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Causes of Strep throat
Strep throat as a complication of other conditions:
Other conditions that might have Strep throat as a complication may, potentially, be an underlying cause of Strep throat. Our database lists the following as having Strep throat as a complication of that condition:
Strep throat as a symptom:
Conditions listing Strep throat as a symptom may also be potential underlying causes of Strep throat. Our database lists the following as having Strep throat as a symptom of that condition:
Medications or substances causing Strep throat:
The following drugs, medications, substances or toxins are some of the possible
causes of Strep throat as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Pimecrolimus
- Elidel Cream
- more drugs...»
Read more about medication causes of Strep throat
Related information on causes of Strep throat:
As with all medical conditions, there may be many causal factors. Further relevant information on causes of Strep throat may be found in:
- Risk factors for Strep throat
- Medications that may cause Strep throat
- Contagiousness for Strep throat
- Hidden causes of Strep throat
Causes of Strep throat: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Strep throat.
Sore Throat:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Viral pharyngitis/laryngitis
–Most common cause of sore throat
–Associated with cough, low-grade fever, nasal congestion, and sneezing
–Influenza occasionally causes sore throat with high fever, cough, severe myalgias
–Rhino-, adeno-, coxsackie-, and herpesvirus
–Acute HIV infection
- Mononucleosis
–Associated with fever, headache, and excessive fatigue
–Most common in teen and college ages
–May have associated lymphadenopathy, splenomegaly, hepatitis, or encephalitis - Streptococcal pharyngitis
–May be associated with scarlatiniform rash, fever >101°F (>38.3°C), exudative pharyngitis, tender cervical lymphadenopathy, and absence of cough
–More common in winter months, ages 5–10, and with history of group A Streptococcus exposure - Allergic pharyngitis
- Gonococcal pharyngitis
- Fungal pharyngitis (e.g., Candida)
-
Foreign body in throat
–Most often occurs in smaller children
–Associated with sudden onset of audible wheezing, stridor, drooling - GERD
- Sore throat secondary to postnasal drip
- Irritation secondary to inhalants (e.g., cigarette smoke), chemicals (e.g., alcohol), hot foods
- Voice abuse (e.g., excessive screaming)
- Deep neck space infections (e.g., retropharyngeal abscess, peritonsillar abscess, Ludwig's angina)
-
Epiglottitis/bacterial tracheitis
–Occurs in children ages 2–7 and increasingly in adults - Diphtheria
- Trauma
- Lymphadenitis (cervical)
- Cancer (e.g., tonsillar, tongue, laryngeal, esophageal)
- Caustic ingestions
- Thyroiditis
- Angina/acute coronary syndrome
Source: In a Page: Signs and Symptoms, 2004
Sore Throat:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
–Viral
–Adenovirus
–Rhinovirus
–Parainfluenza
–Influenza
–Coronavirus
–Others: EBV RSV, CMV, HSV
–Bacterial
–Streptococcus
–Haemophilus
–Moraxella
–Staphylococcus
–Corynebacterium
–Fungal
–Candida
-
Inflammatory
–Allergy
–Gastroesophageal reflux disease
–Sinusitis resulting in postnasal drainage -
Tumors
–Leukemia
–Rhabdosarcomas
–Squamous cell carcinoma secondary to oral ulcerations -
Trauma
–Foreign body ingestion
–Caustic ingestion
–Soft tissue injury from accidental and nonaccidental trauma -
Systemic/rheumatologic disorders
–Kawasaki disease: Mucocutaneous lymph node syndrome may have sore throat at presentation (other oral findings include strawberry tongue, fissured lips, mucosal erythema, fever, and lymphadenopathy)
–Behçet syndrome
–Reiter syndrome- Others
–Cigarette smoke
–Environmental pollutants
–Pharyngeal drying: Mouth and pharynx can be dry from mouth breathing, more common in the winter months
- Others
Source: In A Page: Pediatric Signs and Symptoms, 2007
Mouth lesions:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
Actinomycosis is a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
Behçet’s syndrome is a chronic, progressive syndrome that generally affects young males and produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
Candidiasis is a common fungal infection that characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue:This chronic, recurrent disease is most common in women ages 30 to 40.
Erythema multiforme
Erythema multiforme is an acute inflammatory skin disease that produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include a fever, malaise, a cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis is a recurring periodontal condition that causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and a fever.
Herpes simplex I
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by a fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. A fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa that typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal)
Pemphigoid is a rare autoimmune disease that’s characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
Pemphigus is a chronic skin disease that’s characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Typically the result of injury, trauma, or irritation, pyogenic granuloma — a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue — usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Stomatitis, a common disease, is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, a headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, a low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy
Radiation therapy may cause oral lesions.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Throat pain:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Agranulocytosis
With agranulocytosis, sore throat may accompany other signs and symptoms of infection, such as fever, chills, and headache. Typically, it follows progressive fatigue and weakness. Other findings include nausea and vomiting, anorexia, and bleeding tendencies. Rough-edged ulcers with gray or black membranes may appear on the gums, palate, or perianal area.
Bronchitis (acute)
Acute bronchitis may produce lower throat pain associated with fever, chills, cough, and muscle and back pain. Auscultation reveals rhonchi, wheezing and, at times, crackles.
Chronic fatigue syndrome
Chronic fatigue syndrome is a nonspecific symptom complex that’s characterized by incapacitating fatigue. Associated findings besides sore throat include myalgia and cognitive dysfunction.
Common cold
Sore throat may accompany cough, sneezing, nasal congestion, rhinorrhea, fatigue, headache, myalgia, and arthralgia.
Contact ulcers
Common in men with stressful jobs, contact ulcers appear symmetrically on the posterior vocal cords, resulting in sore throat. The pain is aggravated by talking and may be accompanied by referred ear pain and, occasionally, hemoptysis. Typically, the patient also has a history of chronic throat clearing or acid reflux.
Foreign body
A foreign body lodged in the palatine or lingual tonsil and pyriform sinus may produce localized throat pain. The pain may persist after the foreign body is dislodged until mucosal irritation resolves.
Gastroesophageal reflux disease (GERD)
With GERD, an incompetent gastroesophageal sphincter allows gastric juices to enter the hypopharynx and irritate the larynx, causing chronic sore throat and hoarseness. The arytenoids may also appear red and swollen, resulting in a sensation of a lump in the throat.
Influenza
Patients with the flu commonly complain of sore throat, fever with chills, headache, weakness, malaise, muscle aches, cough and, occasionally, hoarseness and rhinorrhea.
Laryngeal cancer
With extrinsic laryngeal cancer, the chief symptom is pain or burning in the throat when drinking citrus juice or hot liquids or a lump in the throat; with intrinsic laryngeal cancer, the chief symptom is hoarseness that persists for longer than 3 weeks. Later signs and symptoms of metastasis include dysphagia, dyspnea, a cough, enlarged cervical lymph nodes, and pain that radiates to the ear.
