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词条 Pharyngitis
释义

  1. Classification

  2. Cause

     Viral  Bacterial  Fungal   Non-infectious  

  3. Diagnosis

  4. Management

     Medications  Alternative 

  5. Epidemiology

  6. References

  7. External links

{{distinguish|laryngitis}}{{Infobox medical condition (new)
| name = Pharyngitis
| synonyms = Acute sore throat
| image = Pharyngitis.jpg
| caption = Viral pharyngitis resulting in visible redness.
| field = Infectious disease
| pronounce = {{IPAc-en|f|ær|ᵻ|n|ˈ|dʒ|aɪ|t|ᵻ|s}}
| symptoms = Sore throat, fever, runny nose, cough, headache, hoarse voice[1][2]
| complications = Sinusitis, acute otitis media[2]
| onset =
| duration = 3–5 days[2]
| types =
| causes = Usually viral infection[2]
| risks =
| diagnosis = Based on symptoms, rapid antigen detection test, throat swab[2]
| differential = Epiglottitis, thyroiditis, retropharyngeal abscess[2]
| prevention =
| treatment = NSAIDs, lidocaine[2][9]
| medication =
| prognosis =
| frequency = ~7.5% of people in any 3-month period[10]
| deaths =
}}Pharyngitis is inflammation of the back of the throat, known as the pharynx.[2] It typically results in a sore throat and fever.[2] Other symptoms may include a runny nose, cough, headache, and a hoarse voice.[1] Symptoms usually last three to five days.[2] Complications can include sinusitis and acute otitis media.[2] Pharyngitis is a type of upper respiratory tract infection.[1]

Most cases are caused by a viral infection.[2] Strep throat, a bacterial infection, is the cause in about 25% of children and 10% of adults.[2] Uncommon causes include other bacteria such as gonorrhea, fungus, irritants such as smoke, allergies, and gastroesophageal reflux disease.[2][9] Specific testing is not recommended in people who have clear symptoms of a viral infection, such as a cold.[2] Otherwise a rapid antigen detection test (RAPD) or throat swab is recommended.[2] Other conditions that can produce similar symptoms include epiglottitis, thyroiditis, retropharyngeal abscess, and occasionally heart disease.[2]

NSAIDs, such as ibuprofen, can be used to help with the pain.[2] Numbing medication, such as topical lidocaine, may also help.[9] Strep throat is typically treated with antibiotics, such as either penicillin or amoxicillin.[2] It is unclear if steroids are useful in acute pharyngitis, other than possibly in severe cases.[3][4]

About 7.5% of people have a sore throat in any three-month period.[5] Two to three episodes in a year is not uncommon.[6] This resulted in 15 million physician visits in the United States in 2007.[7] Pharyngitis is the most common cause of a sore throat.[8] The word comes from the Greek word pharynx meaning "throat" and the suffix -itis meaning "inflammation".[9][10]

{{TOC limit|3}}

Classification

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.

Tonsillitis is a subtype of pharyngitis.[11] If the inflammation includes both the tonsils and other parts of the throat, it may be called pharyngotonsillitis.[12] Another subclassification is nasopharyngitis (the common cold).[13]

Cause

The majority of cases are due to an infectious organism acquired from close contact with an infected individual.

Viral

These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.[8][14]

  • Adenovirus – 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.
  • Orthomyxoviridae family which cause influenza – present with rapid onset high temperature, headache and generalized ache. A sore throat may be associated.
  • Infectious mononucleosis ("glandular fever") 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.[15]

;Streptococcal pharyngitis
{{Main|Streptococcal pharyngitis}}

Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus (GAS).[16] It is the most common bacterial cause of cases of pharyngitis (15–30%).[15] 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.[17]

;Fusobacterium necrophorum
Fusobacterium necrophorum is a normal inhabitant of the oropharyngeal flora and can occasionally create a peritonsillar abscess. In 1 out of 400 untreated cases, Lemierre's syndrome occurs.[18]
;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.[19][20][21]

Fungal

Some cases of pharyngitis are caused by fungal infection, such as Candida albicans, causing oral thrush.{{Citation needed|date=April 2009}}

Non-infectious

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.[22][23]

Diagnosis

Modified Centor score
PointsProbability of StrepManagement
1 or less <10%No antibiotic or culture needed
2 11–17%Antibiotic based on culture or RAPD
3 28–35%
4 or 5 52%Empiric antibiotics

It is difficult to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone.[50] Thus often a throat swab is done to rule out a bacterial cause.[24]

The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.[17]

One point is given for each of the criteria:[17]

  • Absence of a cough
  • Swollen and tender cervical lymph nodes
  • Temperature more than {{convert|38.0|C|F}}
  • Tonsillar exudate or swelling
  • Age less than 15 (a point is subtracted if age is more than 44)

The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate following positive testing.[50] Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.[25]

Management

The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, fungal, and herpes simplex infections.

