Sore throat, technically known as acute pharyngitis, is a very common condition and constitutes a large number of visits to primary care physicians. The bacteria known as streptococcus is a famous treatable cause but it accounts for a minority of pharyngitis cases in adults. A long list of pathogens can cause pharyngitis. Viruses are believed to cause the most cases of pharyngitis.
Sore Throat Causes
Group A streptococcus is the most treatable cause of pharyngitis and accounts for up to 15 percent of cases in adults. These patients usually have a sudden onset sore throat accompanied by fever, tonsillar exudate and painful lymph node in the neck. These patients usually do not develop a runny nose and cough. This type of pharyngitis could be complicated by development of sinusitis and retropharyngeal abscesses. Some patients might develop rheumatic fever and glomerulonephritis which is a kidney disease.
Viruses are the most common cause of pharyngitis. The most important viruses are influenza, parainfluenza, coronavirus and rhinovirus.
Influenza is treatable. It is also readily transmitted. Influenza is usually seen as presence of many cases in the community (epidemic). These patients experience cough and muscle pain. The pharynx looks red, known as hyperemia, in these patients but exudates are not usually seen on the tonsils.
Epstein-Barr virus has a specific clinical manifestation known as infectious mononucleosis. These patients experience headache and low-grade fever before the onset of pharyngitis. Later, they develop tender lymph nodes in the neck which is accompanied by high fever. Another annoying component of this disease is fatigue which is feeling extremely tired without any energy.
It should always be remembered that primary HIV infection could be presented as sore throat. It is not possible to readily make the diagnosis of primary HIV based on the clinical presentation but establishment of this diagnosis is important to treat these individuals and prevent rapid transmission. Sore throat in the primary HIV infection is accompanied by pharyngeal edema and redness. These patients also experience fever, rash, joint and muscle pain.
Herpes simplex virus infection can account for up to 10 percent of cases of acute pharyngitis. These patients have pharyngeal edema, exudate and ulcerated lesions. A minority of these patients have characteristics lip and mouth lesions which makes the rest of them difficult to distinguish them from other causes.
Other bacteria can also cause acute pharyngitis. Corynebacterium diphtheria is an important example, which is the etiology of diphtheria. These patients have pharyngitis, low-grade fever and malaise. Three other bacteria that may cause pharyngitis are Arcanobacterium haemolyticum, Chlamydophila pneumonia and Neisseria gonorrhoeae.
Pharyngitis can also be developed by non-infectious causes. An important entity in this group is allergy which causes inflammation in the pharynx. Smoking is a very important cause of non-infectious pharyngitis. This can also happen for second-hand smokers. Poorly humidified air in winter can also lead to pharyngitis.
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