Mononucleosis (infectious)
Sore throat is one of the three classic findings in this infection. The other two classic signs are cervical lymphadenopathy and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.
Necrotizing ulcerative gingivitis (acute)
Also known as trench mouth, necrotizing ulcerative gingivitis usually begins abruptly with sore throat and tender gums that ulcerate and bleed. A gray exudate may cover the gums and pharyngeal tonsils. Related signs and symptoms include a foul taste in the mouth, halitosis, cervical lymphadenopathy, headache, malaise, and fever.
Peritonsillar abscess
A complication of bacterial tonsillitis, this abscess typically causes severe throat pain that radiates to the ear. Accompanying the pain may be dysphagia, drooling, dysarthria, halitosis, fever with chills, malaise, and nausea. The patient usually tilts his head toward the side of the abscess. Examination may also reveal a deviated uvula, trismus, and tender cervical lymphadenopathy.
Pharyngitis
Whether bacterial, fungal, or viral, pharyngitis may cause sore throat and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral sore throat. Associated signs and symptoms include dysphagia, fever, malaise, headache, abdominal pain, myalgia, and arthralgia. Inspection reveals an exudate on the tonsil or tonsillar fossae, uvular edema, soft palate erythema, and tender cervical lymph nodes.
Also known as thrush, fungal pharyngitis causes diffuse sore throat — commonly described as a burning sensation — accompanied by pharyngeal erythema and edema. White plaques mark the pharynx, tonsil, tonsillar pillars, base of the tongue, and oral mucosa; scraping these plaques uncovers a hemorrhagic base.
With viral pharyngitis, findings include diffuse sore throat, malaise, fever, and mild erythema and edema of the posterior oropharyngeal wall. Tonsillary enlargement may be present along with anterior cervical lymphadenopathy.
Sinusitis (acute)
Sinusitis may cause sore throat with purulent nasal discharge and postnasal drip, resulting in halitosis. Other effects include headache, malaise, cough, fever, and facial pain and swelling associated with nasal congestion.
Tongue cancer
With tongue cancer, the patient experiences localized throat pain that may occur around a raised white lesion or ulcer. The pain may radiate to the ear and be accompanied by dysphagia.
Tonsillar cancer
Sore throat is the presenting symptom in tonsillar cancer. Unfortunately, the cancer is usually quite advanced before the appearance of this symptom. The pain may radiate to the ear and is accompanied by a superficial ulcer on the tonsil or one that extends to the base of the tongue.
Tonsillitis
With acute tonsillitis, mild to severe sore throat is usually the first symptom. The pain may radiate to the ears and be accompanied by dysphagia and headache. Related findings include malaise, fever with chills, halitosis, myalgia, arthralgia, and tender cervical lymphadenopathy. Examination reveals edematous, reddened tonsils with a purulent exudate.
Chronic tonsillitis causes mild sore throat, malaise, and tender cervical lymph nodes. The tonsils appear smooth, pink and, possibly, enlarged, with purulent debris in the crypts. Halitosis and a foul taste in the mouth are other common findings.
Unilateral or bilateral throat pain just above the hyoid bone occurs with lingual tonsillitis. The lingual tonsils appear red and swollen and are covered with exudate. Other findings include a muffled voice, dysphagia, and tender cervical lymphadenopathy on the affected side.
Uvulitis
Uvulitis may cause throat pain or a sensation of something in the throat. The uvula is usually swollen and red but, in allergic uvulitis, it’s pale.
Other causes
Treatments
Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause sore throat.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Gag reflex abnormalities [Pharyngeal reflex abnormalities]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Basilar artery occlusion
Basilar artery occlusion may suddenly diminish or obliterate the gag reflex. It also causes diffuse sensory loss, dysarthria, facial weakness, extraocular muscle palsies, quadriplegia, and a decreased LOC.
Brain stem glioma
Brain stem glioma causes a gradual loss of the gag reflex. Related symptoms reflect bilateral brain stem involvement and include diplopia and facial weakness. Common involvement of the corticospinal pathways causes spasticity and paresis of the arms and legs as well as gait disturbances.
Bulbar palsy
Loss of the gag reflex reflects temporary or permanent paralysis of muscles supplied by CNs IX and X. Other indicators of bulbar palsy include jaw and facial muscle weakness, dysphagia, loss of sensation at the base of the tongue, increased salivation, possible difficulty articulating and breathing, and fasciculations.
Wallenberg’s syndrome
Paresis of the palate and an impaired gag reflex usually develop within hours to days of thrombosis. The patient may experience analgesia and thermanesthesia, occurring ipsilaterally on the face and contralaterally on the body, and vertigo. He may also display nystagmus, ipsilateral ataxia of the arm and leg, and signs of Horner’s syndrome (unilateral ptosis and miosis, hemifacial anhidrosis).
Other causes
Anesthesia
General and local (throat) anesthesia can produce temporary loss of the gag reflex.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Acute poststreptococcal glomerulonephritis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
APSGN results from the entrapment and collection of antigen-antibody (produced as an immunologic mechanism in response to streptococcus) in the glomerular capillary membranes, inducing inflammatory damage and impeding glomerular function. Sometimes, the immune complement further damages the glomerular membrane. The damaged and inflamed glomerulus loses the ability to be selectively permeable, and allows red blood cells (RBCs) and proteins to filter through as the glomerular filtration rate (GFR) falls. Uremic poisoning may result.
APSGN is most common in males ages 3 to 7, but it can occur at any age. Incidence is rising in the United States and Europe, with epidemics occurring in developing countries in Africa, the West Indies, and the Middle East.
Up to 95% of children and up to 70% of adults with APSGN recover fully; the rest may progress to chronic renal failure within months.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pharyngitis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
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.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Throat abscesses:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Peritonsillar abscess is a complication of acute tonsillitis, usually after streptococcal or staphylococcal infection. It occurs more commonly in adolescents and young adults than in children.
Acute retropharyngeal abscess results from infection in the retropharyngeal lymph glands, which may follow an upper respiratory tract bacterial infection. Most common pathogens are beta-hemolytic Streptococcus and Staphylococcus aureus. These lymph glands begin to atrophy after age 2. Acute retropharyngeal abscess most commonly affects infants and children younger than age 2.
Chronic retropharyngeal abscess may result from tuberculosis of the cervical spine (Pott’s disease) and may occur at any age.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Mouth lesions:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome (AIDS)
Oral lesions may be an early indication of the immunosuppression that’s characteristic of this disease. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate and may appear initially as an asymptomatic, flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial)
This chronic fungal infection typically produces small, firm, flat, usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet’s syndrome
This chronic, progressive syndrome that generally affects young males produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis
This common fungal infection characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Gender Cue: This chronic, recurrent disease is most common in women ages 30 to 40.
