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PHARYNGITIS
NOOR-UL-AIN MEHMOOD
ROLL NO 25
FINAL PROFF
DEPARTMENT OF PHARMACY
WOMEN INSTITUTE OF LEARNING, ABBOTTABAD
TABLE OF
CONTENTS
9/16/2023 2
Context Slide No.
Definition 3
Types of Pharyngitis 4 - 12
Epidemiology 13
Etiology 14 - 15
Risk Factors 16
Transmission 17
Pathophysiology 18 - 19
Pathogenesis 20
Clinical Features 21 - 22
Diagnosis & Testing 23 - 24
Management 25 - 26
Treatment 27 - 29
Complications 30
Prognosis 31
References 33
DEFINATION
◦ “Pharyngitis is the inflammation of the
mucous membranes of the oropharynx.”
OR
◦ “Pharyngitis is defined as an infection or
irritation of the pharynx, back of the
throat.”
 Word Study:
Pharynges = Pharynx &
itis = inflammation
9/16/2023 3
TYPES OF PHARYNGITIS
9/16/2023 4
Pharyngitis
Acute
pharyngitis
Chronic
pharyngitis
Congestive
pharyngitis
Pseudomembranous
pharyngitis
ACUTE PHARYNGITIS
◦ Acute pharyngitis is a very common disease in the cold season, but often occurs with tonsillitis,
rash, influenza, measles, diphtheria, whooping cough or some blood diseases.
◦ The disease is easily transmitted through contact through the nose, throat or saliva.
◦ Doctors usually diagnose acute pharyngitis based on systemic symptoms such as:
a. chills, chills accompanied by body aches (when sore throat is caused by a virus),
b. appearance of an infection syndrome such as fever, dry lips, and tongue dirty (when sore throat
is caused by bacteria).
◦ Other symptoms include a burning sensation in the throat; sore throat, pain when swallowing
(dysphagia); first stage dry cough then cough with sputum; May be accompanied by hoarseness (if
inflammation spreads down the larynx).
9/16/2023 5
Continued…
◦ Clinically, it is often divided into two types: red pharyngitis and white sore throat.
9/16/2023 6
White Sore Throat
Red Pharyngitis
CHRONIC PHARYNGITIS
◦ Chronic pharyngitis is a diffuse inflammation of the pharynx, very common and often associated
with rhinitis, chronic sinusitis or sometimes with chronic laryngitis and tracheo-bronchitis.
◦ The main cause is chronic rhino sinusitis, especially posterior sinusitis. Regular exposure to dust,
lime dust, chemical vapors, cement dust and irritants such as tobacco, alcohol also causes chronic
pharyngitis.
◦ Doctors usually diagnose chronic pharyngitis based on systemic symptoms.
◦ A typical example is diffuse chronic pharyngitis, which often causes the patient to feel a burning
sensation in the throat, dry throat, itching and congestion in the throat. These sensations are very
evident in the morning upon awakening. Patients often have to try to cough, sputum, and clear
throat to loosen phlegm; when swallowing, there is a feeling of entanglement and pain; cough and
sore throat; dull voice. Patients who have a habit of drinking, smoking or talking a lot, the above
symptoms are increased.
9/16/2023 7
Continued…
◦ Chronic pharyngitis is presented in 3 forms: exudative, hypertrophic and atrophic.
9/16/2023 8
Exudative: white exudates (pus) on
tonsils and pharyngeal wall.
Hypertrophic: general
thickening and congestion of
pharyngeal mucus membrane.
Atrophic: membrane is thin,
white, glistening and
sometimes wrinkled.
CONGESTIVE PHARYNGITIS
◦ Congestive pharyngitis appears quite common during the season change.
◦ The erratic weather makes the body unable to adapt quickly, which can easily affect health, reduce
resistance, lead to damage to the respiratory system, causing congestive pharyngitis. In addition,
the disease is also common in people with liver failure, endocrine disorders, and gastrointestinal
disorders.
◦ This type of sore throat is quite dangerous and needs to be treated quickly.
