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{{Short description|Inflammation of the back of the throat}}{{distinguish|laryngitis}}

factoids

| symptoms = Sore throat, fever, runny nose, cough, headache, hoarse voice| complications = Sinusitis, acute otitis media| onset =| duration = 3–10 days, depending on cause| types =| causes = Usually viral infection| risks =| diagnosis = Based on symptoms, rapid antigen detection test, throat swab| differential = Epiglottitis, thyroiditis, retropharyngeal abscess| prevention =| treatment = lidocaine| medication =| prognosis =| frequency = ~7.5% of people in any 3-month period| deaths =}}Pharyngitis is inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, difficulty swallowing, swollen lymph nodes, and a hoarse voice.BOOK, Oral and maxillofacial pathology,www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20110077025, subscription, Elsevier, Neville, Brad W., Damm, Douglas D., Allen, Carl M., Chi, Angela C., 2016, 9781455770526, 4th, St. Louis, MO, 166, 908336985, 17 March 2020, 28 October 2021,web.archive.org/web/20211028081814/https://www.clinicalkey.com/ui-origin/master-1586/2-bundle.js, dead, Symptoms usually last 3–5 days, but can be longer depending on cause.BOOK, David A.Warrell, Timothy M. Cox, John D. Firth, Estée Török, Oxford textbook of medicine infection, 2012, Oxford University Press, Oxford, 9780191631733, 280–281,books.google.com/books?id=qkLibW2ZikYC&pg=PA280, live,web.archive.org/web/20161010214543/https://books.google.com/books?id=qkLibW2ZikYC&pg=PA280, 2016-10-10, Complications can include sinusitis and acute otitis media. Pharyngitis is a type of upper respiratory tract infection.WEB, Pharyngitis,www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561, National Library of Medicine, 4 August 2016, live,www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561," title="web.archive.org/web/20160520133301www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561,">web.archive.org/web/20160520133301www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561, 20 May 2016, dmy-all, Most cases are caused by a viral infection. Strep throat, a bacterial infection, is the cause in about 25% of children and 10% of adults. Uncommon causes include other bacteria such as gonococcus, fungi, irritants such as smoke, allergies, and gastroesophageal reflux disease. Specific testing is not recommended in people who have clear symptoms of a viral infection, such as a cold. Otherwise, a rapid antigen detection test or throat swab is recommended. PCR testing has become common as it is as good as taking a throat swab but gives a faster result.WEB, Acute pharyngitis - Symptoms, diagnosis and treatment {{!, BMJ Best Practice |url=https://bestpractice.bmj.com/topics/en-gb/5?gclid=Cj0KCQiA14WdBhD8ARIsANao07gHoxGoevNSlX5KuGk4-CmaYA3lhsFfKw8rQvaxK5Uvhj1caPOysYsaAiivEALw_wcB |website=bestpractice.bmj.com}} Other conditions that can produce similar symptoms include epiglottitis, thyroiditis, retropharyngeal abscess, and occasionally heart disease.JOURNAL, Hildreth, AF, Takhar, S, Clark, MA, Hatten, B, Evidence-Based Evaluation And Management Of Patients With Pharyngitis In The Emergency Department., Emergency Medicine Practice, September 2015, 17, 9, 1–16; quiz 16–7, 26276908, NSAIDs, such as ibuprofen, can be used to help with the pain. Numbing medication, such as topical lidocaine, may also help. Strep throat is typically treated with antibiotics, such as either penicillin or amoxicillin. It is unclear whether steroids are useful in acute pharyngitis, other than possibly in severe cases, but a recent (2020) review found that when used in combination with antibiotics they moderately improved pain and the likelihood of resolution.JOURNAL, Principi, N, Bianchini, S, Baggi, E, Esposito, S, No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media., European Journal of Clinical Microbiology & Infectious Diseases, February 2013, 32, 2, 151–60, 22993127, 10.1007/s10096-012-1747-y, 7087613, JOURNAL, de Cassan, Simone, Thompson, Matthew J., Perera, Rafael, Glasziou, Paul P., Del Mar, Chris B., Heneghan, Carl J., Hayward, Gail, 1 May 2020, Corticosteroids as standalone or add-on treatment for sore throat, The Cochrane Database of Systematic Reviews, 2020, 5, CD008268, 10.1002/14651858.CD008268.pub3, 1469-493X, 7193118, 32356360, About 7.5% of people have a sore throat in any 3-month period.BOOK, Jones, Roger, Oxford Textbook of Primary Medical Care, 2004, Oxford University Press, 9780198567820, 674,books.google.com/books?id=2LB0PC17uFsC&pg=PA674, 4 August 2016, en, Two or three episodes in a year are not uncommon.BOOK, Rutter, Paul Professor, Newby, David, Community Pharmacy ANZ: Symptoms, Diagnosis and Treatment, 2015, Elsevier Health Sciences, 9780729583459, 19,books.google.com/books?id=NbjVCgAAQBAJ&pg=PA19, en, live,web.archive.org/web/20170908192747/https://books.google.com/books?id=NbjVCgAAQBAJ&pg=PA19, 8 September 2017, dmy-all, This resulted in 15 million physician visits in the United States in 2007.JOURNAL, Weber, R, Pharyngitis., Primary Care, March 2014, 41, 1, 91–8, 24439883, 10.1016/j.pop.2013.10.010, 7119355, Pharyngitis is the most common cause of a sore throat.BOOK, Rosen’s emergency medicine: concepts and clinical practice, 7th, Marx, John, 2010, Mosby/Elsevier, Philadelphia, Pennsylvania, 978-0-323-05472-0, Chapter 30, The word comes from the Greek word pharynx meaning “throat” and the suffix -itis meaning “inflammation”.BOOK, Beachey, Will, Respiratory Care Anatomy and Physiology, Foundations for Clinical Practice,3: Respiratory Care Anatomy and Physiology, 2013, Elsevier Health Sciences, 978-0323078665, 5,books.google.com/books?id=LBzD30OmrSwC&pg=PA5, en, live,web.archive.org/web/20170908192747/https://books.google.com/books?id=LBzD30OmrSwC&pg=PA5, 8 September 2017, dmy-all, BOOK, Hegner, Barbara, Acello, Barbara, Caldwell, Esther, Nursing Assistant: A Nursing Process Approach – Basics, 2009, Cengage Learning, 9781111780500, 45,books.google.com/books?id=LopsCgAAQBAJ&pg=PA45, en, live,web.archive.org/web/20170908192747/https://books.google.com/books?id=LopsCgAAQBAJ&pg=PA45, 8 September 2017, dmy-all, {{TOC limit}}