Epulis (giant cell)
This rare tumor or growth occurs on the gingival or alveolar process, anterior to the molars. Dark red, pedunculated or sessile, and 0.5 to 1.5 cm in diameter, it commonly ulcerates to produce a concave defect in the underlying bone. Gingivae bleed easily with slight trauma.
Erythema multiforme
This acute inflammatory skin disease produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgias, arthralgias, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
This recurring periodontal condition causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
Painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
This common viral infection may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules often erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia
This painless nodular swelling of the buccal mucosa typically results from cheek trauma or irritation and is characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that cannot be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Lichen planus
Oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Mucous duct obstruction
Obstruction produces a ranula—a painless, slow-growing mucocele on the floor of the mouth near the ducts of the submandibular and sublingual glands.
Pemphigoid (benign mucosal)
This rare autoimmune disease is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less often, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus
This chronic skin disease is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma
Commonly the result of injury, trauma, or irritation, this soft, tender nodule, papule, or polypoid mass of excessive granulation tissue usually appears on the gingivae but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma
This is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
This common disease is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (often chronic, painless, superficial nodules or deep granulomatous lesions, called gummas) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Trauma
The most common cause of oral lesions, trauma can produce ulcers anywhere in the mouth, especially on the tongue and buccal mucosa.
Tuberculosis (oral mucosal)
This rare disorder produces a painless ulcer (usually on the tongue) and, sometimes, caseation. Other findings include lymphadenopathy, fatigue, weakness, anorexia, weight loss, cough, low fever, and night sweats.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Orthodontics
The rubbing of orthodontic equipment or prosthesis on the buccal mucosa may cause eroded, tender areas.
Radiation therapy
Radiation therapy may cause oral lesions.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Throat pain:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Agranulocytosis
In this disorder, sore throat may accompany other signs and symptoms of infection, such as fever, chills, and headache. Typically, it follows progressive fatigue and weakness. Other findings include nausea and vomiting, anorexia, and bleeding tendencies. Rough-edged ulcers with gray or black membranes may appear on the gums, palate, or perianal area.
Allergic rhinitis
Occurring seasonally or year-round, this disorder may produce sore throat as well as nasal congestion with a thin nasal discharge, postnasal drip, paroxysmal sneezing, decreased sense of smell, frontal or temporal headache, and itchy eyes, nose, and throat. Examination reveals pale and glistening nasal mucosa with edematous nasal turbinates, watery eyes, reddened conjunctivae and eyelids and, possibly, swollen eyelids.
Avian influenza
Throat pain, muscle aches, cough, and fever are common early symptoms of avian influenza. The most virulent of these viruses, avian influenza A (H5N1), may also cause pneumonia, acute respiratory distress, and other life-threatening complications. A recent outbreak of the H5N1 virus among domesticated birds (chickens, turkeys, geese) in Asian countries has caused human sickness and death in those who contracted the virus from infected poultry and contaminated surfaces. Studies are underway to investigate the effectiveness of antiviral medications and vaccines.
Bronchitis (acute)
This disorder may produce lower throat pain, fever, chills, cough, and muscle and back pain. Auscultation reveals rhonchi, wheezing, and sometimes crackles.
Chronic fatigue syndrome
This nonspecific symptom complex is characterized by incapacitating fatigue. Associated findings include sore throat, myalgia, and cognitive dysfunction.
Common cold
Sore throat may accompany cough, sneezing, nasal congestion, rhinorrhea, fatigue, headache, myalgia, and arthralgia.
Contact ulcers
Common in men with stressful jobs, contact ulcers appear symmetrically on the posterior vocal cords, resulting in sore throat. The pain is aggravated by talking and may be accompanied by referred ear pain and occasionally hemoptysis. Typically, the patient also has a history of chronic throat clearing or acid reflux.
Foreign body
A foreign body lodged in the palatine or lingual tonsil and pyriform sinus may produce localized throat pain. The pain may persist after the foreign body is dislodged until mucosal irritation resolves.
Gastroesophageal reflux disease
In this disorder, an incompetent gastroesophageal sphincter allows gastric juices to enter the hypopharynx and irritate the larynx, causing chronic sore throat and hoarseness. The arytenoid cartilage may also appear red and swollen, resulting in a sensation of a lump in the throat.
Glossopharyngeal neuralgia
Triggered by a specific pharyngeal movement, such as yawning or swallowing, this condition causes unilateral, knifelike throat pain in the tonsillar fossa that may radiate to the ear.
Herpes simplex virus
Sore throat may result from lesions on the oral mucosa, especially the tongue, gingivae, and cheeks. After causing brief prodromal discomfort, lesions erupt into erythematous vesicles that eventually rupture and leave a painful ulcer, followed by a yellowish crust. In generalized infection, the vesicles accompany submaxillary lymphadenopathy, halitosis, increased salivation, anorexia, and fever of up to 105° F (40.6° C).
Influenza
Patients with the flu commonly complain of sore throat, fever with chills, headache, weakness, malaise, myalgia, cough and, occasionally, hoarseness and rhinorrhea.
Laryngeal cancer
In extrinsic laryngeal cancer, the chief symptom is pain or burning in the throat when drinking citrus juice or hot liquids, or a lump in the throat; in intrinsic laryngeal cancer, it’s hoarseness that persists for longer than 3 weeks. Later signs and symptoms of metastasis include dysphagia, dyspnea, a cough, enlarged cervical lymph nodes, and pain that radiates to the ear.
Laryngitis (acute)
This disorder produces sore throat, but its cardinal sign is mild to severe hoarseness, perhaps with temporary loss of voice. Other findings are malaise, low-grade fever, dysphagia, dry cough, and tender, enlarged cervical lymph nodes.
Monkeypox
Early symptoms of this rare viral disease include sore throat, fever, lymphadenopathy, chills, myalgia, and rash. The virus exhibits some similarities to smallpox, but its symptoms tend to be milder. Monkeypox is spread primarily through contact with lesions or body fluids of infected animals. Although it occurs primarily in central and western Africa, the virus has also been reported in the United States since 2003. There’s no specific treatment for monkeypox, which typically lasts 2 to 4 weeks.
Mononucleosis (infectious)
Sore throat is one of the three classic findings in this infection. The other two classic signs are cervical lymphadenopathy and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.
Necrotizing ulcerative gingivitis (acute)
Also known as trench mouth, this disorder usually begins abruptly with sore throat and tender gums that ulcerate and bleed. A gray exudate may cover the gums and pharyngeal tonsils. Related signs and symptoms include a foul taste in the mouth, halitosis, cervical lymphadenopathy, headache, malaise, and fever.