◦ Patients with congestive pharyngitis often have a burning sensation in the throat accompanied
by itching, coughing episodes. Cough usually occurs at bedtime.
9/16/2023 9
9/16/2023 10
PSEUDOMEMBRANOUS
PHARYNGITIS
◦ Also known as diphtheria pharyngitis, is a fairly rare form of pharyngitis.
◦ The cause of pseudomembranous pharyngitis is when the body is affected by the Klebs-Löffler
bacillus also known as Corynebacterium diphtheria.
◦ The typical tell-tale sign is that in the pharynx mucosa will appear a thick, gray-white
pseudomembranous membrane that adheres firmly to the pharynx mucosa and is difficult to peel;
acute laryngitis.
◦ Patients can also have a high fever above 38.5 degrees Celsius. The disease can appear at different
ages, but from 2 to 7 years old is the most common age to get sick.
9/16/2023 11
9/16/2023 12
EPIDEMIOLOGY
◦ Pharyngitis is a common disorder in adults and children.
◦ In a prospective family study, 16% of adults and 41% of children reported an
illness with sore throat over a 1-year time frame.
◦ It is diagnosed in more than 1.9 million people a year in the Pakistan.
9/16/2023 13
ETIOLOGY
9/16/2023 14
A. About 50% to 80% of pharyngitis, or sore throat, symptoms are viral in origin and include a variety of
viral pathogens. These pathogens are predominantly;
• Rhinovirus
• Influenza
• Adenovirus
• Coronavirus
• Parainfluenza
B. Less common viral pathogens include;
• Herpes
• Epstein-Barr virus
• Human immunodeficiency virus (HIV)
• Coxsackie virus
Continued…
C. More severe cases tend to be bacterial and may develop after an initial viral infection.
The most common bacterial infection is Group A beta-hemolytic streptococci, which causes 5% to 36% of cases of
acute pharyngitis. Other bacterial etiologies include Group B & C streptococci;
◦ Chlamydia pneumonia
◦ Mycoplasma pneumonia
◦ Haemophilus influenza
◦ Candida albicans
◦ Neisseria meningitides
◦ Neisseria gonorrhea
◦ Arcanobacterium haemolyticum
◦ Fusobacterium necrophorum
◦ Corynebacterium diphtheriae.
D. Environmental allergies and chemical exposures may also cause acute pharyngitis.
9/16/2023 15
Streptococcus pyogenes (group A
Streptococcus) on Gram stain. Source:
Public Health Image Library, CDC
RISK FACTORS
◦ Age: Children and teens are most likely to develop sore throats. Children ages 3 to 15 are also more likely to
have strep throat, the most common bacterial infection associated with a sore throat.
◦ Exposure to tobacco smoke: Smoking can irritate the throat. The use of tobacco products also increases
the risk of cancers of the mouth, throat and voice box.
◦ Allergies: Seasonal allergies or ongoing allergic reactions to dust, molds or pet dander make developing a
sore throat more likely.
◦ Exposure to chemical irritants: Particles in the air from burning fossil fuels and common household
chemicals can cause throat irritation.
◦ Chronic or frequent sinus infections: Drainage from your nose can irritate throat or spread infection.
◦ Close quarters. Viral and bacterial infections spread easily anywhere people gather.
◦ Weakened immunity. Immune-compromised people are susceptible to infections in general as resistance
to infections is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or
chemotherapy drugs, stress, fatigue, and poor diet.
9/16/2023 16
TRANSMISSION
◦ Group A strep pharyngitis is most commonly spread through direct person-to-person
transmission.
◦ Typically, transmission occurs through respiratory droplets but can also occur through contact
with secretions, such as saliva, wound discharge, or nasal secretions, from an infected
person.
9/16/2023 17
PATHOPHYSIOLOGY
9/16/2023 18
release of local toxins, proteases
irritation of mucosa by secretion
local inflammation
invasion of pharynx mucosa by causative organisms
Continued…
9/16/2023 19
inflammation of pharynx
release of histamine, prostaglandins
antigen-antibodies reaction occurs
PATHOGENESIS
◦ In viral pharyngitis, viruses gain access to the mucosal cells lining the nasopharynx and replicate
in these cells. Damage to the host is often caused by damage to the cells where the viruses are
replicating.
