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Acute pharyngitis
Classification and external resources

Viral pharyngitis.
The oropharynx is swollen and red.
ICD-10 J02., J31.2
ICD-9 462, 472.1
DiseasesDB 24580
MedlinePlus 000655
eMedicine emerg/419
MeSH D010612

Pharyngitis (pronounced /ˌfærɪnˈdʒaɪtɪs/) is an inflammation of the throat or pharynx.[1] In most cases it is painful and the initial infection can extend for a lengthy time period, and is often referred to as a sore throat.

Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic. Pharyngitis can result in very large tonsils which cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough or fever, for example, if caused by an upper respiratory tract infection.

Most acute cases are caused by viral infections (40%–60%), with the remainder caused by bacterial infections, fungal infections, or irritants such as pollutants or chemical substances.[2] Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and anti-fungals respectively.



Acute pharyngitis is one type of upper respiratory tract infection.


The pharynx is a common site of infection. After a person is directly exposed to the causing agent, such as viruses or bacteria, the latter will often settle in this part of the body. Examples of direct contact include inhaling dust or water vapour containing the microorganism.


Viral pharyngitis

These comprise about 40-60% of all infectious cases and can be a feature of many different types of viral infections.[2]

Bacterial pharyngitis

A number of different bacteria can infect the human throat. The most common is Group A streptococcus, however others include, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.[3]

Streptococcal pharyngitis

The most common bacterial agent is streptococcus. It causes about 15-30% of cases of pharyngitis.[3] 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 of sudden onset with severe pain (often the patient finds it painful to talk or swallow), the patient may have a high temperature, headache, and aching muscles (myalgia) and joints (arthralgia). White or yellow spots on the back of the throat may be present on exam. These spots may also appear on the tonsils when those glands are involved.

It may be impossible to distinguish between viral and bacterial causes of sore throat.[4]

Coughing is usually absent in strep throat though a dry, nonproductive cough (similar to how a person clears his or her voice) may appear in some patients; in addition coughing may appear when there is co-infection with a virus. A stuffy nose is also considered uncommon and is more likely due to a virus instead of the strep bacteria.

Some immune-system mediated complications may occur:

  • Scarlet fever with its vivid rash, although the milder disease seen after the 1950s suggests that the bacteria may have mutated to less virulent illness and some doctors now call this scarlatina (literally a "little scarlet fever")
  • Historically the most important complication was of the generalized inflammatory disorder of rheumatic fever which could later result in Rheumatic heart disease affecting the valves of the heart. Antibiotics may reduce the incidence of this complication to under one-third.[5] However, the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.[6][7] 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.
  • Post-streptococcal glomerulonephritis is an inflammation of the kidney. It is disputed whether antibiotics might reduce the small risk of this or not.[5][8]
  • Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening septicaemia (Lemierre's syndrome)
Fusobacterium necrophorum

Fusobacterium necrophorum are normal inhabitants of the oropharyngeal flora. Occasionally however it can create a peritonsillar abscess. In 1 out of 400 untreated cases Lemierre's syndrome occurs.[9]


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.


A few other causes are rare but potentially fatal and include parapharyngeal space infections: peritonsillar abscess ("quinsy"), submandibular space infection (Ludwig's angina) and epiglottitis.[10]

Other causes

Fungal infections

Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.


Treatment can be divided into symptomatic and remedial. Symptomatic treatments attempt to reduce pain and discomfort. Remedial treatments attempt to cure pharyngitis or prevent long term complications such as rheumatic fever.

Remedial treatments are effective for bacterial infections and fungal infection. No specific treatment for viral infections have been found to be effective and most cases will settle within a few days.



  • Antibiotics are useful if a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect. These infections are treated by controlling or relieving symptoms until the virus runs its course.[5]
  • Antiviral drugs are not used except in cases when the patient's immune system is compromised.


Alternative medicines are promoted and used for the treatment of sore throats.[15] Alternative treatments are however poorly supported by evidence, and UpToDate, an evidence-based peer-reviewed resource, recommends that they not be used to treat pharyngitis.[16] The Mayo Foundation specifies that herbal treatments, such as marshmallow root, eucalyptus, and chamomile have limited evidence to support their use.[15]

External links


  1. ^ pharyngitis at Dorland's Medical Dictionary
  2. ^ a b "eMedicine - Pharyngitis : Article by John R Acerra".  
  3. ^ a b Bisno AL (January 2001). "Acute pharyngitis". N. Engl. J. Med. 344 (3): 205–11. PMID 11172144.  
  4. ^ Del Mar C (1992). "Managing sore throat: a literature review. I. Making the diagnosis". Med. J. Aust. 156 (8): 572–5. PMID 1565052.  
  5. ^ a b c Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140.   - Meta-analysis of published research
  6. ^ Ohlsson A, Clark K (2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ 171 (7): 721. doi:10.1503/cmaj.1041275. PMID 15451830.  
  7. ^ Danchin MH, Curtis N, Nolan TM, Carapetis JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". Med. J. Aust. 177 (9): 512–5. PMID 12405896.  
  8. ^ Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]" (in Polish). Wiad. Lek. 54 (1-2): 56–63. PMID 11344703.  
  9. ^ "Expand the Pharyngitis Paradigm for Adolescents and Young Adults — Ann Intern Med".  
  10. ^ "UpToDate Inc.".  
  11. ^ Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract 50 (459): 817–20. PMID 11127175. PMC 1313826.  
  12. ^ PMID 19661138
  13. ^ "BestBets: Do Steroids Reduce Symptoms in Acute Pharyngitis". Retrieved 2009-01-14.  
  14. ^
  15. ^ a b "Sore throat: Self-care -". Retrieved 2007-09-17.  
  16. ^ "UpToDate Inc.". Uptodate.  

1911 encyclopedia

Up to date as of January 14, 2010
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