Classification

(File:Amigdalas (cropped).jpg|thumb|A normal throat)Pharyngitis is a type of inflammation caused by an upper respiratory tract infection. It may be classified as acute or chronic. Acute pharyngitis may be catarrhal, purulent, or ulcerative, depending on the causative agent and the immune capacity of the affected individual. Chronic pharyngitis may be catarrhal, hypertrophic, or atrophic.{{citation needed|date=August 2020}}Tonsillitis is a subtype of pharyngitis.WEB, Tonsillitis,www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069, 4 August 2016, live,www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069," title="web.archive.org/web/20160325080921www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069,">web.archive.org/web/20160325080921www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069, 25 March 2016, dmy-all, If the inflammation includes both the tonsils and other parts of the throat, it may be called pharyngotonsillitis or tonsillopharyngitis.JOURNAL, Rafei K, Lichenstein R, Airway Infectious Disease Emergencies, Pediatric Clinics of North America, 53, 2, 215–242, 2006, 16574523, 10.1016/j.pcl.2005.10.001, Another subclassification is nasopharyngitis (the common cold).WEB,www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069, www.nlm.nih.gov, live,www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069," title="web.archive.org/web/20151117014738www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069,">web.archive.org/web/20151117014738www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069, 17 November 2015, dmy-all, Clergyman’s sore throat or clergyman’s throat is an archaic term formerly used for chronic pharyngitis associated with overuse of the voice as in public speaking. It was sometimes called dysphonia clericorum or chronic folliculitis sore throat.JOURNAL, Broadwater, Kimberly, 2021, Clergyman’s Sore Throat,muse.jhu.edu/article/803425, Journal of Singing, 78, 1, 113–117, 10.53830/CNLB1302, 239663449, 2769-4046,

Cause

Most cases are due to an infectious organism acquired from close contact with an infected individual.{{citation needed|date=August 2020}}

Viral

File:Mononucleosis.JPG|thumb|left|Exudative pharyngitis in a person with infectious mononucleosisinfectious mononucleosisThese comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.WEB,emedicine.medscape.com/article/764304-overview, Pharyngitis, Acerra JR, eMedicine, 28 April 2010, live,emedicine.medscape.com/article/764304-overview," title="web.archive.org/web/20100317130804emedicine.medscape.com/article/764304-overview,">web.archive.org/web/20100317130804emedicine.medscape.com/article/764304-overview, 17 March 2010, dmy-all,

• Adenovirus is the most common of the viral causes. Typically, the degree of neck lymph node enlargement is modest and the throat often does not appear red, although it is painful.
• The family Orthomyxoviridae which cause influenza are present with rapid onset high temperature, headache, and generalized ache. A sore throat may be associated.
• Infectious mononucleosis (“glandular fever“) is caused by the Epstein–Barr virus. This may cause significant lymph-node swelling and an exudative tonsillitis with marked redness and swelling of the throat. The heterophile test can be used if this is suspected.
• Herpes simplex virus can cause multiple mouth ulcers.
• Measles
• Common cold: rhinovirus, coronavirus, respiratory syncytial virus, and parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often pain.

