Acute Pharyngitis

Introduction

Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.

Classification

Acute pharyngitis can be categorized based on its underlying cause:

• • Viral: Accounting for 40% to 60% of cases, viral infections are the most prevalent cause. Common cold viruses, influenza, adenovirus, and Epstein-Barr virus (mononucleosis) are among the most common viruses.

• • Bacterial: Responsible for approximately 15% to 30% of cases in adults and 20% to 30% in children, bacterial infections, notably Group A Streptococcus (strep throat), are a significant cause of acute pharyngitis.

• • Other Causes: Fungal pharyngitis, exemplified by candidiasis, may emerge due to prolonged use of antibiotics or inhaled corticosteroids and is more common in immunosuppressed individuals, particularly those with HIV infections.

• • Additional contributing factors: These include dry air, smoking, GERD, allergies, postnasal drip, ET intubation, exposure to chemical fumes, and throat tumors.

Avoiding allergens that can trigger such reactions is crucial to minimize the risk of allergic pharyngitis. It may entail staying indoors when pollen counts are high, maintaining a dust-free living space, and actively preventing exposure to specific allergens.

Clinical Manifestations:

The primary symptom of acute pharyngitis is a sore throat. Additional symptoms may include:

• • Pain or discomfort while swallowing
• • Red, swollen tonsils
• • White patches or pus on the tonsils
• • A hoarse or muffled voice
• • Fever
• • Cough
• • Runny nose
• • Sneezing
• • Body aches
• • Headache

Diagnosis: An accurate diagnosis of acute pharyngitis is vital for determining its cause (viral or bacterial) and initiating timely treatment. Rapid antigen detection testing (RADT) involves swabbing the posterior pharynx and tonsils to collect specimens, enabling early treatment, symptom alleviation, and reduced pathogen transmission. While RADT is specific to strep throat, rapid tests are also available for other infections, such as influenza. Influenza shares respiratory symptoms like fever, sore throat, and fatigue, which can overlap with those of strep throat. Accurate differentiation between these infections is essential for proper treatment and to minimize the spread of infectious pathogens.

If RADT yields a negative result, but the patient still exhibits strep throat symptoms, a throat culture is often preferred to confirm the diagnosis.

In contrast, a throat culture is a more sensitive test. It entails obtaining a sample from the back of the throat and allowing any bacteria present to grow in a laboratory for a few days. This test can accurately diagnose the presence of strep bacteria, even when RADT provides a negative result.

Management

Once a precise diagnosis is established, implementing suitable treatment measures based on the underlying cause accelerates symptom resolution and minimizes the spread of the illness.

• • Viral pharyngitis: Treatment mainly focuses on symptom relief. Analgesic medications, such as aspirin or acetaminophen, taken every 4 to 6 hours, provide relief from severe sore throats. In cases requiring stronger pain control, acetaminophen with codeine can be taken three or four times daily. Gargles with benzocaine may also offer symptom relief in more severe cases. Rest, consumption of warm liquids, throat lozenges, and cool-mist humidifiers are also recommended.

• • Bacterial pharyngitis: Antibiotics are usually prescribed to prevent complications from bacterial pharyngitis. The preferred treatment typically involves penicillin, with a standard recommendation being a 10-day oral regimen of penicillin V potassium. Penicillin injections are reserved for cases where concerns exist about the patient's adherence to oral therapy. In case of allergy to penicillin, other antibiotics such as erythromycin, clarithromycin, or azithromycin may be used.

• • Fungal pharyngitis: Candida infections mandate antifungal antibiotics such as nystatin.

• • Other Causes: Treatment depends on the specific cause and may involve avoiding allergens or irritants or addressing the underlying condition.

Nutritional therapy focuses on meeting the patient's appetite and ensuring comfortable swallowing. A soft or liquid diet is typically recommended, with choices based on the individual's preferences. Cool beverages, warm liquids, and flavored frozen desserts such as ice pops are commonly suggested to alleviate throat discomfort. In instances where severe soreness impedes oral intake of liquids, intravenous (IV) fluids may be necessary. Otherwise, patients are encouraged to consume as much fluid as possible, with a target of at least 2 to 3 liters daily.