Peritonsillar abscess
A complication of bacterial tonsillitis, this abscess typically causes severe throat pain that radiates to the ear. Accompanying the pain may be dysphagia, drooling, dysarthria, halitosis, fever with chills, malaise, and nausea. The patient usually tilts his head toward the side of the abscess. Examination may also reveal a deviated uvula, trismus, and tender, enlarged cervical lymph nodes.Pharyngeal burns
First- or second-degree burns of the posterior pharynx may cause throat pain and dysphagia.
Pharyngitis
Whether bacterial, fungal, or viral, pharyngitis may cause sore throat and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral sore throat. Associated signs and symptoms include dysphagia, fever, malaise, headache, abdominal pain, myalgia, and arthralgia. Inspection reveals an exudate on the tonsil or tonsillar fossa, uvular edema, soft palate erythema, and tender cervical lymph nodes.
Also known as thrush, fungal pharyngitis causes diffuse sore throat—commonly described as a burning sensation—accompanied by pharyngeal erythema and edema. White plaques mark the pharynx, tonsil, tonsillar pillars, base of the tongue, and oral mucosa; scraping these plaques uncovers a hemorrhagic base.
Viral pharyngitis produces a diffuse sore throat, malaise, fever, and mild erythema and edema of the posterior oropharyngeal wall. Tonsil enlargement and anterior cervical lymphadenopathy may be present.
Pharyngomaxillary space abscess
A complication of untreated pharyngeal or tonsillar infection or tooth extraction, pharyngomaxillary space abscess causes mild throat pain. Inspection reveals a bulge in the medial wall of the pharynx accompanied by swelling of the neck and at the jaw angle on the affected side. Other signs and symptoms include fever, dysphagia, trismus and, possibly, signs of respiratory distress or toxemia.
Sinusitis (acute)
This disorder may cause sore throat with a purulent nasal discharge and postnasal drip, resulting in halitosis. Other effects include headache, malaise, cough, fever, and facial pain and swelling associated with nasal congestion.
Tongue cancer
The patient with tongue cancer experiences localized throat pain that may occur around a raised white lesion or ulcer. The pain may radiate to the ear and be accompanied by dysphagia.
Tonsillar cancer
Sore throat is the presenting symptom in tonsillar cancer. Unfortunately, the cancer is usually quite advanced before this symptom appears. The pain may radiate to the ear and is accompanied by a superficial ulcer on the tonsil or one that extends to the base of the tongue.
Tonsillitis
Mild to severe sore throat is usually the first symptom of acute tonsillitis. The pain may radiate to the ears and be accompanied by dysphagia and headache. Related findings include malaise, fever with chills, halitosis, myalgia, arthralgia, and tender cervical lymph nodes. Examination reveals edematous, reddened tonsils with a purulent exudate.
Chronic tonsillitis causes a mild sore throat, malaise, and tender cervical lymph nodes. The tonsils appear smooth, pink and, possibly, enlarged, with purulent debris in the crypts. Halitosis and a foul taste in the mouth are other common findings.
Unilateral or bilateral throat pain occurs just above the hyoid bone in lingual tonsillitis. The lingual tonsils appear red and swollen and are covered with exudate. Other findings include a muffled voice, dysphagia, and tender cervical lymph nodes on the affected side.
Uvulitis
This inflammation may cause throat pain or a sensation of something in the throat. The uvula is usually swollen and red but, in allergic uvulitis, it’s pale.
Other causes
Treatments
Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause sore throat.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gag reflex abnormalities [Pharyngeal reflex abnormalities]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Basilar artery occlusion
This disorder may suddenly diminish or obliterate the gag reflex. It also causes diffuse sensory loss, dysarthria, facial weakness, extraocular muscle palsies, quadriplegia, and decreased LOC.
Brain stem glioma
This lesion causes gradual loss of the gag reflex. Related symptoms reflect bilateral brain stem involvement and include diplopia and facial weakness. Involvement of the corticospinal pathways causes spasticity and paresis of the arms and legs as well as gait disturbances.
Bulbar palsy
Loss of the gag reflex reflects temporary or permanent paralysis of muscles supplied by cranial nerves IX and X. Other indicators of this paralysis include jaw and facial muscle weakness, dysphagia, loss of sensation at the base of the tongue, increased salivation, fasciculations and, possibly, difficulty articulating and breathing.
Myasthenia gravis
In severe myasthenia, the motor limb of the gag reflex is reduced. Weakness worsens with repetitive use and may also involve other muscles.
Wallenberg’s syndrome
Paresis of the palate and an impaired gag reflex usually develop within hours to days of thrombosis. The patient may experience analgesia and thermanesthesia, occurring ipsilaterally on the face and contralaterally on the body, as well as vertigo. He may also display nystagmus, ipsilateral ataxia of the arm and leg, and signs of Horner’s syndrome (unilateral ptosis and miosis, hemifacial anhidrosis).
Other causes
Anesthesia
General and local (throat) anesthesia can produce temporary loss of the gag reflex.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Sore Throat:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr virus
❑ Adenovirus
❑ Influenza
❑ Candida/thrush
❑ Herpes simplex virus
❑ Peritonsillar abscess
❑ Mycoplasma pneumoniae
❑ Coxsackievirus
❑ Primary HIV
❑ Neisseria gonorrhea
❑ Epiglottitis
❑ Corynebacterium diphtheriae
❑ Leukemia
Source: Field Guide to Bedside Diagnosis, 2007
Glomerulo-nephritis, acute poststreptococcal:
Causes
(Handbook of Diseases)
APSGN results from the entrapment and collection of antigen-antibody complexes (produced as an immunologic mechanism in response to streptococci) in the glomerular capillary membranes, inducing inflammatory damage and impeding glomerular function.
Sometimes the immune complement further damages the glomerular membrane. The damaged and inflamed glomerulus loses the ability to be selectively permeable and allows red blood cells (RBCs) and proteins to filter through as the glomerular filtration rate (GFR) falls. Uremic poisoning may result.
Source: Handbook of Diseases, 2003
Pharyngitis:
Causes
(Handbook of Diseases)
Pharyngitis is usually caused by a virus. The most common viral agents are rhinovirus, coronavirus, adenovirus, influenza, and parainfluenza. The most common bacterial cause is group A beta-hemolytic streptococci. Other common causes include Mycoplasma and Chlamydia.
Source: Handbook of Diseases, 2003
Mouth lesions:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
Oral lesions may be an early indication of the immunosuppression that’s characteristic of acquired immunodeficiency syndrome (AIDS). Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi’s sarcoma. The tumor is usually found on the hard palate. Initially producing no symptoms, it may appear as a flat or raised lesion, ranging in color from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Candidiasis
Candidiasis, a common fungal infection, characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and foul odor may be present.
Discoid lupus erythematosus
Oral lesions are common in discoid lupus erythematosus. They typically appear on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scale.
