Pharyngitis
Pharyngitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
The most common throat disorder, pharyngitis is an acute or chronic inflammation of the pharynx. It frequently accompanies the common cold.
Causes and incidence
Pharyngitis is usually caused by a virus. The most common bacterial cause is group A beta-hemolytic streptococci. Other common causes include Mycoplasma and Chlamydia. In up to 30% of cases, no organism is identified.
Pharyngitis is widespread among adults who live or work in dusty or very dry environments, use their voices excessively, habitually use tobacco or alcohol, or suffer from chronic sinusitis, persistent coughs, or allergies.
Signs and symptoms
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 mild fever, headache, muscle and joint pain, coryza, and rhinorrhea. Uncomplicated pharyngitis usually subsides in 3 to 10 days.
PEDIATRIC TIP More than 90% of cases of sore throat and fever in children are of viral origin. Associated symptoms usually include runny nose and nonproductive cough.
Diagnosis
Physical examination of the pharynx reveals generalized redness and inflammation of the posterior wall, and red, edematous mucous membranes studded with white or yellow follicles. Exudate is usually confined to the lymphoid areas of the throat, sparing the tonsillar pillars. Bacterial pharyngitis usually produces a large amount of exudate.
A throat culture may be performed to identify bacterial organisms that may be the cause of the inflammation.
Treatment
Treatment for acute viral pharyngitis 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, I.V. hydration may be required.
Suspected bacterial pharyngitis requires rigorous treatment with penicillin or another broad-spectrum antibiotic because Streptococcus is the chief infecting organism. Antibiotic therapy should continue for 48 hours until culture results are back. 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.
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.
Special considerations
❑ Administer analgesics and warm saline gargles, as ordered and as appropriate.
❑ Encourage the patient to drink plenty of fluids. Scrupulously monitor intake and output, and watch for signs of dehydration.
❑ Provide meticulous mouth care to prevent dry lips and oral pyoderma, and maintain a restful environment.
❑ Obtain throat cultures, and administer antibiotics as needed. If the patient has acute bacterial pharyngitis, emphasize the importance of completing the full course of antibiotic therapy.
❑ Teach the patient with chronic pharyngitis how to minimize sources of throat irritation in the environment such as by using a bedside humidifier.
❑ Refer the patient to a self-help group to stop smoking if appropriate.
❑ Children attending school should receive at least 24 hours of therapy before being allowed to return to school.
❑ If the patient has exhibited three or more documented bacterial infections within 6 months, consider daily penicillin prophylaxis during the winter months. Also, consider treatment of carriers who live in closed or semiclosed communities.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Gag reflex abnormalities [Pharyngeal reflex abnormalities] (Professional Guide to Signs & Symptoms (Fifth Edition))
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