Bacterial

A number of different bacteria can infect the human throat. The most common is group A streptococcus (Streptococcus pyogenes), but others include Streptococcus pneumoniae, Haemophilus influenzae, Bordetella pertussis, Bacillus anthracis, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Fusobacterium necrophorum.JOURNAL, Bisno AL, Acute pharyngitis, N Engl J Med, 344, 3, 205–11, January 2001, 11172144, 10.1056/NEJM200101183440308,

Streptococcal pharyngitis

(File:Pos strep.JPG|thumb|A case of strep throat)Streptococcal pharyngitis or strep throat is caused by a group A beta-hemolytic streptococcus (GAS).JOURNAL, Baltimore RS, Re-evaluation of antibiotic treatment of streptococcal pharyngitis, Curr. Opin. Pediatr., 22, 1, 77–82, February 2010, 19996970, 10.1097/MOP.0b013e32833502e7, 13141765, It is the most common bacterial cause of cases of pharyngitis (15–30%). Common symptoms include fever, sore throat, and large lymph nodes. It is a contagious infection, spread by close contact with an infected individual. A definitive diagnosis is made based on the results of a throat culture. Antibiotics are useful to both prevent complications (such as rheumatic fever) and speed recovery.JOURNAL, Choby BA, Diagnosis and treatment of streptococcal pharyngitis, Am Fam Physician, 79, 5, 383–90, March 2009, 19275067,www.aafp.org/afp/2009/0301/p383.html, live,www.aafp.org/afp/2009/0301/p383.html," title="web.archive.org/web/20150208124744www.aafp.org/afp/2009/0301/p383.html,">web.archive.org/web/20150208124744www.aafp.org/afp/2009/0301/p383.html, 8 February 2015, dmy-all,

Fusobacterium necrophorum

Fusobacterium necrophorum is a normal inhabitant of the oropharyngeal flora and can occasionally create a peritonsillar abscess. In one out of 400 untreated cases, Lemierre’s syndrome occurs.JOURNAL, Centor RM, Expand the pharyngitis paradigm for adolescents and young adults, Ann Intern Med, 151, 11, 812–5, 1 December 2009, 19949147, 10.7326/0003-4819-151-11-200912010-00011, 10.1.1.669.7473, 207535809,

Diphtheria

Diphtheria is a potentially life-threatening upper respiratory infection caused by Corynebacterium diphtheriae, which has been largely eradicated in developed nations since the introduction of childhood vaccination programs, but is still reported in the Third World and increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but recovery is generally slow.{{Citation needed|date=April 2009}}

Others

A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess (“quinsy abscess“), submandibular space infection (Ludwig’s angina), and epiglottitis.WEB,www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result, UpToDate Inc., live,www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result," title="web.archive.org/web/20090627030426www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result,">web.archive.org/web/20090627030426www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result, 27 June 2009, dmy-all, (registration required)JOURNAL, Reynolds SC, Chow AW, Severe soft tissue infections of the head and neck: a primer for critical care physicians, Lung (journal), Lung, 187, 5, 271–9, Sep–Oct 2009, 19653038, 10.1007/s00408-009-9153-7, 9009912, JOURNAL, Bansal A, Miskoff J, Lis RJ, Otolaryngologic critical care, Crit Care Clin, 19, 1, 55–72, January 2003, 12688577, 10.1016/S0749-0704(02)00062-3,

Fungal

Some cases of pharyngitis are caused by fungal infection, such as Candida albicans, causing oral thrush.WEB, Harvard Medical School, Sore Throat (Pharyngitis),www.health.harvard.edu/a_to_z/sore-throat-pharyngitis-a-to-z, Harvard Health Publishing Harvard Medical School, Harvard Health Publishing, 3 December 2019,

Noninfectious

Pharyngitis may also be caused by mechanical, chemical, or thermal irritation, for example cold air or acid reflux. Some medications may produce pharyngitis, such as pramipexole and antipsychotics.WEB,bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Mirapex/Mirapex.pdf, Mirapex product insert, 2009, Boehringer Ingelheim, 30 June 2010, live,bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf," title="web.archive.org/web/20100614020208bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf,">web.archive.org/web/20100614020208bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf, 14 June 2010, dmy-all, WEB,medical-dictionary.thefreedictionary.com/olanzapine, Mosby’s Medical Dictionary, 8th edition, 2009, Elsevier, 30 June 2010,

Diagnosis{| class“wikitable” style “float: right; margin-left:15px; text-align:center“|+ Modified Centor score

!Points||Probability of Strep||Management|

Epidemiology

Acute pharyngitis is the most common cause of a sore throat and, together with cough, it is diagnosed in more than 1.9 million people a year in the United States.