Understanding Gastroesophageal Reflux Disease(GERD)

SORE THROAT/PHARYNGITIS: CAUSES, SYMPTOMS & TREATMENT

Sore Throat Or Pharyngitis

SORE THROAT/PHARYNGITIS

Sore throat or pharyngitis refers to the inflammation of the pharynx. The pharynx is the mucous membrane present at the back of the mouth. It is also defined as an infection or irritation of the pharynx or tonsils.

Strep throat and tonsillitis are some other terms that are used in the same context in some cases. The etiology is usually infectious with most cases of viral origin and most bacterial cases attributable to group A streptococcus (GAS).

Not all instances of sore throat or pharyngitis are because of infection. Some are brought about by different factors like smoking. Different causes incorporate hypersensitivity, injury, trauma, allergic reactions, poisons, and neoplasia. If a sore throat or pharyngitis is brought about by an infection, most cases are viral and form a part of the cold and influenza range.

Pharyngitis is a typical ailment. Much of the time, it never comes to clinical consideration and is treated with straightforward treatment coordinated at symptom relief. It is normally relieved on its own within seven days with no clinical consideration utilized. In any case, in instances of extreme disease, you need clinical consideration. It is almost entirely expected during winter.

Pharyngitis happens with a much more prominent recurrence in the pediatric populace. Kids experience more than 5 URIs each year and a normal of one streptococcal disease each long term. The pinnacle occurrence of bacterial and viral pharyngitis happens in school-matured kids ages 4-7 years, with GABHS happening essentially in patients aged 5-15 years.

If pharyngitis or sore throat is left untreated, it can cause different complications such as peritonsillar abscess (Quinsy), otitis media, rhinosinusitis, epiglottitis, and toxic shock syndrome.

CAUSES OF SORE THROAT/PHARYNGITIS

The most common bacteria involved in causing bacterial pharyngitis are Streptococcus pyogenes which are Group A beta-hemolytic streptococci (GABHS), Group A streptococcus (GAS), Arcanobacterium haemolyticum, Mycoplasma pneumonia, Chlamydia pneumonia, and Neisseria gonorrhoeae.

The most common viruses involved in causing viral pharyngitis are Adenovirus, Herpes simplex virus, Coxsackieviruses, Epstein-Barr virus (EBV), Rhinovirus and coronavirus, Common cold virus, Influenza virus, Chickenpox virus, Measles virus, and Mononucleosis disease.

Epstein–Barr virus (EBV), which causes glandular fever (infectious mononucleosis) is a more uncommon yet significant reason for sore throat since it very well might be mistaken for streptococcal disease. Corynebacterium diphtheria is accounted for infrequently in causing a sore throat. Practically 70% of instances of sore throat are brought about by infections and needn't bother with any treatment.

Rhinovirus and Coronavirus can cause irritation of pharyngeal mucosa secondary to nasal secretions. Streptococcal infections cause local invasion and secretion of extracellular toxins and proteases. M protein fragments of certain Group A streptococcus (GAS) are similar to myocardial sarcolemma antigens and are linked to rheumatic fever. Antigen-antibody complexes may deposit into glomeruli and lead to PSGN.

Sore throat/Pharyngitis can likewise develop because of a hypersensitive response to dust, grass, pet dander, and certain synthetic substances. Smoking, tobacco, air contamination, and dry air can likewise disturb sore throat. Dry air sucks all the dampness from your mouth or throat, causing the sensation of dryness and scratching. Gastroesophageal reflux infection (GERD) can likewise cause side effects of sore throat/pharyngitis.

SYMPTOMS OF SORE THROAT/PHARYNGITIS

Patients diagnosed with pharyngitis may present the symptoms of sore throat, often associated with fever and the usual symptoms of the common cold. Pharyngeal infection may occasionally give rise to disseminated infection elsewhere, but this is rare.

