Pharyngitis - Causes, Symptoms and Treatments
The most common throat disorder, pharyngitis is an acute or chronic inflammation of the pharynx. It is widespread among adults who live or work industy or very dry environments, use their voices excessively, habitually use tobacco or alcohol, or suffer from chronic sinusitis, persistent coughs, or allergies.
Causes of Pharyngitis:
Pharyngitis is usually caused by respiratory viruses such as rhinovirus, coronavirus, adenovirus, influenza, and parainfluenza viruses. The most common concern is infection due to group A betahemolytic streptococci, because of the associated, preventable risk of rheumatic fever. Other common causes include Mycoplasma and Chlamydia. A host of other bacteria, viruses, fungi, and spirochetes have also been identified as etiologic agents. Mycobacterium tuberculosis is a rare cause of pharyngitis.
Signs and symptoms of Pharyngitis:
Pharyngitis produces a sore throat and slight difficulty in swallowing. Swallowing saliva is usually more painful than swallowing food. Pharyngitis may also cause the sensation of a lump in the throat as well as a constant, aggravating urge to swallow. Associated features may include fever, headache, muscle and joint pain, coryza, and rhinorrhea. Inquire about drooling, any preferred neck position, and pain on extension of the neck. Uncomplicated pharyngitis usually subsides in 3 to 10 days.
Diagnosis of Pharyngitis:
Physical examination of the pharynx reveals generalized redness and inflammation of the posterior wall and red, edematous mucous membranes studded with white or yellow exudate. Exudate is usually confined to the lymphoid areas of the throat, sparing the tonsillar pillars. Bacterial pharyngitis usually produces a large amount of exudate. Assess for anterior vs. posterior cervical adenopathy, gingivitis or necrotic tonsillar ulcers. Associated physical findings, such as viral exanthem, conjunctivitis, petechiae, generalized lymphadenopathy, splenomegaly, or hepatic tenderness, may provide important clues to etiology.
Treatment of Pharyngitis:
There are several approaches to the management of pharyngitis. Deciding factors include the reliability of cultures and rapid tests for streptococci, the incidence of pharyngitis not due to group A beta-hemolytic streptococci, patient followup, medical compliance, and costs.
In acute viral pharyngitis, treatment is usually symptomatic, and consists mainly of rest, warm saline gargles, throat lozenges containing a mild anesthetic, plenty of fluids, and analgesics as needed.If the patient can't swallow fluids, hospitalization may be required for I.V. hydration.
Suspected bacterial pharyngitis requires rigorous treatment with penicillin or another broad-spectrum antibiotic because Streptococcus is the chief infecting microbe. Antibiotic therapy should continue for 48 hours until culture results are known.
If the culture (or a rapid strep test) is positive for group A beta-hemolytic streptococci, or if bacterial infection is suspected despite negative culture results, penicillin therapy should be continued for 10 days. This is to prevent the sequelae of acute rheumatic fever. Erythromycin, amoxicillin, or penicillin are effective. Patients suspected of noncompliance may be given a long-acting parenteral penicillin such as benzathine penicillin. The macrolide antibiotics have also been reported to be successful in shorter-duration regimens. Azithromycin need only be taken for 3 days.
Chronic pharyngitis requires the same supportive measures as acute pharyngitis but with greater emphasis on eliminating the underlying cause, such as an allergen. Preventive measures include adequate humidification and avoiding excessive exposure to air conditioning. In addition, the patient should be urged to stop smoking.
Antibiotic choices for treatment failures are controversial. Alternatives to penicillin include cefuroxime and certain other cephalosporins, dicloxacillin, and amoxicillin with clavulanate. In cases of prior severe penicillin reaction, cephalosporins should probably be avoided. The cross reaction is believed to be higher than the overall 8% rate.
Special considerations and Prevention tips of Pharyngitis:
1. Administer analgesics and warm saline gargles as appropriate.
2. Encourage the patient to drink plenty of fluids. Monitor intake and output scrupulously, and watch for signs of dehydration. Assess skin turgor, mucous membranes and, in young children, tearing.
3. Provide meticulous mouth care to prevent dry lips and oral pyoderma, and maintain a restful environment.
4. Elevate the patient's head with three or four pillows.
5. Obtain throat cultures, and administer antibiotics as required if the patient has acute bacterial pharyngitis.
6. Teach the patient with chronic pharyngitis how to minimize sources of throat irritation in the environment, such as using a bedside humidifier.
7. Refer the patient to a self-help group to stop smoking, if appropriate.
8. In severe cases, anesthetic gargles and lozenges (such as benzocaine) may provide additional symptomatic relief.
Stress to patients the importance of completing the 10-day course of antibiotics regardless of symptom response. Patients are presumed to be noninfectious after 24 hours of antibiotic coverage.
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