Pharyngitis, a common inflammatory condition of the throat, presents a significant burden on healthcare systems globally. This comprehensive review explores the multifaceted aspects of pharyngitis, encompassing its etiology, clinical manifestations, diagnostic approaches, and therapeutic interventions. Pharyngitis, often referred to as sore throat, can stem from various infectious and non-infectious causes, including viral and bacterial pathogens, environmental irritants, and underlying medical conditions. Clinical presentation typically involves symptoms such as throat pain, difficulty swallowing, fever, and swollen lymph nodes. Differential diagnosis is crucial to distinguish between viral and bacterial etiologies, with streptococcal pharyngitis being a common bacterial cause requiring specific treatment. Diagnostic modalities include clinical evaluation, throat swabs for culture or rapid antigen testing, and, in some cases, imaging studies. Treatment strategies range from supportive measures, such as rest and hydration, to antimicrobial therapy for bacterial infections. Additionally, symptomatic relief can be achieved through analgesics, antipyretics, and throat lozenges. Prevention of pharyngitis involves practicing good hygiene, avoiding exposure to respiratory pathogens, and vaccination against specific bacterial pathogens. This review provides valuable insights into the epidemiology, pathophysiology, and management of pharyngitis, aiming to optimize patient care and outcomes. Keywords: Pharyngitis, sore throat, streptococcal pharyngitis, diagnosis, treatment, antimicrobial therapy, viral infections, bacterial infections

1. PHARYNGITIS
NOOR-UL-AIN MEHMOOD
ROLL NO 25
FINAL PROFF
DEPARTMENT OF PHARMACY
WOMEN INSTITUTE OF LEARNING, ABBOTTABAD

2. TABLE OF
CONTENTS
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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
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4. TYPES OF PHARYNGITIS
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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).
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6. Continued…
◦ Clinically, it is often divided into two types: red pharyngitis and white sore throat.
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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.
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8. Continued…
◦ Chronic pharyngitis is presented in 3 forms: exudative, hypertrophic and atrophic.
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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.
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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.
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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.
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14. ETIOLOGY
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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.
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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.
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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.
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18. PATHOPHYSIOLOGY
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release of local toxins, proteases
irritation of mucosa by secretion
local inflammation
invasion of pharynx mucosa by causative organisms

19. Continued…
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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.
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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.”
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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
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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.
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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.
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25. MANAGEMENT
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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.
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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
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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.
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29. Table: Antibiotic regimens recommended for group A streptococcal pharyngitis
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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.)
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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.
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32. 9/16/2023 32

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)
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