The most common symptoms of sore throat or pharyngitis are red, swollen tonsils coated with white or yellow patches, difficult or painful swallowing, enlarged lymph nodes in the neck, scratchy or muffled voice, and bad breath. You may also have headaches, stiff neck, scarlatiniform rash, rhinorrhea, conjunctivitis, cough, and abdominal pain, particularly in younger children.

More frequent accompaniments are otitis media, peritonsillar abscess, and sinusitis. These should be distinguished from the non-suppurative complications of streptococcal infection, rheumatic fever, and glomerulonephritis.

DIAGNOSIS OF SORE THROAT/PHARYNGITIS

The purpose of any diagnostic measure used for sore throat is to distinguish the streptococcal sore throat from viral infections. If a definite bacterial diagnosis is required, a throat swab should be taken for culture.

The aim of the culture technique is to detect β-hemolytic streptococci. If bacterial culture is negative and glandular fever is suspected, blood should be taken for serological confirmation. Blood tests use either the non-specific ‘mono spot test’ for atypical lymphocytes or specific tests for antibodies to EBV.

GABHS rapid antigen detection test is the best test used for emergency situations but its sensitivity and specificity vary. The Sensitivity of the throat culture test is 90-99 %.

Viral pharyngitis may be diagnosed by viral culture or serology, but this does not usually contribute to management. Rapid bedside tests are available that detect group A streptococcal antigens in the throat, but there are concerns about their sensitivity and specificity.

  

STREP THROAT PREDICTION METHOD

Two criteria are used for the prediction of strep throat which are discussed below,

CENTOR CRITERIA

• Fever (1 point)
• Cervical node swelling (1 point)
• Tonsillar swelling (1 point)
• Absence of cough (1 point)
• Unlikely = 0-1 point
• 30 % chances = 3 point
• 50 % chances = 4 points

ATTIA CRITERIA

• Scarlatiniform rash (2 point)
• Cervical node swelling (1 point)
• Tonsillar swelling (1 point)
• No coryza (1 point)
• Low likelihood = 0 point
• Intermediate likelihood = 1-3 points
• Higher likelihood = 4-5 points

TREATMENT OF SORE THROAT/PHARYNGITIS

Treatment of viral sore throat is aimed at indicative alleviation, for instance, with rest, antipyretics, and aspirin gargle. Streptococcal sore throat is normally treated with antibiotics albeit to the degree to which they abbreviate the span of manifestations and lessen the rate of suppurative complications.

There is likewise a contention that treatment used to kill streptococcal carriage may decrease the danger of backsliding or later streptococcal infections at different destinations.

Extensively, there are three treatment methodologies:

1. Antibiotics are given to all patients with suspected streptococcal infection and aren't explored except if side effects persevere.
2. Offer anti-microbial to all patients with suspected streptococcal contamination yet stop them if a throat swab is negative

Wait for the results of the throat swab culture before starting antibiotics
The symptomatic treatment is effective for viral sore throat. It is relieved by taking proper rest and hydration. You can also use antipyretics for the reduction of fever such as acetaminophen, ibuprofen, and naproxen. Avoid these medicines in children because they can cause Reye syndrome. You can also gargle with salt water or aspirin.

Antibiotics are prescribed if the sore throat is caused by a bacterial infection. Antibiotics are very effective because they shorten the duration of symptoms of sore throat. Antibiotics that are effective against Streptococcus pyogenes include penicillin, cephalosporin, amoxicillin, and macrolides. Resistance to penicillin and cephalosporins has not been described in group A streptococci. The resistance of bacteria to erythromycin is reported to be 4%.

Penicillins such as benzylpenicillin (penicillin G) or phenoxymethylpenicillin (penicillin V) are considered the treatment of choice for streptococcal sore throat. At the present time, cephalosporins are more effective in terms of both clinical response and eradication of the organism from the oropharynx.

The most commonly prescribed antibiotics include clarithromycin, azithromycin, ciprofloxacin, and clindamycin. Cefalexin is the preferred cephalosporin. Penicillin or amoxicillin is the preferred penicillin. Dextromethorphan is an effective antitussive used for coughing during a sore throat.