Erythema multiforme
Erythema multiforme, an acute inflammatory skin disease, produces sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative)
Gingivitis, a recurring periodontal condition, causes a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Gonorrhea
With gonorrhea, painful lip ulcerations may occur, along with rough, reddened, bleeding gingivae (possibly necrotic and covered by a yellowish pseudomembrane), and a swollen, ulcerated tongue. Related effects vary. Most men develop dysuria, purulent urethral discharge, and a reddened, edematous urinary meatus. Most women remain asymptomatic, but others develop inflammation and a greenish yellow cervical discharge.
Herpes simplex 1
With primary herpes simplex infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on any part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster
Herpes zoster is a common viral infection that may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small, red nodules usually erupt unilaterally around the thorax or vertically on the arms and legs and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Leukoplakia, erythroplakia
Leukoplakia is a white lesion that can’t be removed simply by rubbing the mucosal surface — unlike candidiasis. It may occur in response to chronic irritation from dentures or tobacco or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of erythroplakia cases are either dysplasia or cancer.
Lichen planus
With lichen planus, oral lesions develop on the buccal mucosa or, less commonly, on the tongue as painless, white or gray, velvety, threadlike papules. These precede the eruption of violet papules with white lines or spots, usually on the genitalia, lower back, ankles, and anterior lower legs; pruritus; nails with longitudinal ridges; and alopecia.
Squamous cell carcinoma
A squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or the floor of the mouth. High risk factors include chronic smoking and alcohol intake.
Stomatitis (aphthous)
Aphthous stomatitis is a common disease characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It’s commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave a scar.
Syphilis
Primarysyphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondary stage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, sore throat, low fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas — chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus
Oral lesions are common with systemic lupus erythematosus (SLE) and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs
Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Treatments
Radiation therapy may cause oral lesions.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Throat pain:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Agranulocytosis
With agranulocytosis, sore throat may accompany other signs and symptoms of infection, such as fever, chills, and headache. Typically, sore throat follows progressive fatigue and weakness. Other findings include nausea and vomiting, anorexia, and bleeding tendencies. Rough-edged ulcers with gray or black membranes may appear on the gums, palate, or perianal area.
Allergic rhinitis
Occurring seasonally or year-round, allergic rhinitis may produce sore throat as well as nasal congestion with a thin nasal discharge, postnasal drip, paroxysmal sneezing, decreased sense of smell, frontal or temporal headache, and itchy eyes, nose, and throat. Examination reveals pale and glistening nasal mucosa with edematous nasal turbinates, watery eyes, reddened conjunctiva and eyelids and, possibly, swollen lids.
Bronchitis (acute)
Acute bronchitis may produce lower throat pain associated with fever, chills, cough, and muscle and back pain. Auscultation reveals rhonchi, wheezing and, at times, crackles.
Chronic fatigue syndrome
Chronic fatigue syndrome is a nonspecific symptom complex that’s characterized by incapacitating fatigue. Associated findings besides sore throat include myalgia, lymphadenopathy, and cognitive dysfunction.
Common cold
With the common cold, sore throat may accompany cough, sneezing, nasal congestion, mouth breathing, rhinorrhea, fatigue, headache, myalgia, and arthralgia. The patient may also have a transient loss of taste and smell.
Contact ulcers
Common in men with stressful jobs, contact ulcers appear symmetrically on the posterior vocal cords, resulting in sore throat. The pain is aggravated by talking and may be accompanied by referred ear pain and, occasionally, hemoptysis. Typically, the patient also has a history of chronic throat clearing or acid reflux.
Foreign body
A foreign body lodged in the palatine or lingual tonsil and pyriform sinus may produce localized throat pain. The pain may persist after the foreign body is dislodged until mucosal irritation resolves.
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) may cause chronic sore throat and hoarseness. The arytenoids may also appear red and swollen, resulting in a sensation of a lump in the throat. Pyrosis, usually severe, is the most common symptom of this disorder.
Glossopharyngeal neuralgia
Triggered by a specific pharyngeal movement, such as yawning, chewing or swallowing, glossopharyngeal neuralgia causes unilateral, knifelike throat pain in the tonsillar fossa that may radiate to the ear. Eating spicy foods may also trigger this pain.
Herpes simplex virus
Sore throat in those infected with the herpes simplex virus may result from lesions on the oral mucosa, especially the tongue, gingivae, and cheeks. After causing brief prodromal discomfort, lesions erupt into erythematous vesicles that eventually rupture and leave a painful ulcer, followed by a yellowish crust. In generalized infection, the vesicles accompany submaxillary lymphadenopathy, halitosis, increased salivation, anorexia, and fever of up to 105° F (40.6° C).
Influenza
Patients with influenza commonly complain of sore throat, fever with chills, headache, weakness, malaise, muscle aches, cough and, occasionally, hoarseness and rhinorrhea. Chills generally subside after the first few days, but intermittent fever, weakness, and cough may persist for up to 1 week.
Laryngeal cancer
With extrinsic laryngeal cancer, the chief symptom is pain or burning in the throat when drinking citrus juice or hot liquids, or a lump in the throat; with intrinsic laryngeal cancer, it’s hoarseness that persists for longer than 3 weeks. Later signs and symptoms of metastasis include dysphagia, dyspnea, a cough, enlarged cervical lymph nodes, and pain that radiates to the ear.
Laryngitis (acute)
Acute laryngitis produces sore throat. Its cardinal sign, however, is mild to severe hoarseness, perhaps with temporary loss of voice. Other findings are malaise, low-grade fever, dysphagia, dry cough, and tender, enlarged cervical lymph nodes.
Mononucleosis (infectious)
Sore throat is one of the three classic findings in mononucleosis. The other two classic signs are cervical lymphadenopathy and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.
Necrotizing ulcerative gingivitis (acute)
Also known as trench mouth, necrotizing ulcerative gingivitis usually begins abruptly with sore throat and tender gums that ulcerate and bleed. A gray exudate may cover the gums and pharyngeal tonsils. Related signs and symptoms include a foul taste in the mouth, halitosis, cervical lymphadenopathy, headache, malaise, and fever.
Peritonsillar abscess
A complication of bacterial tonsillitis, peritonsillar abscess typically causes severe throat pain that radiates to the ear. Accompanying the pain may be dysphagia, drooling, dysarthria, halitosis, fever with chills, malaise, and nausea. The patient usually tilts his head toward the side of the abscess. Examination may also reveal a deviated uvula, trismus, and tender cervical lymphadenopathy.
Pharyngeal burns
First- or second-degree burns of the posterior pharynx may cause throat pain and dysphagia. Laryngeal edema, bronchospasm, and stridor may occur if the larynx is involved in the burn.