Medications

  • Pain medication, such as NSAIDs and acetaminophen (paracetamol), can help reduce the pain associated with a sore throat. Aspirin may be used in adults but is not recommended in children due to the risk of Reye syndrome.[26]
  • Steroids (such as dexamethasone) may be useful for severe pharyngitis.[27][4] Their general use however is poorly supported.[3]
  • Viscous lidocaine relieves pain by numbing the mucous membranes.[28]
  • Antibiotics are useful if a bacterial infection is the cause of the sore throat.[29][30] For viral infections, antibiotics have no effect. In the United States, they are used in 25% of people before a bacterial infection has been detected.[31]
  • Oral analgesic solutions, the active ingredient usually being phenol, but also less commonly benzocaine, cetylpyridinium chloride and/or menthol. Chloraseptic and Cepacol are two examples of brands of these kinds of analgesics.

Alternative

{{see also|Alternative treatments used for the common cold}}

Gargling salt water is often suggested but evidence looking at its usefulness is lacking.[7] Alternative medicines are promoted and used for the treatment of sore throats.[65] However, they are poorly supported by evidence.[32]

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.[8]

References

1. ^{{cite web|title=Pharyngitis|url=https://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561|website=National Library of Medicine|accessdate=4 August 2016|deadurl=no|archiveurl=https://web.archive.org/web/20160520133301/http://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?mode=&term=Pharyngitis&field=entry#TreeC08.730.561|archivedate=20 May 2016|df=dmy-all}}
2. ^1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 {{cite journal|last1=Hildreth|first1=AF|last2=Takhar|first2=S|last3=Clark|first3=MA|last4=Hatten|first4=B|title=Evidence-Based Evaluation And Management Of Patients With Pharyngitis In The Emergency Department.|journal=Emergency Medicine Practice|date=September 2015|volume=17|issue=9|pages=1–16; quiz 16–7|pmid=26276908}}
3. ^1 {{cite journal|last1=Principi|first1=N|last2=Bianchini|first2=S|last3=Baggi|first3=E|last4=Esposito|first4=S|title=No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media.|journal=European Journal of Clinical Microbiology & Infectious Diseases|date=February 2013|volume=32|issue=2|pages=151–60|pmid=22993127|doi=10.1007/s10096-012-1747-y}}
4. ^1 {{cite journal|last1=Hayward|first1=G|last2=Thompson|first2=MJ|last3=Perera|first3=R|last4=Glasziou|first4=PP|last5=Del Mar|first5=CB|last6=Heneghan|first6=CJ|title=Corticosteroids as standalone or add-on treatment for sore throat.|journal=The Cochrane Database of Systematic Reviews|date=17 October 2012|volume=10|pages=CD008268|pmid=23076943|doi=10.1002/14651858.CD008268.pub2}}
5. ^1 {{cite book|last1=Jones|first1=Roger|title=Oxford Textbook of Primary Medical Care|date=2004|publisher=Oxford University Press|isbn=9780198567820|page=674|url=https://books.google.com/books?id=2LB0PC17uFsC&pg=PA674|accessdate=4 August 2016|language=en}}
6. ^1 2 {{cite book|last1=Rutter|first1=Paul Professor|last2=Newby|first2=David|title=Community Pharmacy ANZ: Symptoms, Diagnosis and Treatment|date=2015|publisher=Elsevier Health Sciences|isbn=9780729583459|page=19|url=https://books.google.com/books?id=NbjVCgAAQBAJ&pg=PA19|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20170908192747/https://books.google.com/books?id=NbjVCgAAQBAJ&pg=PA19|archivedate=8 September 2017|df=dmy-all}}
7. ^1 2 3 4 {{cite journal|last1=Weber|first1=R|title=Pharyngitis.|journal=Primary Care|date=March 2014|volume=41|issue=1|pages=91–8|pmid=24439883|doi=10.1016/j.pop.2013.10.010}}
8. ^1 2 {{cite book |title=Rosen's emergency medicine: concepts and clinical practice |edition=7th |last=Marx |first=John |year=2010 |publisher=Mosby/Elsevier |location=Philadelphia, Pennsylvania |isbn=978-0-323-05472-0 |at=Chapter 30 |url= }}
