Pharyngitis: Difference between revisions
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In [[medicine]], '''pharyngitis''' is "inflammation of the throat (pharynx)."<ref>{{MeSH}}</ref> | In [[medicine]], '''pharyngitis''' is an upper [[respiratory tract infection]] that is "inflammation of the throat (pharynx)."<ref>{{MeSH}}</ref> | ||
==Causes== | ==Causes== | ||
| Line 7: | Line 7: | ||
The majority of pharyngtis is caused by viral infection. | The majority of pharyngtis is caused by viral infection. | ||
===Bacterial=== | ===Bacterial=== | ||
Group A β-hemolytic streptococcus ([[streptococcus pyogenes]]). | |||
''[[Fusobacterium necrophorum]]'' may be as common as group A β-hemolytic streptococcus and can cause [[Lemierre syndrome]].<ref name="pmid19949147">{{Cite journal | volume = 151 | issue = 11 | pages = 812-815 | last = Centor | first = Robert | title = Expand the Pharyngitis Paradigm for Adolescents and Young Adults | journal = Annals of Internal Medicine | accessdate = 2009-12-01 | date = 2009-12-01 | url = http://www.annals.org/content/151/11/812.abstract | pmid=19949147 }}</ref> Lemierre syndrome is "suppurative thrombophlebitis of the internal jugular vein, bacteremia, and metastatic infections."</ref> | |||
===Chemical and physical agents=== | ===Chemical and physical agents=== | ||
{{r|Aspiration burns}} | {{r|Aspiration burns}} | ||
| Line 12: | Line 16: | ||
{{r|Swallowed caustics}} | {{r|Swallowed caustics}} | ||
{{r|Bulimia}} | {{r|Bulimia}} | ||
==Differential diagnosis== | |||
==Diagnosis== | |||
Diagnosis has been reviewed by the [[Rational Clinical Examination]] who noted the Centor criteria.<ref name="pmid11147989">{{cite journal| author=Ebell MH, Smith MA, Barry HC, Ives K, Carey M| title=The rational clinical examination. Does this patient have strep throat? | journal=JAMA | year= 2000 | volume= 284 | issue= 22 | pages= 2912-8 | pmid=11147989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11147989 }} </ref> | |||
Centor criteria:<ref name="pmid22566485">{{cite journal| author=Fine AM, Nizet V, Mandl KD| title=Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis. | journal=Arch Intern Med | year= 2012 | volume= | issue= | pages= | pmid=22566485 | doi=10.1001/archinternmed.2012.950 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22566485 }} </ref> | |||
* [[fever]] | |||
* No cough | |||
* Tonsilar exudate | |||
* Tender anterior cervical lymph nodes | |||
The McIsaac criteria adds to the Centor:<ref name="pmid22566485">{{cite journal| author=Fine AM, Nizet V, Mandl KD| title=Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis. | journal=Arch Intern Med | year= 2012 | volume= | issue= | pages= | pmid=22566485 | doi=10.1001/archinternmed.2012.950 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22566485 }} </ref> | |||
* Age less than 15: add one point | |||
* Age greater than 45: subtract one point | |||
According to the [[Centers for Disease Control and Prevention]]: | |||
* 0 points: do not test nor treat | |||
* 1 points: do not test nor treat | |||
* 2 points: rapid test and treat if positive | |||
* 3 points | |||
** Option 1: rapid test and treat if positive | |||
** Option 2: treat empirically | |||
* 4 points: treat empirically | |||
===Differential diagnosis=== | |||
{{r|Angioedema}} | {{r|Angioedema}} | ||
Pharyngitis caused by [[Fusobacterium necrophorum]] may lead to [[Lemierre syndrome]].<ref name="pmid19949147"/> | |||
==Treatment== | ==Treatment== | ||
Antibiotics may be used for patients with sufficient likelihood of streptococcal infection.<ref name="pmid15069046">{{cite journal| author=McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE| title=Empirical validation of guidelines for the management of pharyngitis in children and adults. | journal=JAMA | year= 2004 | volume= 291 | issue= 13 | pages= 1587-95 | pmid=15069046 | doi=10.1001/jama.291.13.1587 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15069046 }} </ref> | |||
Losenges with [[amylmetacresol]] and 2,4-dichlorobenzyl alcohol may help.<ref name="pmid19849767">{{cite journal| author=McNally D, Simpson M, Morris C, Shephard A, Goulder M| title=Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised controlled trial. | journal=Int J Clin Pract | year= 2010 | volume= 64 | issue= 2 | pages= 194-207 | pmid=19849767 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19849767 | doi=10.1111/j.1742-1241.2009.02230.x }} </ref> | |||
[[Corticosteroid]]s, such as [[prednisone]] 60 mg by mouth for one or two days may reduce symptoms among patients with severe pharyngitis.<ref name="pmid19661138">{{cite journal| author=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P| title=Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. | journal=BMJ | year= 2009 | volume= 339 | issue= | pages= b2976 | pmid=19661138 | [[Corticosteroid]]s, such as [[prednisone]] 60 mg by mouth for one or two days may reduce symptoms among patients with severe pharyngitis.<ref name="pmid19661138">{{cite journal| author=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P| title=Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. | journal=BMJ | year= 2009 | volume= 339 | issue= | pages= b2976 | pmid=19661138 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19661138 | pmc=PMC2722696 | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19661138 | pmc=PMC2722696 | ||
| Line 20: | Line 55: | ||
==References== | ==References== | ||
<references/> | <references/>[[Category:Suggestion Bot Tag]] | ||
Latest revision as of 11:00, 3 October 2024
In medicine, pharyngitis is an upper respiratory tract infection that is "inflammation of the throat (pharynx)."[1]
Causes
Viral
The majority of pharyngtis is caused by viral infection.
