In this slide I gave all information about pharyngitis. Like and share if you find it informative.

1. PHARYNGITIS. -Pranav Patel.

2. TERMINOLOGY.
Acute rheumatic fever-It is an illness following an autoimmune
response to a group A streptococcus, it causes inflammation,
especially of the heart, blood vessels and joints.
Adenovirus-They are a group of common viruses that infect the lining
of your eyes, airways and lungs, intestines, urinary tract, and nervous
system.
anaphylaxis -Serious,life-threatning allergic reaction.
Cephalosporin-They are bactericidal (kill bacteria) and work in a
similar way to penicillin.
Coxsackieviruses-They RNA viruses that may cause hand, foot, and
mouth disease (HFMD), as well as disease of muscles, lungs, and
heart.

3. Epstein-Barr virus-The Epstein–Barr virus, formally called Human gamma
herpes virus 4, is one of the nine known human herpes virus types in the
herpes family, and is one of the most common viruses in humans. It is best
known as the cause of infectious mononucleosis.
Etiology-Etiology is the study of causation or origination of disease.
Group A streptococcus-GAS bacteria is a Gram positive, beta-hemolytic
coccus in chains. It is responsible for a range of diseases in humans. These
diseases include strep throat (acute pharyngitis) and skin and soft tissue
infections.
Herpes-A virus causing contagious sores, most often around the mouth or
on the genitals.
Influenza-It is a viral infection that attacks your respiratory system-your
nose, throat and lungs, influenza is commonly known as flu.

4. Macrolide- they are a class of natural products that consist of a large
macro cyclic lactone ring, it is often prescribed to treat rather
common bacterial infections.
Mastoiditis-It is usually caused by middle ear infection, it can result
in damage of mastoid bone and formation of pus filled crystals.
Otitis media-An ear infection is usually caused by bacteria or viruses.
Peritonsillar abscesses- A peritonsillar abscess occurs when a
collection of pus forms and infection spreads beyond the tonsils into
the neck and chest.
Post streptococcal glomerulonephritis-is a kidney disease that
develops 10 to 14 days after a skin or throat infection. it is not
caused by the bacteria itself, but by the body's infection fighting

5. Parainfluenza-They are a paraphyletic group of four distinct single-stranded
RNA viruses belonging to the Paramyxoviridae family. These viruses are
closely associated with both human and veterinary disease.
Rhinorrhea- rhinorrhea is a condition where the nasal cavity is filled with a
significant amount of mucus fluid.
Rhinovirus-It is the most common viral infectious agent in humans and is
the predominant cause of the common cold.
Sinusitis-It is an inflammation or swelling of the tissue lining the sinuses.
Healthy sinuses are filled with air. But when they become blocked and filled
with fluid, germs can grow and cause an infection.
Toxic shock syndrome-It is a rare but serious medical condition caused by a
bacterial infection. t is caused when the bacterium streptococcus aureus gets
into the bloodstream and produces toxins.

6. INTRODUCTION.
Pharyngitis is a medical term for a sore throat.
Causes of pharyngitis include viral infection, common cold and
bacterial infection, such a group A streptococcus.
Pharyngitis is defined as an infection or irritation of the pharynx,
which is in the back of the throat. It is most often referred to simply
as “sore throat”
Pharyngitis can also cause scratchiness in the throat and difficulty in
swallowing.

7. HISTORY
Viral and bacterial causes of pharyngitis are similar and
differentiation of etiology is based on examination of history
and physical examination alone.
Classic presentation are listed below:
1. Group A Streptococcus(GAS) infection is the most common in
children.
2. Sudden onset is consistent with a GAS pharyngitis.
Pharyngitis following several days of coughing or rhinorrhea
is more consistent with a viral etiology.
3. Headache is consistent in GAS infection.
4. Cough is usually not associated with GAS infection.

8. ETIOLOGY.
About 50-80% of pharyngitis or symptoms are viral in origin and
include various viral pathogens.
These pathogens are rhinovirus,influenza,adenovirus,coronavirus and
parainfluenza.
Less common viral pathogens include herpes,Epstein-barr virus,HIV
and coxsackievirus.
The most common bacterial infection in Group A streptococci, which
causes 5-36% of cases of acute pharyngitis.

