Pharyngitis can be of viral, bacterial, fungal or non-infectious origin. Each variant should be treated differently to avoid problems in the future.
Sore throat and pharyngitis account for 2% and 5% of all adult and pediatric medical visits, respectively. It is estimated that, globally, in 2010some 1,800 million people went to the emergency clinic for pharyngitis, of which almost 700 million were patients under 15 years of age.
With these data, we want to show that pharyngitis is an extremely common clinical event in the population. Many viruses and bacteria enter our body through the nostrils or mouth and, therefore, it is common for one of the first places of colonization to be the pharyngeal tissue. The harmful actions by viruses and bacteria cause damage to the tissue of this structure, but in addition, inflammation is also encouraged by the patient’s own immune response.
Pharyngitis is usually accompanied by other symptoms such as stuffy nose, coughing, fever, swallowing difficulties and raspy voice, althoughsymptoms are usually not delayed for more than 5 days. If you want to know everything about this clinical sign and how to treat it, read on.
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What is pharyngitis?
Pharyngitis is defined as inflammation of the pharynx, and therefore, the throat. Specifically, we speak ofan acute inflammation of the oropharyngeal mucosa, located behind the mouth (ranging from the lower edge of the soft palate to the upper edge of the epiglottis). This area is highly exposed to the invasion of microorganisms, as it is part of both the respiratory and digestive systems. Whether by inhaling microparticles or eating infected food, pathogens can easily enter this area.
Bacteria and viruses are capable of directly invading the pharyngeal mucosa. Once they settle, they begin to synthesize harmful substances or multiply uncontrollably, sending “signals” to the patient’s immune system that something is not quite right. Thus, lymphocytes and other cell bodies trigger inflammatory responses, whose purpose is to eliminate the primary cause of tissue damage, eliminate necrotic cells and begin a repair process as quickly as possible.
This inflammatory response, in almost all cases and tissues, is reduced to the following concepts: heat, pain, flushing, swelling and loss of function. In the picture of pharyngitis we usually face acute episodes, that is, product of a primary response of the immune system towards the damaged area, where mainly leukocytes (granulocytes) and plasma movement are involved. In summary, the local invasion of pathogens in the oropharyngeal mucosa promotes inflammation, edema and secretion.
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Causes and symptoms of pharyngitis
There are multiple pathogens that can establish themselves in the oropharyngeal mucosa. It is essential to distinguish the etiology of the different variants of pharyngitis, since a viral infection has nothing to do with a bacterial one in terms of treatment. We show you the most common causative agents of this clinical picture in the following lines.
1. Viruses
Up to 80% of acute pharyngitis is of viral origin. The predominant pathogens in this category belong to the group of adenoviruses (most common), rhinovirus, influenza virus, coronavirus and parainfluenza. Viral pharyngitis is usually self-limited and mild, with those of bacterial origin reporting the most problems in the short and long term.
These types of infections have a clear seasonal pattern, as they are highly contagious and easily transmitted, especially in the coldest months of the year (autumn and winter, sometimes spring). Its establishment in the population nucleus (and in the patient) is gradual, starting the symptoms in general after a short incubation period of 1 to 3 days. Fatigue and chills are one of the first symptoms of pharyngeal viral infection, sometimes accompanied by a mild fever that never exceeds 38 degrees.
Odynophagia (pain when swallowing food), discomfort in the throat and itching are the clinical signs that make their way after the initial symptoms and are usually present, to a greater or lesser extent, in all cases of pharyngitis. Normally, these signs experience the symptomatic peak 3-5 days after their onset and, fortunately, resolve on their own in a maximum of 10 days. Rhinorrhea, conjunctivitis and headache are typical of viral pharyngitis.
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2. Bacteria
As its name suggests, in this case bacterial microorganisms are the cause of the disease. The pathogenStreptococcus pyogenes (group A streptococcus or GAS) is particularly striking, since it is estimated to be the cause of 30% of clinical pictures in adults and 15% of children. In 0.015% of pediatric patients this infection can evolve into a serious problem, soit is considered a variant of pharyngitis slightly more worrying than the viral one.
Bacterial pharyngitis does not follow a seasonal pattern, as bacteria surround us in the middle at virtually any time of the year. Its establishment is abrupt and rapid, usually forming epidemiological outbreaks that tend to suffocate over time. It is difficult to differentiate this variant from the viral in the first instance, but a medical professional can find key differences in the patient.
In the first place, it is common for the patient to present a fever that oscillates between 38 and 40 degrees, while in the viral variant the first value is never exceeded. Odynophagia is more pronounced, as the patient manifests very intense pain when swallowing food and / or saliva. It is also common for cervical adenopathy, that is, inflammation of the lymph nodes in the neck, to appear in response to bacterial infection.
On the other hand, bacterial pharyngitis does not show signs of upper respiratory tract infestation, so runny nose and coughing are rare. In summary, the symptoms are more pronounced in the pharyngeal mucosa, and above all it is diagnosed by the presence of pharyngeal plaques and associated lymphadenopathy, in addition to the relevant laboratory tests (mucosal exudate and microscopic observation).
3. Other causes
Some fungi (such asCandida albicans) can also cause pharyngitis. In addition, there are non-infectious causes of this pathology, such as irritation of the pharynx due to continued gastroesophageal reflux (GERD), as an effect derived from tobacco consumption or alcoholism, among other things.
Treatment of pharyngitis
In viral infections, treatment (almost) is always symptomatic, while in bacterial and fungal infections, antibiotics and antifungals should be used, respectively. Giving a patient antibiotics during a viral infection will not helpand, in addition, can create a significant rebound effect on a social level. Interestingly, pharyngitis is more prevalent in countries where these drugs are overprescribed: the more antibiotics people consume when they don’t need them, the more likely they are to develop multidrug-resistant bacterial strains.
Sore throats are only treated with antibiotics if a test by a doctor for strep is positive or, failing that, a culture for chlamydia or gonorrhea is positive. Otherwise, it is assumed that the infection is viral and, therefore, drugs that work in the elimination of the virus are almost never prescribed (it is the immune system itself that must take care of it).
What can be done, in all cases, is to resort to over-the-counter analgesic drugs, such as paracetamol, to reduce pain and inflammation. Patients are also advised to drink plenty of fluids, gargle, suck on hard candy, and use fresh air vaporizers. In general, with this home care any viral infection resolves on its own in about 7-10 days.
Summary
In summary, most pharyngitis is caused by viral etiologies and, as such, does not require specific medication. With resting at home and taking certain measures to relieve the symptoms, it is enough for thedisease to come to fruition.
On the other hand, if the infection is persistent and the symptoms become severe (or differential compared to a viral picture), it is necessary to go to the doctor in all cases.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.