Bacterial
Group A β-hemolytic streptococcus (streptococcus pyogenes).
Fusobacterium necrophorum may be as common as group A β-hemolytic streptococcus and can cause Lemierre syndrome.[2] Lemierre syndrome is "suppurative thrombophlebitis of the internal jugular vein, bacteremia, and metastatic infections."</ref>
Chemical and physical agents
- Aspiration burns [r]: Add brief definition or description
- Inhalation burns [r]: Add brief definition or description
- Swallowed caustics [r]: Add brief definition or description
- Bulimia [r]: Add brief definition or description
Diagnosis
Diagnosis has been reviewed by the Rational Clinical Examination who noted the Centor criteria.[3]
Centor criteria:[4]
- fever
- No cough
- Tonsilar exudate
- Tender anterior cervical lymph nodes
The McIsaac criteria adds to the Centor:[4]
- Age less than 15: add one point
- Age greater than 45: subtract one point
According to the Centers for Disease Control and Prevention:
- 0 points: do not test nor treat
- 1 points: do not test nor treat
- 2 points: rapid test and treat if positive
- 3 points
- Option 1: rapid test and treat if positive
- Option 2: treat empirically
- 4 points: treat empirically
Differential diagnosis
- Angioedema [r]: Allergic skin reaction causing localized redness, swelling, and itching. [e]
Pharyngitis caused by Fusobacterium necrophorum may lead to Lemierre syndrome.[2]
Treatment
Antibiotics may be used for patients with sufficient likelihood of streptococcal infection.[5]
Losenges with amylmetacresol and 2,4-dichlorobenzyl alcohol may help.[6]
Corticosteroids, such as prednisone 60 mg by mouth for one or two days may reduce symptoms among patients with severe pharyngitis.[7][8]
References
- ↑ Anonymous (2024), Pharyngitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 Centor, Robert (2009-12-01). "Expand the Pharyngitis Paradigm for Adolescents and Young Adults". Annals of Internal Medicine 151 (11): 812-815. PMID 19949147. Retrieved on 2009-12-01.
- ↑ Ebell MH, Smith MA, Barry HC, Ives K, Carey M (2000). "The rational clinical examination. Does this patient have strep throat?". JAMA 284 (22): 2912-8. PMID 11147989. [e]
- ↑ 4.0 4.1 Fine AM, Nizet V, Mandl KD (2012). "Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis.". Arch Intern Med. DOI:10.1001/archinternmed.2012.950. PMID 22566485. Research Blogging.
- ↑ McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE (2004). "Empirical validation of guidelines for the management of pharyngitis in children and adults.". JAMA 291 (13): 1587-95. DOI:10.1001/jama.291.13.1587. PMID 15069046. Research Blogging.
- ↑ McNally D, Simpson M, Morris C, Shephard A, Goulder M (2010). "Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised controlled trial.". Int J Clin Pract 64 (2): 194-207. DOI:10.1111/j.1742-1241.2009.02230.x. PMID 19849767. Research Blogging.
- ↑ Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P (2009). "Corticosteroids for pain relief in sore throat: systematic review and meta-analysis.". BMJ 339: b2976. PMID 19661138. PMC PMC2722696.
- ↑ Kiderman A, Yaphe J, Bregman J, Zemel T, Furst AL (March 2005). "Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice". Br J Gen Pract 55 (512): 218–21. PMID 15808038. PMC 1463093. [e]