9. ^{{cite book|last1=Beachey|first1=Will|title=Respiratory Care Anatomy and Physiology, Foundations for Clinical Practice,3: Respiratory Care Anatomy and Physiology|date=2013|publisher=Elsevier Health Sciences|isbn=978-0323078665|page=5|url=https://books.google.com/books?id=LBzD30OmrSwC&pg=PA5|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20170908192747/https://books.google.com/books?id=LBzD30OmrSwC&pg=PA5|archivedate=8 September 2017|df=dmy-all}}
10. ^{{cite book|last1=Hegner|first1=Barbara|last2=Acello|first2=Barbara|last3=Caldwell|first3=Esther|title=Nursing Assistant: A Nursing Process Approach – Basics|date=2009|publisher=Cengage Learning|isbn=9781111780500|page=45|url=https://books.google.com/books?id=LopsCgAAQBAJ&pg=PA45|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20170908192747/https://books.google.com/books?id=LopsCgAAQBAJ&pg=PA45|archivedate=8 September 2017|df=dmy-all}}
11. ^{{cite web|title=Tonsillitis|url=https://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069|accessdate=4 August 2016|deadurl=no|archiveurl=https://web.archive.org/web/20160325080921/http://www.nlm.nih.gov/cgi/mesh/2016/MB_cgi?field=uid&term=D014069|archivedate=25 March 2016|df=dmy-all}}
12. ^{{cite journal |vauthors=Rafei K, Lichenstein R | title = Airway Infectious Disease Emergencies | journal = Pediatric Clinics of North America | volume = 53 | issue = 2 | pages = 215–242 | year = 2006 | pmid = 16574523 | pmc = | doi = 10.1016/j.pcl.2005.10.001 }}
13. ^{{cite web |url=https://www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069 |title=www.nlm.nih.gov |website= |accessdate= |deadurl=no |archiveurl=https://web.archive.org/web/20151117014738/http://www.nlm.nih.gov/cgi/mesh/2010/MB_cgi?field=uid&term=D014069 |archivedate=17 November 2015 |df=dmy-all }}
14. ^{{cite web |url=http://emedicine.medscape.com/article/764304-overview |title=Pharyngitis |author=Acerra JR |work=eMedicine |accessdate=28 April 2010 |deadurl=no |archiveurl=https://web.archive.org/web/20100317130804/http://emedicine.medscape.com/article/764304-overview |archivedate=17 March 2010 |df=dmy-all }}
15. ^1 {{cite journal | author = Bisno AL | title = Acute pharyngitis | journal = N Engl J Med | volume = 344 | issue = 3 | pages = 205–11 | date = January 2001 | pmid = 11172144 | doi = 10.1056/NEJM200101183440308 }}
16. ^{{cite journal | author = Baltimore RS | title = Re-evaluation of antibiotic treatment of streptococcal pharyngitis | journal = Curr. Opin. Pediatr. | volume = 22 | issue = 1 | pages = 77–82 | date = February 2010 | pmid = 19996970 | doi = 10.1097/MOP.0b013e32833502e7 | url = }}
17. ^1 2 {{cite journal | author = Choby BA | title = Diagnosis and treatment of streptococcal pharyngitis | journal = Am Fam Physician | volume = 79 | issue = 5 | pages = 383–90 | date = March 2009 | pmid = 19275067 | doi = | url = http://www.aafp.org/afp/2009/0301/p383.html | deadurl = no | archiveurl = https://web.archive.org/web/20150208124744/http://www.aafp.org/afp/2009/0301/p383.html | archivedate = 8 February 2015 | df = dmy-all }}
18. ^{{cite journal | author = Centor RM | title = Expand the pharyngitis paradigm for adolescents and young adults | journal = Ann Intern Med | volume = 151 | issue = 11 | pages = 812–5 | date = 1 December 2009 | pmid = 19949147 | doi = 10.7326/0003-4819-151-11-200912010-00011 | citeseerx = 10.1.1.669.7473 }}
19. ^{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=pc_id/4421&selectedTitle=1~150&source=search_result |title=UpToDate Inc. |website= |accessdate= |deadurl=no |archiveurl=https://web.archive.org/web/20090627030426/http://www.uptodate.com/online/content/topic.do?topicKey=pc_id%2F4421&selectedTitle=1~150&source=search_result |archivedate=27 June 2009 |df=dmy-all }} (registration required)
20. ^{{cite journal |vauthors=Reynolds SC, Chow AW | title = Severe soft tissue infections of the head and neck: a primer for critical care physicians | journal = Lung | volume = 187 | issue = 5 | pages = 271–9 | date = Sep–Oct 2009 | pmid = 19653038 | doi = 10.1007/s00408-009-9153-7 }}