◦ In bacterial pharyngitis, bacteria invade the mucosal tissues of the pharynx directly.
Extracellular factors such as proteases facilitate the tissue invasion and cause the inflammation
that elicits swelling, exudates, fever, and pain with swallowing.
9/16/2023 20
CLINICAL FEATURES
◦ Group A strep pharyngitis is an acute pharyngitis that commonly presents with;
 Sudden-onset of sore throat
 Pain with swallowing ( dysphagia)
 Fever
◦ Other symptoms may include headache, abdominal pain, nausea, and vomiting — especially among
children.
◦ “Patients with group A strep pharyngitis typically do not have cough, rhinorrhea, hoarseness, oral
ulcers, or conjunctivitis. These symptoms strongly suggest a viral etiology.”
9/16/2023 21
Continued…
◦ On clinical examination, patients with group A strep pharyngitis usually have
• Pharyngeal and tonsillar erythema ( redness)
• Tonsillar hypertrophy with or without exudates
• Palatal petechiae (bruising on the roof of your mouth)
• Anterior cervical lymphadenopathy
9/16/2023 22
DIAGNOSIS & TESTING
◦ Laboratory studies that may be helpful include the following:
a. Group A beta-hemolytic streptococcal rapid antigen detection test (preferred diagnostic
method in emergency settings)
b. Throat culture (criterion standard for diagnosis of GAS infection [90-99% sensitive])
c. Mono spot (up to 95% sensitive in children; less than 60% sensitive in infants) [The mononucleosis spot test
looks for 2 hetero-antibodies in the blood. These antibodies appear during or after an infection with the virus
that causes mononucleosis caused by Epstein-Barr virus.]
d. Peripheral smear may show atypical lymphocytes in infectious mononucleosis. [A blood smear is a type
of blood test. It looks at the appearance, number, and shape of your red and white blood cells and platelets.]
e. Gonococcal culture if indicated by the history. [to detect Niserria gonorrhea]
f. A complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein have a
low predictive value and usually are not indicated.
9/16/2023 23
Continued…
◦ Imaging studies generally are not indicated for uncomplicated viral or
streptococcal pharyngitis. However, the following may be considered:
a. Lateral neck film in patients with suspected epiglottitis or airway compromise
b. Soft-tissue neck CT if concern for abscess or deep-space infection exists
◦ A throat swab may also be done.
9/16/2023 24
MANAGEMENT
9/16/2023 25
Continued…
◦ The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on
five clinical criteria, it indicates the probability of a streptococcal infection.
◦ One point is given for each of the criteria:
1. Absence of a cough
2. Swollen and tender cervical lymph nodes
3. Temperature more than 38.0 °C (100.4 °F)
4. Tonsillar exudate or swelling
5. Age less than 15 (a point is subtracted if age is more than 44)
◦ The Infectious Disease Society of America recommends against empirical treatment and considers
antibiotics only appropriate following positive testing. Testing is not needed in children under three, as both
group A strep and rheumatic fever are rare, except if they have a sibling with the disease.
9/16/2023 26
TREATMENT
i. Non-pharmacological Treatment
 Rest
 oral fluids
 salt-water gargling (for soothing effect)
 throat lozenges – lemon & ginger
 wearing mask - to avoid exposure to pollution
 avoid cold drinks & food
 warm water with honey
9/16/2023 27
Continued…
i. Pharmacological Treatment
◦ The use of a recommended antibiotic regimen to treat group A strep pharyngitis:
o Shortens the duration of symptoms
o Reduces the likelihood of transmission to family members, classmates, and other close contacts
o Prevents the development of complications, including acute rheumatic fever
◦ Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is the
drug of choice.
◦ Lozenges can be used for soothing sore throat or cough.