Pharyngitis
Whether bacterial, fungal, or viral, pharyngitis may cause sore throat and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral sore throat. Associated signs and symptoms include dysphagia, fever, malaise, headache, abdominal pain, myalgia, and arthralgia. Inspection reveals an exudate on the tonsil or tonsillar fossae, uvular edema, soft palate erythema, and tender cervical lymph nodes.
Also known as thrush, fungal pharyngitis causes diffuse sore throat — commonly described as a burning sensation — accompanied by pharyngeal erythema and edema. White plaques mark the pharynx, tonsil, tonsillar pillars, base of the tongue, and oral mucosa; scraping these plaques uncovers a hemorrhagic base.
With viral pharyngitis, findings include diffuse sore throat, malaise, fever, and mild erythema and edema of the posterior oropharyngeal wall. Tonsillary enlargement may be present along with anterior cervical lymphadenopathy.
Pharyngomaxillary space abscess
A complication of untreated pharyngeal or tonsillar infection or tooth extraction, pharyngomaxillary space abscess causes mild throat pain. Inspection reveals a bulge in the medial wall of the pharynx accompanied by swelling of the neck and at the jaw angle on the affected side. Other signs and symptoms include fever, dysphagia, trismus and, possibly, signs of respiratory distress or toxemia.
Sinusitis (acute)
Acute sinusitis may cause sore throat with purulent nasal discharge and postnasal drip, resulting in halitosis. Other effects include headache, malaise, cough, fever, and facial pain and swelling associated with nasal congestion.
Tongue cancer
With tongue cancer, the patient experiences localized throat pain that may occur around a raised white lesion or ulcer. The pain may radiate to the ear and be accompanied by dysphagia.
Tonsillar cancer
Sore throat is the presenting symptom in tonsillar cancer. Unfortunately, the cancer is usually quite advanced before the appearance of this symptom. The pain may radiate to the ear and is accompanied by a superficial ulcer on the tonsil or one that extends to the base of the tongue.
Tonsillitis
With acute tonsillitis, mild to severe sore throat is usually the first symptom. The pain may radiate to the ears and be accompanied by dysphagia and headache. Related findings include malaise, fever with chills, halitosis, myalgia, arthralgia, and tender cervical lymphadenopathy. Examination reveals edematous, reddened tonsils with a purulent exudate.
Chronic tonsillitis causes mild sore throat, malaise, and tender cervical lymph nodes. The tonsils appear smooth, pink and, possibly, enlarged, with a purulent debris in the crypts. Halitosis and a foul taste in the mouth are other common findings.
Unilateral or bilateral throat pain just above the hyoid bone occurs with lingual tonsillitis. The lingual tonsils appear red and swollen and are covered with exudate. Other findings include a muffled voice, dysphagia, and tender cervical lymphadenopathy on the affected side.
Uvulitis
Uvulitis is an inflammation that can cause throat pain or a sensation of something in the throat. The uvula is usually swollen and red but, in allergic uvulitis, it’s pale.
Other causes
Treatments
Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause sore throat.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Sore Throat:
Principal Causes of Sore Throat
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Infection
- Pharyngitis/tonsillitis
- Viral
- Bacterial
- Group A Streptococcus
- Other bacteria
- Peritonsillar, retropharyngeal, andlateral pharyngeal abscesses
- Pharyngitis/tonsillitis
- Irritants
- Excessive dryness
- Dust
- Smoke
- Postnasal drip secondary to allergicrhinitis or sinusitis
- Trauma
- Vocal abuse
- Thermal injury
- Foreign body
- Caustic substances
- Psychogenic
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Mouth lesions:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome (AIDS).Oral lesions may be an early indication of the immunosuppression that's characteristic of AIDS. Fungal infections can occur, with oral candidiasis being the most common. Bacterial or viral infections of the oral mucosa, tongue, gingivae, and periodontal tissue may also occur.
The primary oral neoplasm associated with AIDS is Kaposi's sarcoma. The tumor is usually found on the hard palate and may appear initially as a flat or raised lesion that produces no symptoms and ranges from red to blue to purple. As these tumors grow, they may ulcerate and become painful.
Actinomycosis (cervicofacial).Actinomycosisis a chronic fungal infection that typically produces small, firm, flat, and usually painless swellings on the oral mucosa and under the skin of the jaw and neck. Swellings may indurate and abscess, producing fistulas and sinus tracts with a characteristic purulent yellow discharge.
Behçet's syndrome.Behçet's syndrome produces small, painful ulcers on the lips, gums, buccal mucosa, and tongue. In severe cases, the ulcers also develop on the palate, pharynx, and esophagus. The ulcers typically have a reddened border and are covered with a gray or yellow exudate. Similar lesions appear on the scrotum and penis or labia majora; small pustules or papules on the trunk and limbs; and painful erythematous nodules on the shins. Ocular lesions may also develop.
Candidiasis.Candidiasis characteristically produces soft, elevated plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; the plaques may be wiped away. The lesions of acute atrophic candidiasis are red and painful. The lesions of chronic hyperplastic candidiasis are white and firm. Localized areas of redness, pruritus, and a foul odor may be present.
Discoid lupus erythematosus.Oral lesions are common with discoid lupus erythematosus, typically appearing on the tongue, buccal mucosa, and palate as erythematous areas with white spots and radiating white striae. Associated findings include skin lesions on the face, possibly extending to the neck, ears, and scalp; if the scalp is involved, alopecia may result. Hair follicles are enlarged and filled with scales.
Erythema multiforme.Erythema multiforme produces a sudden onset of vesicles and bullae on the lips and buccal mucosa. Also, erythematous macules and papules form symmetrically on the hands, arms, feet, legs, face, and neck and, possibly, in the eyes and on the genitalia. Lymphadenopathy may also occur. With visceral involvement, other findings include fever, malaise, cough, throat and chest pain, vomiting, diarrhea, myalgia, arthralgia, fingernail loss, blindness, hematuria, and signs of renal failure.
Gingivitis (acute necrotizing ulcerative).Gingivitiscauses a sudden onset of gingival ulcers covered with a grayish white pseudomembrane. Other findings include tender or painful gingivae, intermittent gingival bleeding, halitosis, enlarged lymph nodes in the neck, and fever.
Herpes simplex I.With primary herpes simplex I infection, a brief period of prodromal tingling and itching, which is accompanied by fever and pharyngitis, is followed by eruption of small and irritating vesicles on part of the oral mucosa, especially the tongue, gums, and cheeks. Vesicles form on an erythematous base and then rupture, leaving a painful ulcer, followed by a yellowish crust. Other findings include submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and keratoconjunctivitis.