9. EPIDEMIOLOGY.
In 2010,there were 1.814million emergency department visits for
pharyngitis, of which 692,000 were for patients under the age of 15.
Most of cases of pharyngitis occurs in children age under 5,adults can
develop the disease but at lower rate.
Globally, pharyngitis is observed in most of countries where
antibiotics are overprescribed.

10. PATHOPHYSIOLOGY.
With infectious pharyngitis, bacteria or viruses directly invade the
pharyngeal mucosa, causing a local inflammatory response.
Other viruses such as rhinovirus and coronavirus can cause irritation
of pharyngeal mucosa secondary to nasal secretions.
Streptococcal infections are characterized by local invasion and
release of extracellular toxins and proteases.
In addition protein M protein segment* of certain serotypes of GAS
are similar to myocardial sarcolemma antigens are linked to
rheumatic fever and subsequent heart valve damage.

11. EVALUATION.
A variety of clinical decision rules have been developed to improve
the diagnosis of group A beta-haemolytic streptococcal pharyngitis
and to guide the treatment.
Centor criteria* for group A beta-haemolytic streptococci:
1. Tonsilir exudate(Inflammation of tonsils)
2. Tender anterior cervical left mentoanterior.
3. History of fever.
4. Absence of cough.

12. POINT TOTALS AND
RECOMMENDED ACTIONS.
White blood cell counts have minimal value in the differentiation of
viral versus bacterial etiologies of pharyngitis. A lymphocytosis
(greater than 50%) or increased atypical lymphocytes (greater than
10%) may suggest infectious mononucleosis.
Rapid antigen detection tests(RADT):
oIt is very specific for group A beta-hemolytic streptococci, but their
sensitivity widely ranges from 70-90%.
If positive-Treatment should be initiated.
If negative-Particular in children, throat culture should be obtained
and should guide treatment.

13. A hetrophile antibody or monospot test:
oTest is 70-92% sensitive and 96-100% specific.
oThis test is specific for infectious mononucleosis is commonly
available, but ideal standard is to use Epstein-Barr virus serology.
oThe test sensitivity is lessened by testing early in the course of
illness and by the age of the patient.

14. TREATMENT.
Antibiotics for pharyngitis are usually used for group A beta-
haemolytic streptococcal pharyngitis.
Antibiotics may shorten the duration of symptoms by 16-24 hours
and prevent rheumatic fever.
Older data suggests 1 in 400(0.25%)remain untreated in case of
pharyngitis.
Antibiotics should be given only in cases of group A beta-haemolytic
streptococcal-positive patients.
Treatment option for group A beta-haemolytic streptococcal
pharyngitis include oral treatment with penicillin V oral amoxicillin.

15. Cephalosporins,macrolides and clindamycin may also be used.
Intramuscular penicillin is also a option.
In patients with a mild penicillin allergy, cephalosporin can be used.
In patients with a history of anaphylaxis to penicillin, azithromycin or
clindamycin can be used. The disease is no longer infectious after 24
hours of antibiotics.
Single-dose corticosteroids like dexamethasone may be given to
reduce the severity of symptoms, although the evidence for this
approach is limited.
For patients with infectious mononucleosis, contact sports should be
avoided for 6 to 8 weeks due to the risk of splenic rupture.

16. PROGNOSIS.
In developing countries, over 20 million individuals are affected by
group B streptococci and develop rheumatic fever. This disorder is
leading to cause leading to death in younger people.
Other complications as a result of streptococcal pharyngitis include
peritonsillar abscesses, acute glomerulonephritis, and toxic shock
syndrome.
Mortality from pharyngitis is rare but does occur if the airway is
compromised.

17. COMPLICATIONS.
complications of bacterial pharyngitis include:
Epiglottitis.
Otitis media.
Mastoiditis.
Sinusitis.
Acute rheumatic fever.
Post streptococcal glomerulonephritis.
Toxic shock syndrome.