9/16/2023 28
Table: Antibiotic regimens recommended for group A streptococcal pharyngitis
9/16/2023 29
COMPLICATIONS
◦ Complications of bacterial pharyngitis include:
i. Epiglottitis ( inflammation of epiglottis )
ii. Otitis media (an infection of the middle ear that causes inflammation; redness and swelling and a build-up
of fluid behind the eardrum)
iii. Mastoiditis (an infection of the mastoid bone of the skull.)
iv. Sinusitis [ Sinus infections happen when fluid builds up in the air-filled pockets in the face (sinuses) ]
v. Acute rheumatic fever (a condition that can inflame or make the heart, joints, brain, and skin swell.)
vi. Post-streptococcal glomerulonephritis (a bacterial infection that causes rapid deterioration of the kidney
function due to an inflammatory response after streptococcal infection.)
vii. Toxic shock syndrome (a rare but life-threatening condition caused by bacteria getting into the body and
releasing harmful toxins.)
9/16/2023 30
PROGNOSIS
◦ In general, the prognosis for pharyngitis is good as both viral and bacterial infections are typically
self-limited to 5 to 7 days.
◦ In developing countries, over 20 million individuals are affected by group A streptococci and
develop acute rheumatic fever. This disorder is the leading cause of death in young
people. Mortality from pharyngitis is rare but does occur if the airway is compromised.
◦ Most cases of pharyngitis resolve within 7 to 10 days. Treatment failures are usually due to
antibiotic resistance, poor compliance, and untreated close contacts.
9/16/2023 31
9/16/2023 32
REFERENCES
◦ Pharyngitis: Practice Essentials, Background, Pathophysiology (medscape.com)
◦ Common types of pharyngitis | Vinmec
◦ https://www.sciencedirect.com/topics/immunology-and-microbiology/pharyngitis
◦ Pharyngitis - StatPearls - NCBI Bookshelf (nih.gov)
◦ Sore throat - Symptoms and causes - Mayo Clinic
◦ https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat
◦ Acute Pharyngitis (slideshare.net)
◦ https://www.researchgate.net
◦ pharyngitis- OM VERMA.pdf (slideshare.net)
◦ Bacterial Pharyngitis - StatPearls - NCBI Bookshelf (nih.gov)
◦ https://emedicine.medscape.com/article/225362
◦ https://www.google.com.pk (all images and tables)
9/16/2023 33

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Unveiling Pharyngitis: Causes, Symptoms, Diagnosis, and Treatment Strategies.pdf

  • 1. PHARYNGITIS NOOR-UL-AIN MEHMOOD ROLL NO 25 FINAL PROFF DEPARTMENT OF PHARMACY WOMEN INSTITUTE OF LEARNING, ABBOTTABAD
  • 2. TABLE OF CONTENTS 9/16/2023 2 Context Slide No. Definition 3 Types of Pharyngitis 4 - 12 Epidemiology 13 Etiology 14 - 15 Risk Factors 16 Transmission 17 Pathophysiology 18 - 19 Pathogenesis 20 Clinical Features 21 - 22 Diagnosis & Testing 23 - 24 Management 25 - 26 Treatment 27 - 29 Complications 30 Prognosis 31 References 33
  • 3. DEFINATION ◦ “Pharyngitis is the inflammation of the mucous membranes of the oropharynx.” OR ◦ “Pharyngitis is defined as an infection or irritation of the pharynx, back of the throat.”  Word Study: Pharynges = Pharynx & itis = inflammation 9/16/2023 3
  • 4. TYPES OF PHARYNGITIS 9/16/2023 4 Pharyngitis Acute pharyngitis Chronic pharyngitis Congestive pharyngitis Pseudomembranous pharyngitis
  • 5. ACUTE PHARYNGITIS ◦ Acute pharyngitis is a very common disease in the cold season, but often occurs with tonsillitis, rash, influenza, measles, diphtheria, whooping cough or some blood diseases. ◦ The disease is easily transmitted through contact through the nose, throat or saliva. ◦ Doctors usually diagnose acute pharyngitis based on systemic symptoms such as: a. chills, chills accompanied by body aches (when sore throat is caused by a virus), b. appearance of an infection syndrome such as fever, dry lips, and tongue dirty (when sore throat is caused by bacteria). ◦ Other symptoms include a burning sensation in the throat; sore throat, pain when swallowing (dysphagia); first stage dry cough then cough with sputum; May be accompanied by hoarseness (if inflammation spreads down the larynx). 9/16/2023 5
