Acute Pharyngitis

Aetiology
Acute pharyngitis is very common and occurs due to varied
aetiological factors like viral, bacterial, fungal or others
Viral causes are more common. Acute
streptococcal pharyngitis (due to Group A beta haemolytic
streptococci) has received more importance because of its
aetiology in rheumatic fever and post-streptococcal
glomerulonephritis.
Clinical Features
Pharyngitis may occur in different grades of sever ity.
Milder infections present with discomfort in the throat,
some malaise and low grade fever. Pharynx in these cases
is congested but there is no lymphadenopathy. Moderate
and severe infections present with pain in throat, dysphagia,
headache, malaise and high fever. Pharynx in these
cases shows erythema, exudate and enlargement of to nsi
ls and lympho id follicles on the posterior pharyngea l
walL Ver), severe cases show oedema of soft palate and
uvula with enlargement of cervical nodes.
It is not possible, on clinical examination, to differentiate
viral from bacterial infections but, viral infections are
generally mild and are accompanied by rhinorrhea and
hoarseness while the bacterial ones are severe. Gonococcal
pharyngitis is mild and may even be asymptomatic.
Diagnosis
Culture of throat swab is helpful in the diagnosis of
bacterial pharyngitis. It can detect 90% of Group A
Streptococci. Diphtheria is cultured on special media. Swab
from a suspected case of gonococcal pharyngitis should be
cultured immediately without delay. Failure to get any
bacterial growth suggests a viral ae tiology.

Treatment:

General measures. Bed rest, plenty of fluids, warm
sa line gargles or pharyngea l irrigations and analgesics
form the mainstay of tre atment.
Loca l discomfort in the throat in severe cases can be
relieved by lignocaine v iscous before meals to facilitate
swa llowing.
Specific treatment. Streptococcal pharyngitis (Group
A, be ta-haemo lyticus) is treated with penic illin G,
200,000 to 250,000 units orally four times a day for 10
days or benzathine penic ill in G, 600,000 units once i.m.
for patient <601b in weight and 1.2 million units once
i.m. for patient >60 lb. In penicillin-sensitive individuals,
erythromycin, 20 to 40 mg/kg body weight daily, in divided
oral doses for 10 days is equa lly effec ti ve .
Diphtheria is treated by diphthe ria antitoxin and
administration of pen icillin or erythromycin
Gonococcal pharyngitis responds to conven tional
doses of penicillin or tetracycline.

Pharyngoconjunctival fever. It is caused hy an adenovirus,
and is characterised by sore throat, fe ver and conjunc
ti vitis. There may be pain in abdomen, mimicking
appendicitis.
Acute lymphonodular pharyngitis. It is usually caused by
a coxsackie virus and characterised by fever, malaise and
sore th roat. White-yellow, solid nodules appear on the
posterior pha ryngeal wall in this type of pharyngitis.
Measles and chickenpox also cause pharyngitis. Measles is
characterised by the appearance of Koplik's spots (white
Spots surrounded by red areola) on the buccal mucosa
opposi te the molar tee th . The spots appear 3-4 days before
the appearance of rash .
Fungal Pharyngitis
Candida infection of the oropharynx can occur as an
extension of oral thrush. It is seen in pa tients who are
immunosuppressed, debilitated or taking high doses of
antimicrobials. Often patient complains of pain in the
throat with dysphagia. Nystatin is the drug of choice.
Miscellaneous Causes of Pharyngitis
Chlamydia trachomatis infection causes acute pharyngitis
and can be treated by erythromycin or sulphonamides.
Toxoplasmosis is caused by Toxoplasma gondii, an obligate
intracellular parasite. This infection is very rare.