21. ^{{cite journal |vauthors=Bansal A, Miskoff J, Lis RJ | title = Otolaryngologic critical care | journal = Crit Care Clin | volume = 19 | issue = 1 | pages = 55–72 | date = January 2003 | pmid = 12688577 | doi = 10.1016/S0749-0704(02)00062-3 }}
22. ^{{cite web |url=http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Mirapex/Mirapex.pdf |title=Mirapex product insert |year=2009 |website= |publisher=Boehringer Ingelheim |pages= |accessdate=30 June 2010 |deadurl=no |archiveurl=https://web.archive.org/web/20100614020208/http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=%2FPrescribing+Information%2FPIs%2FMirapex%2FMirapex.pdf |archivedate=14 June 2010 |df=dmy-all }}
23. ^{{cite web |url=http://medical-dictionary.thefreedictionary.com/olanzapine |title=Mosby's Medical Dictionary, 8th edition |year=2009 |website= |publisher=Elsevier |pages= |accessdate=30 June 2010}}
24. ^{{cite journal | author = Del Mar C | title = Managing sore throat: a literature review. I. Making the diagnosis | journal = Med J Aust | volume = 156 | issue = 8 | pages = 572–5 | year = 1992 | pmid = 1565052 | doi = }}
25. ^1 2 {{cite journal |vauthors=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C | title = Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. | journal = Clinical Infectious Diseases | volume = 55 | issue = 10 | pages = e86–102 | date = 9 September 2012 | pmid = 22965026 | doi = 10.1093/cid/cis629 }}
26. ^{{cite journal|title=Re-evaluation of antibiotic treatment of streptococcal pharyngitis|date=February 2010|issue=Curr. Opin. Pediatr. 22 (1)|pages=77–82|doi=10.1097/MOP.0b013e32833502e7|pmid=19996970|volume=22|author=Baltimore RS|journal=Current Opinion in Pediatrics}}
27. ^{{cite journal |vauthors=Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P | title = Corticosteroids for pain relief in sore throat: systematic review and meta-analysis | journal = BMJ | volume = 339 | issue = | pages = b2976 | year = 2009 | pmid = 19661138 | pmc = 2722696 | doi = 10.1136/bmj.b2976 | url = }}
28. ^{{cite web |url=http://www.medicinenet.com/lidocaine_viscous/article.htm |title=LIDOCAINE VISCOUS (Xylocaine Viscous) side effects, medical uses, and drug interactions. |website= |accessdate= |deadurl=no |archiveurl=https://web.archive.org/web/20100408065631/http://www.medicinenet.com/lidocaine_viscous/article.htm |archivedate=8 April 2010 |df=dmy-all }}
29. ^{{cite journal|last1=Kocher|first1=JJ|last2=Selby|first2=TD|title=Antibiotics for sore throat.|journal=American Family Physician|date=1 July 2014|volume=90|issue=1|pages=23–4|pmid=25077497}}
30. ^{{cite journal|last1=Spinks|first1=A|last2=Glasziou|first2=PP|last3=Del Mar|first3=CB|title=Antibiotics for sore throat.|journal=The Cochrane Database of Systematic Reviews|date=5 November 2013|volume=11|issue=11|pages=CD000023|pmid=24190439|doi=10.1002/14651858.CD000023.pub4}}
31. ^{{cite journal|last1=Urkin|first1=J|last2=Allenbogen|first2=M|last3=Friger|first3=M|last4=Vinker|first4=S|last5=Reuveni|first5=H|last6=Elahayani|first6=A|title=Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases.|journal=Acta Paediatrica|date=November 2013|volume=102|issue=11|pages=1075–80|pmid=23879261|doi=10.1111/apa.12364}}
32. ^1 {{cite web |url=http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10 |title=Sore throat: Self-care |publisher=Mayo Clinic |accessdate=17 September 2007 |website= |deadurl=no |archiveurl=https://web.archive.org/web/20070929153814/http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION%3D10 |archivedate=29 September 2007 |df=dmy-all }}

External links

{{Medical resources
| DiseasesDB = 24580
| ICD10 = {{ICD10|J|02||j|00}}, {{ICD10|J|31|2|j|30}}
| ICD9 = {{ICD9|462}}, {{ICD9|472.1}}
| ICDO =
| OMIM =
| MedlinePlus = 000655
| eMedicineSubj = emerg
| eMedicineTopic = 419
| MeshID = D010612
}}{{Commons category}}{{Respiratory pathology}}{{Inflammation}}{{Common cold}}{{Use dmy dates|date=April 2018}}

7 : Infectious diseases|Inflammations|Upper respiratory tract diseases|Gastrointestinal tract disorders|RTT|Pharynx|RTTEM
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