  • 6. Continued… ◦ Clinically, it is often divided into two types: red pharyngitis and white sore throat. 9/16/2023 6 White Sore Throat Red Pharyngitis
  • 7. CHRONIC PHARYNGITIS ◦ Chronic pharyngitis is a diffuse inflammation of the pharynx, very common and often associated with rhinitis, chronic sinusitis or sometimes with chronic laryngitis and tracheo-bronchitis. ◦ The main cause is chronic rhino sinusitis, especially posterior sinusitis. Regular exposure to dust, lime dust, chemical vapors, cement dust and irritants such as tobacco, alcohol also causes chronic pharyngitis. ◦ Doctors usually diagnose chronic pharyngitis based on systemic symptoms. ◦ A typical example is diffuse chronic pharyngitis, which often causes the patient to feel a burning sensation in the throat, dry throat, itching and congestion in the throat. These sensations are very evident in the morning upon awakening. Patients often have to try to cough, sputum, and clear throat to loosen phlegm; when swallowing, there is a feeling of entanglement and pain; cough and sore throat; dull voice. Patients who have a habit of drinking, smoking or talking a lot, the above symptoms are increased. 9/16/2023 7
  • 8. Continued… ◦ Chronic pharyngitis is presented in 3 forms: exudative, hypertrophic and atrophic. 9/16/2023 8 Exudative: white exudates (pus) on tonsils and pharyngeal wall. Hypertrophic: general thickening and congestion of pharyngeal mucus membrane. Atrophic: membrane is thin, white, glistening and sometimes wrinkled.
  • 9. CONGESTIVE PHARYNGITIS ◦ Congestive pharyngitis appears quite common during the season change. ◦ The erratic weather makes the body unable to adapt quickly, which can easily affect health, reduce resistance, lead to damage to the respiratory system, causing congestive pharyngitis. In addition, the disease is also common in people with liver failure, endocrine disorders, and gastrointestinal disorders. ◦ This type of sore throat is quite dangerous and needs to be treated quickly. ◦ Patients with congestive pharyngitis often have a burning sensation in the throat accompanied by itching, coughing episodes. Cough usually occurs at bedtime. 9/16/2023 9
  • 11. PSEUDOMEMBRANOUS PHARYNGITIS ◦ Also known as diphtheria pharyngitis, is a fairly rare form of pharyngitis. ◦ The cause of pseudomembranous pharyngitis is when the body is affected by the Klebs-Löffler bacillus also known as Corynebacterium diphtheria. ◦ The typical tell-tale sign is that in the pharynx mucosa will appear a thick, gray-white pseudomembranous membrane that adheres firmly to the pharynx mucosa and is difficult to peel; acute laryngitis. ◦ Patients can also have a high fever above 38.5 degrees Celsius. The disease can appear at different ages, but from 2 to 7 years old is the most common age to get sick. 9/16/2023 11
  • 13. EPIDEMIOLOGY ◦ Pharyngitis is a common disorder in adults and children. ◦ In a prospective family study, 16% of adults and 41% of children reported an illness with sore throat over a 1-year time frame. ◦ It is diagnosed in more than 1.9 million people a year in the Pakistan. 9/16/2023 13
  • 14. ETIOLOGY 9/16/2023 14 A. About 50% to 80% of pharyngitis, or sore throat, symptoms are viral in origin and include a variety of viral pathogens. These pathogens are predominantly; • Rhinovirus • Influenza • Adenovirus • Coronavirus • Parainfluenza B. Less common viral pathogens include; • Herpes • Epstein-Barr virus • Human immunodeficiency virus (HIV) • Coxsackie virus
  • 15. Continued… C. More severe cases tend to be bacterial and may develop after an initial viral infection. The most common bacterial infection is Group A beta-hemolytic streptococci, which causes 5% to 36% of cases of acute pharyngitis. Other bacterial etiologies include Group B & C streptococci; ◦ Chlamydia pneumonia ◦ Mycoplasma pneumonia ◦ Haemophilus influenza ◦ Candida albicans ◦ Neisseria meningitides ◦ Neisseria gonorrhea ◦ Arcanobacterium haemolyticum ◦ Fusobacterium necrophorum ◦ Corynebacterium diphtheriae. D. Environmental allergies and chemical exposures may also cause acute pharyngitis. 9/16/2023 15 Streptococcus pyogenes (group A Streptococcus) on Gram stain. Source: Public Health Image Library, CDC