Herpes zoster.Herpes zoster may produce painful vesicles on the buccal mucosa, tongue, uvula, pharynx, and larynx. Small red nodules typically erupt unilaterally around the thorax or vertically on the arms and legs, and rapidly become vesicles filled with clear fluid or pus; vesicles dry and form scabs about 10 days after eruption. Fever and general malaise accompany pruritus, paresthesia or hyperesthesia, and tenderness along the course of the involved sensory nerve.
Inflammatory fibrous hyperplasia.Inflammatory fibrous hyperplasia is a painless nodular swelling of the buccal mucosa characterized by pink, smooth, pedunculated areas of soft tissue.
Leukoplakia, erythroplakia.Leukoplakia is a white lesion that can't be removed simply by rubbing the mucosal surface—unlike candidiasis. It may occur in response to chronic irritation from dentures or from tobacco use or pipe smoking, or it may represent dysplasia or early squamous cell carcinoma.
Erythroplakia is red and edematous and has a velvety surface. About 90% of all cases of erythroplakia are either dysplasia or cancer.
Pemphigoid (benign mucosal).Pemphigoid is characterized by thick-walled vesicles on the oral mucous membranes, the conjunctiva and, less commonly, the skin. Mouth lesions typically develop months or even years before other manifestations and may occur as desquamative patchy gingivitis or as a vesicobullous eruption. Secondary fibrous bands may lead to dysphagia, hoarseness, and blindness. Recurrent skin lesions include vesicobullous eruptions, usually on the inguinal area and extremities, and an erythematous, vesicobullous plaque on the scalp and face near the affected mucous membranes.
Pemphigus.Pemphigus is characterized by thin-walled vesicles and bullae that appear in cycles on skin or mucous membranes that otherwise appear normal. On the oral mucosa, bullae rupture, leaving painful lesions and raw patches that bleed easily. Associated findings include bullae anywhere on the body, denudation of the skin, and pruritus.
Pyogenic granuloma.Pyogenic granuloma is a soft, tender nodule, papule, or polypoid mass of excessive granulated tissue that usually appears on the gingivae, but can also erupt on the lips, tongue, or buccal mucosa. The lesions bleed easily because they contain many capillaries. The affected area may be smooth or have a warty surface; erythema develops in the surrounding mucosa. The lesions may ulcerate, producing a purulent exudate.
Squamous cell carcinoma.Squamous cell carcinoma is typically a painless ulcer with an elevated, indurated border. It may erupt in areas of leukoplakia and is most common on the lower lip, but it may also occur on the edge of the tongue or floor of the mouth. High risk factors include chronic tobacco use and alcohol intake.
Stomatitis (aphthous).Stomatitis is characterized by painful ulcerations of the oral mucosa, usually on the dorsum of the tongue, gingivae, and hard palate.
With recurrent aphthous stomatitis minor, the ulcer begins as one or more erosions covered by a gray membrane and surrounded by a red halo. It's commonly found on the buccal and lip mucosa and junction, tongue, soft palate, pharynx, gingivae, and all places not bound to the periosteum.
With recurrent aphthous stomatitis major, large, painful ulcers commonly occur on the lips, cheek, tongue, and soft palate; they may last up to 6 weeks and leave ascar.
Syphilis.Primary syphilis typically produces a solitary painless, red ulcer (chancre) on the lip, tongue, palate, tonsil, or gingivae. The ulcer appears as a crater with undulated, raised edges and a shiny center; lip chancres may develop a crust. Similar lesions may appear on the fingers, breasts, or genitals, and regional lymph nodes may become enlarged and tender.
During the secondarystage, multiple painless ulcers covered by a grayish white plaque may erupt on the tongue, gingivae, or buccal mucosa. A macular, papular, pustular, or nodular rash appears, usually on the arms, trunk, palms, soles, face, and scalp; genital lesions usually subside. Other findings include generalized lymphadenopathy, headache, malaise, anorexia, weight loss, nausea, vomiting, a sore throat, low-grade fever, metrorrhagia, and postcoital bleeding.
At the tertiarystage, lesions (usually gummas—chronic, painless, superficial nodules or deep granulomatous lesions) develop on the skin and mucous membranes, especially the tongue and palate.
Systemic lupus erythematosus (SLE).Oral lesions are common with SLE and appear as erythematous areas associated with edema, petechiae, and superficial ulcers with a red halo and a tendency to bleed. Primary effects include nondeforming arthritis, a butterfly rash across the nose and cheeks, and photosensitivity.
Other causes
Drugs.Various chemotherapeutic agents can directly produce stomatitis. Also, allergic reactions to penicillin, sulfonamides, gold, quinine, streptomycin, phenytoin, aspirin, and barbiturates commonly cause lesions to develop and erupt. Inhaled steroids used for pulmonary disorders can also cause oral lesions.
Radiation therapy.Radiation therapy may cause oral lesions.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Throat pain:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Agranulocytosis.With agranulocytosis, throat pain may accompany other signs and symptoms of infection, such as fever, chills, and headache. Typically, it follows progressive fatigue and weakness. Other findings include nausea and vomiting, anorexia, and bleeding tendencies. Rough-edged ulcers with gray or black membranes may appear on the gums, palate, or perianal area.
Avian influenza.Throat pain, muscle aches, cough, and fever are common early symptoms of avian influenza. The most virulent of these viruses, avian influenza A (H5N1), may also cause pneumonia, acute respiratory distress, and other life-threatening complications.
Bronchitis (acute).Acute bronchitis may produce lower throat pain associated with fever, chills, cough, and muscle and back pain. Auscultation reveals rhonchi, wheezing and, at times, crackles.
Chronic fatigue syndrome.Chronic fatigue syndrome is characterized by incapacitating fatigue. Associated findings include throat pain, myalgia, and cognitive dysfunction.
Contact ulcers.Common in men with stressful jobs, contact ulcers appear symmetrically on the posterior vocal cords, resulting in sore throat. The pain is aggravated by talking and may be accompanied by referred ear pain and, occasionally, hemoptysis. Typically, the patient also has a history of chronic throat clearing or acid reflux.
Gastroesophageal reflux disease (GERD).With GERD, an incompetent gastroesophageal sphincter allows gastric juices to enter the hypopharynx and irritate the larynx, causing chronic throat pain and hoarseness. The arytenoids may also appear red and swollen, resulting in a sensation of a lump in the throat.
Influenza.Patients with the flu commonly complain of throat pain, fever with chills, headache, weakness, malaise, muscle aches, cough and, occasionally, hoarseness and rhinorrhea.
Laryngeal cancer.With extrinsic laryngeal cancer, the chief symptom is pain or burning in the throat when drinking citrus juice or hot liquids or a lump in the throat; with intrinsic laryngeal cancer, the chief symptom is hoarseness that persists for longer than 3 weeks. Later signs and symptoms of metastasis include dysphagia, dyspnea, cough, enlarged cervical lymph nodes, and pain that radiates to the ear.
