodes.
• Fusobacterium necrophorum: These organism are normal inhabitants of oropharyngeal flora. However, they may cause peritonsillar abscess in some cases [2].
• Diphtheria: This is a life threatening upper respiratory infection caused by Corynebacteria diphtheria.

Fungal: Sometimes, the oral thrush caused by Candida albicans may extend to involve the pharynx.

Non-infectious

Non-infectious cases of acute pharyngitis result from mechanical, chemical or thermal irritation including cold air or acid reflux. Neoplastic conditions can also cause pharyngitis [3].

Streptococcal pharyngitis is one of the most common respiratory infections of the childhood. The disease is uncommon under the age of 1 year. The peak incidence occurs in children between the age of 5 and 15 years. Pharyngitis in children younger than 2 years of age is often viral. The incidence is higher in the winter and early spring. It is estimated that it affects more than 1.9 million people a year.

Etiologic agents may directly invade or cause irritation to the pharyngeal mucosa, resulting in localized inflammatory reaction or cause secondary irritation.

The following are the known ways of preventing pharyngitis.

• Frequent washing of the hands.
• Avoidance of the sharing of eating utensils or cups with anyone who has a sore throat, flu, common cold or bacterial infection.
• Avoiding both active and passive smoking.
• Using a humidifier if the surrounding air is dry.
• Using vitamin C supplements may also be helpful as it improves components of human immune system such as natural killer cell activity.
• Supplementation of zinc may also be essential as it may be involved directly in antibody production to help you fight infections.

Pharyngitis is the inflammation of the pharynx commonly caused by upper airway infection. The disease can be acute or chronic. In most of the cases, it is quite painful and results in enlarging of the tonsils which cause trouble in swallowing or even in breathing. Due to systemic infection, it may also be associated with cough and fever. Pharyngitis can be viral or bacterial. The most common and clinically significant bacterial cause of acute pharyngitis are group A beta-hemolytic streptococci.

Pharyngitis is the inflammation of the throat (pharynx). Pharyngitis is most often caused by viruses, but can also result from bacterial infection. The main symptom is a dry and sore throat. Other common symptoms include fever, swollen lymph nodes in the neck, cough, headache, pain in the ears and hoarseness. The treatment depends on the cause.

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