  • 16. RISK FACTORS ◦ Age: Children and teens are most likely to develop sore throats. Children ages 3 to 15 are also more likely to have strep throat, the most common bacterial infection associated with a sore throat. ◦ Exposure to tobacco smoke: Smoking can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box. ◦ Allergies: Seasonal allergies or ongoing allergic reactions to dust, molds or pet dander make developing a sore throat more likely. ◦ Exposure to chemical irritants: Particles in the air from burning fossil fuels and common household chemicals can cause throat irritation. ◦ Chronic or frequent sinus infections: Drainage from your nose can irritate throat or spread infection. ◦ Close quarters. Viral and bacterial infections spread easily anywhere people gather. ◦ Weakened immunity. Immune-compromised people are susceptible to infections in general as resistance to infections is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet. 9/16/2023 16
  • 17. TRANSMISSION ◦ Group A strep pharyngitis is most commonly spread through direct person-to-person transmission. ◦ Typically, transmission occurs through respiratory droplets but can also occur through contact with secretions, such as saliva, wound discharge, or nasal secretions, from an infected person. 9/16/2023 17
  • 18. PATHOPHYSIOLOGY 9/16/2023 18 release of local toxins, proteases irritation of mucosa by secretion local inflammation invasion of pharynx mucosa by causative organisms
  • 19. Continued… 9/16/2023 19 inflammation of pharynx release of histamine, prostaglandins antigen-antibodies reaction occurs
  • 20. PATHOGENESIS ◦ In viral pharyngitis, viruses gain access to the mucosal cells lining the nasopharynx and replicate in these cells. Damage to the host is often caused by damage to the cells where the viruses are replicating. ◦ In bacterial pharyngitis, bacteria invade the mucosal tissues of the pharynx directly. Extracellular factors such as proteases facilitate the tissue invasion and cause the inflammation that elicits swelling, exudates, fever, and pain with swallowing. 9/16/2023 20
  • 21. CLINICAL FEATURES ◦ Group A strep pharyngitis is an acute pharyngitis that commonly presents with;  Sudden-onset of sore throat  Pain with swallowing ( dysphagia)  Fever ◦ Other symptoms may include headache, abdominal pain, nausea, and vomiting — especially among children. ◦ “Patients with group A strep pharyngitis typically do not have cough, rhinorrhea, hoarseness, oral ulcers, or conjunctivitis. These symptoms strongly suggest a viral etiology.” 9/16/2023 21
  • 22. Continued… ◦ On clinical examination, patients with group A strep pharyngitis usually have • Pharyngeal and tonsillar erythema ( redness) • Tonsillar hypertrophy with or without exudates • Palatal petechiae (bruising on the roof of your mouth) • Anterior cervical lymphadenopathy 9/16/2023 22
  • 23. DIAGNOSIS & TESTING ◦ Laboratory studies that may be helpful include the following: a. Group A beta-hemolytic streptococcal rapid antigen detection test (preferred diagnostic method in emergency settings) b. Throat culture (criterion standard for diagnosis of GAS infection [90-99% sensitive]) c. Mono spot (up to 95% sensitive in children; less than 60% sensitive in infants) [The mononucleosis spot test looks for 2 hetero-antibodies in the blood. These antibodies appear during or after an infection with the virus that causes mononucleosis caused by Epstein-Barr virus.] d. Peripheral smear may show atypical lymphocytes in infectious mononucleosis. [A blood smear is a type of blood test. It looks at the appearance, number, and shape of your red and white blood cells and platelets.] e. Gonococcal culture if indicated by the history. [to detect Niserria gonorrhea] f. A complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein have a low predictive value and usually are not indicated. 9/16/2023 23
