Acute pharyngitis

Pharyngitis is an inflammation of the pharynx, most cases are caused by a viral infection. The disease is not limited to tonsils, other parts of the respiratory tract are also affected. Symptoms of pharyngitis include sore throat, dysphagia, and fever with a general feeling of being unwell. Unlike tonsillitis (which is usually of bacterial origin), symptoms of pharyngitis may include a runny nose, burning in the nose, tearing, sneezing and a dry cough.

CAVE! Due to the difficult clinical distinction between pharyngitis and angina, the term tonsillopharyngitis has been introduced.

Etiology
The disease of a child under two years of age is usually caused by viral agents. These are typically rhinoviruses, coronaviruses , adenoviruses , enteroviruses , EBV , CMV and HSV.

In a case of infection of children older than 5 years, it is most often a streptococcal infection, the most common is group A streptococcus. However, this bacterium is detected from the collected microbiological material only in 10 to 20% of cases.

If an adolescent develops pharyngitis, it is usually caused by a mycoplasma, gonococcal or Arcanobacterium haemolyticum .

It is important to keep in mind a possible diagnosis of HIV infection, as pharyngitis along with fever, adenopathy and maculopapular rash are the first clinical manifestations of this infection.

The clinical picture
During the physical examination of the neck, we may find redness, leakage of the mucosa, petechiae on the palate, enlarged tonsils and possibly lymphadenopathy in the front section of neck. The examination does not distinguish between viral and bacterial etiology, however, finding of ulcerations and vesicles indicates an infection by HSV and coxsackie viruses (so-called herpangina ), simultaneous occurrence of conjunctivitis indicates adenoviral infection, grey-white fibrinous membranes with swelling of the throat indicates diphtherial infection and maculopapullous rash  for beta-hemolytic group A streptococcus, less often for A. haemolyticum.

Diagnosis

 * Clinical signs: sudden pain, sore throat
 * Normal or slightly elevated CRP
 * Negative cultivation of a tonsil swab, that does not show streptococcal tonsillopharyngitis

Therapy
Treatment of pharyngitis is symptomatic. Antipyretics and gargles are recommended.

Related articles

 * Acute laryngitis
 * Pneumonia

Literature

 * BEHRMAN, Richard E a Robert KLIEGMAN. Nelson essentials of pediatrics. 4. vydání. Philadelphia : Saunders Company, 2002.  ISBN 0-7216-9406-3.

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 * ROZSYPAL, Hanuš. Základy infekčního lékařství. 1. vydání. Praha : Karolinum, 2015. 566 s.  ISBN 978-80-246-2932-2.