Monkeypox.Early symptoms of this rare viral disease include throat pain, fever, lymphadenopathy, chills, myalgia, and rash. The virus exhibits some similarities to smallpox, but its symptoms tend to be milder.
Mononucleosis (infectious).Throat pain is one of the three classic findings in this infection. The other two classic signs are cervical lymphadenopathy and fluctuating temperature with an evening peak of 1018 to 1028 F (38.38 to 38.98 C). Splenomegaly and hepatomegaly may also develop.
Necrotizing ulcerative gingivitis (acute).Also known as trench mouth, necrotizing ulcerative gingivitis usually begins abruptly with throat pain and tender gums that ulcerate and bleed. A gray exudate may cover the gums and pharyngeal tonsils. Related signs and symptoms include a foul taste in the mouth, halitosis, cervical lymphadenopathy, headache, malaise, and fever.
Peritonsillar abscess.A complication of bacterial tonsillitis, this abscess typically causes severe throat pain that radiates to the ear. Accompanying the pain may be dysphagia, drooling, dysarthria, halitosis, fever with chills, malaise, and nausea. The patient usually tilts his head toward the side of the abscess. Examination may also reveal a deviated uvula, trismus, and tender cervical lymphadenopathy.
Pharyngitis.Whether bacterial, fungal, or viral, pharyngitis may cause throat pain and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral throat pain. Associated signs and symptoms include dysphagia, fever, malaise, headache, abdominal pain, myalgia, and arthralgia. Inspection reveals an exudate on the tonsil or tonsillar fossae, uvular edema, soft palate erythema, and tender cervical lymph nodes.
Also known as thrush, fungal pharyngitis causes diffuse throat pain—commonly described as a burning sensation—accompanied by pharyngeal erythema and edema. White plaques mark the pharynx, tonsil, tonsillar pillars, base of the tongue, and oral mucosa; scraping these plaques uncovers a hemorrhagic base.
With viral pharyngitis, findings include diffuse throat pain, malaise, fever, and mild erythema and edema of the posterior oropharyngeal wall. Tonsillary enlargement may be present along with anterior cervical lymphadenopathy.
Sinusitis (acute).Sinusitis may cause throat pain with purulent nasal discharge and postnasal drip, resulting in halitosis. Other effects include headache, malaise, cough, fever, and facial pain and swelling associated with nasal congestion.
Tongue cancer.With tongue cancer, the patient experiences localized throat pain that may occur around a raised white lesion or ulcer. The pain may radiate to the ear and be accompanied by dysphagia.
Tonsillar cancer.Throat pain is the presenting symptom in tonsillar cancer. Unfortunately, the cancer is usually quite advanced before the appearance of this symptom. The pain may radiate to the ear and is accompanied by a superficial ulcer on the tonsil or one that extends to the base of the tongue.
Tonsillitis.With acute tonsillitis, mild to severe throat pain is usually the first symptom. The pain may radiate to the ears and be accompanied by dysphagia and headache. Related findings include malaise, fever with chills, halitosis, myalgia, arthralgia, and tender cervical lymphadenopathy. Examination reveals edematous, reddened tonsils with a purulent exudate.
Chronic tonsillitis causes mild throat pain, malaise, and tender cervical lymph nodes. The tonsils appear smooth, pink and, possibly, enlarged, with purulent debris in the crypts. Halitosis and a foul taste in the mouth are other common findings.
Unilateral or bilateral throat pain just above the hyoid bone occurs with lingual tonsillitis. The lingual tonsils appear red and swollen and are covered with exudate. Other findings include a muffled voice, dysphagia, and tender cervical lymphadenopathy on the affected side.
Upper respiratory infection (URI).With a URI, throat pain may accompany coughing, sneezing, nasal congestion, rhinorrhea, fatigue, headache, myalgia, and arthralgia.
Uvulitis.Uvulitis may cause throat pain or a sensation of something in the throat. The uvula is usually swollen and red but, in allergic uvulitis, it's pale.
Other causes
Foreign body aspiration.A foreign body lodged in the palatine or lingual tonsil and pyriform sinus may produce localized throat pain. The pain may persist after the foreign body is dislodged until mucosal irritation resolves.
Treatments.Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause throat pain.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Gag reflex abnormalities [Pharyngeal reflex abnormalities]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Basilar artery occlusion.Basilar artery occlusion may suddenly diminish or obliterate the gag reflex. It also causes diffuse sensory loss, dysarthria, facial weakness, extraocular muscle palsies, quadriplegia, and a decreased LOC.
Brain stem glioma.Brain stem glioma causes a gradual loss of the gag reflex. Related symptoms reflect bilateral brain stem involvement and include diplopia and facial weakness. Common involvement of the corticospinal pathways causes spasticity and paresis of the arms and legs as well as gait disturbances.
Bulbar palsy.Loss of the gag reflex reflects temporary or permanent paralysis of muscles supplied by CNs IX and X. Other indicators of bulbar palsy include jaw and facial muscle weakness, dysphagia, loss of sensation at the base of the tongue, increased salivation, possible difficulty articulating and breathing, and fasciculations.
Wallenberg's syndrome.Paresis of the palate and an impaired gag reflex usually develop within hours to days of thrombosis. The patient may experience analgesia and thermanesthesia, occurring ipsilaterally on the face and contralaterally on the body, and vertigo. He may also display nystagmus, ipsilateral ataxia of the arm and leg, and signs of Horner syndrome (unilateral ptosis and miosis, hemifacial anhidrosis).
Other causes
Anesthesia.General and local (throat) anesthesia can produce temporary loss of the gag reflex.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pharyngitis:
Pharyngitis - etiology
(The 5-Minute Pediatric Consult)
- Viral:
- Adenovirus types 1–7, 7a, 9, 14, 15, and 16
- Epstein–Barr virus (EBV)
- Influenza A, B: Usually associated with more severe systemic complaints
- Parainfluenza 1, 2, and 3
- Enteroviruses: Coxsackie A and B and echoviruses
- Measles, rubella, coronavirus, and cytomegalovirus
- Herpes simplex virus (HSV)
- Rhinovirus and respiratory syncytial virus (RSV): Not usually associated with pharyngeal inflammation
- HIV
- Bacterial:
- Streptococcus pyogenes (group A β-hemolytic streptococcus)
- Group C or G streptococci
- Corynebacterium diphtheriae (diphtheria)
- Corynebacterium hemolyticum
- Neisseria gonorrhoeae and Neisseria meningitidis
- Mycoplasma pneumoniae and Mycoplasma hominis
- Chlamydia pneumoniae, Chlamydia psittaci
- Yersinia enterocolitica
- Treponema pallidum (syphilis)
- Oral anaerobes (Vincent angina)
- Fungi: Candida species (oral thrush)
Source: The 5-Minute Pediatric Consult, 2008
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