  • 24. Continued… ◦ Imaging studies generally are not indicated for uncomplicated viral or streptococcal pharyngitis. However, the following may be considered: a. Lateral neck film in patients with suspected epiglottitis or airway compromise b. Soft-tissue neck CT if concern for abscess or deep-space infection exists ◦ A throat swab may also be done. 9/16/2023 24
  • 26. Continued… ◦ The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on five clinical criteria, it indicates the probability of a streptococcal infection. ◦ One point is given for each of the criteria: 1. Absence of a cough 2. Swollen and tender cervical lymph nodes 3. Temperature more than 38.0 °C (100.4 °F) 4. Tonsillar exudate or swelling 5. Age less than 15 (a point is subtracted if age is more than 44) ◦ The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three, as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease. 9/16/2023 26
  • 27. TREATMENT i. Non-pharmacological Treatment  Rest  oral fluids  salt-water gargling (for soothing effect)  throat lozenges – lemon & ginger  wearing mask - to avoid exposure to pollution  avoid cold drinks & food  warm water with honey 9/16/2023 27
  • 28. Continued… i. Pharmacological Treatment ◦ The use of a recommended antibiotic regimen to treat group A strep pharyngitis: o Shortens the duration of symptoms o Reduces the likelihood of transmission to family members, classmates, and other close contacts o Prevents the development of complications, including acute rheumatic fever ◦ Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is the drug of choice. ◦ Lozenges can be used for soothing sore throat or cough. 9/16/2023 28
  • 29. Table: Antibiotic regimens recommended for group A streptococcal pharyngitis 9/16/2023 29
  • 30. COMPLICATIONS ◦ Complications of bacterial pharyngitis include: i. Epiglottitis ( inflammation of epiglottis ) ii. Otitis media (an infection of the middle ear that causes inflammation; redness and swelling and a build-up of fluid behind the eardrum) iii. Mastoiditis (an infection of the mastoid bone of the skull.) iv. Sinusitis [ Sinus infections happen when fluid builds up in the air-filled pockets in the face (sinuses) ] v. Acute rheumatic fever (a condition that can inflame or make the heart, joints, brain, and skin swell.) vi. Post-streptococcal glomerulonephritis (a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response after streptococcal infection.) vii. Toxic shock syndrome (a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.) 9/16/2023 30
  • 31. PROGNOSIS ◦ In general, the prognosis for pharyngitis is good as both viral and bacterial infections are typically self-limited to 5 to 7 days. ◦ In developing countries, over 20 million individuals are affected by group A streptococci and develop acute rheumatic fever. This disorder is the leading cause of death in young people. Mortality from pharyngitis is rare but does occur if the airway is compromised. ◦ Most cases of pharyngitis resolve within 7 to 10 days. Treatment failures are usually due to antibiotic resistance, poor compliance, and untreated close contacts. 9/16/2023 31
  • 33. REFERENCES ◦ Pharyngitis: Practice Essentials, Background, Pathophysiology (medscape.com) ◦ Common types of pharyngitis | Vinmec ◦ https://www.sciencedirect.com/topics/immunology-and-microbiology/pharyngitis ◦ Pharyngitis - StatPearls - NCBI Bookshelf (nih.gov) ◦ Sore throat - Symptoms and causes - Mayo Clinic ◦ https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat ◦ Acute Pharyngitis (slideshare.net) ◦ https://www.researchgate.net ◦ pharyngitis- OM VERMA.pdf (slideshare.net) ◦ Bacterial Pharyngitis - StatPearls - NCBI Bookshelf (nih.gov) ◦ https://emedicine.medscape.com/article/225362 ◦ https://www.google.com.pk (all images and tables) 9/16/2023 33