PHARYNGITIS

PHARYNGITIS
PHARYNGITIS
Inflammation of the mucosal
lining of the pharynx
I. Acute Pharyngitis
II. Chronic Pharyngitis

I. ACUTE PHARYNGITIS
A. Non-specific: Acute simple pharyngitis
B. Specific: Bacterial: Diphtheria,

Vincent's angina
Fungal: Moniliasis
Viral: Infectious
mononucleosis
C. Due to Blood diseases:
Agranulocytosis, Acute
leukaemia
1. ACUTE Simple PHARYNGITIS
Aetiology:
1. Viral infection, followed by secondary bacterial
infection.
Predisposing factors: Low resistance, rhinitis,
sinusitis and pyorrhea
2. Prodroma of infectious diseases as measles and
scarlet fever
Symptoms:
Fever, headache and malaise Sore throat and
referred otalgia
1. ACUTE Simple PHARYNGITIS
Signs :
1. Diffuse congestion of the pharyngeal mucosa and
tonsils
2. Enlarged tender cervical lymph nodes
Complications: Otitis media and laryngitis
Treatment :
1. Rest, fluids, analgesics and antipyretics
2. Antibiotics
2. Diphtheria
Faucial Diphtheria
Age: Children 2-6 years
Aetiology: Corynebacterium diphtheriae
Transmission: Droplet infection
Incubation period: 2-5 days
Sites of infection: Faucial (tonsils) 60%, Laryngeal
10%, and Nasal 5%
Pathology: Local: Pseudomembrane

Systemic: Toxaemia (due to absorbed
exotoxins)
2. Diphtheria
Faucial Diphtheria
Symptoms: Insidious onset of mild fever,
sore throat and foetor oris
Pathology:
1. Pseudomembrane on the tonsil, which is:
– Unilateral, exceeding the margins of the tonsils to the
pharynx or larynx
– Grayish yellow, formed of sloughed mucosa and thick
fibrinous exudates
– Adherent; when removed it leaves a raw bleeding area
and recurs rapidly
2. Toxaemia: Pallor and rapid pulse asynchronous
with the temperature
3. Bilateral markedly enlarged tender cervical lymph
nodes (Bull's neck).
2. Diphtheria
Faucial Diphtheria
Investigation: Throat swab cultured on Tellurite or
Loffler's media for diphtheria bacilli
Differential Diagnosis: From other causes of

a membrane on the tonsil:
1. Acute follicular tonsillitis
2. Vincent's angina
3. Moniliasis
4. Infectious mononucleosis
5. Agranulocytosis
6. Acute leukaemia
2. Diphtheria
Faucial Diphtheria
Complications:
1. Respiratory complications:
– Laryngeal obstruction due to extension of the membrane
to the larynx
– Lung collapse due to inhalation of a piece of the
membrane
2. Cardiovascular complications: Heart failure
– Early: due to toxic myocarditis
– Late: due to vagal neuritis
3. Kidney complications: Acute nephritis causing
albuminuria
2. Diphtheria
Faucial Diphtheria
Complications:
4. Paralytic complications: occur after 2-3 weeks
– Palatal paralysis (the earliest) causes nasal regurgitation

of fluid
– Pharyngeal paralysis causes dysphagia
– Laryngeal paralysis causes hoarseness and poor
coughing
– Chest muscle paralysis (diaphragm and intercostals)
causes suffocation
– Ocular muscle paralysis causes diplopia and loss of
accommodation
2. Diphtheria
Faucial Diphtheria
Treatment:
1. Rest for 3 weeks to prevent heart failure
2. Isolation until 3 successive swabs are negative
3. Anti-toxic serum 40.000-100.000 I.U. I.M.
4. Penicillin for 10 days
5. Treatment of complications: Nasogastric tube for
dysphagia, tracheostomy for
stridor, artificial respiration for chest muscle paralysis
Prophylaxis:
1. Active immunization: by D.P.T.
2. Passive immunization: 3000-10.000 I.U. anti-toxic serum
to contacts
3. Tonsillectomy: for diphtheria carriers
3. Vincent's Angina
Aetiology: Acute ulcerative inflammation of
the pharynx and gums.
Causative organisms: Two anaerobic organisms:

1. Spirochaeta denticola (Borrelia vincenti)
2. Fusiform bacilli
Symptoms: Mild fever, severe sore throat and

foetor oris
3. Vincent's Angina
Signs:
1. Unilateral grayish membrane on the tonsil, may extend to
the pillars and soft palate,
on separation leaves an ulcer with deep punched-out
edge and irregular flattened
base.
2. Ulcers on the gums with marked foetor
Investigations: Throat swab examined for the
organisms
Treatment: Penicillin, Metronidazole, Hydrogen
peroxide mouthwash
4. Moniliasis (Oral thrush
Aetiology: Candida albicans fungus
Clinical picture:
1. Mild sore throat
2. Multiple milky white patches in the oral
cavity and pharynx.
Treatment:
1. Topical anti-fungal drugs as nystatin
2. Systemic anti-fungal drugs in severe cases
3. Treatment of predisposing factor
(Glandular fever)
Aetiology: Epstein-Barr virus
Symptoms: Persistent fever, severe sore
throat and dysphagia
Signs:
1. Diffuse congestion of the pharyngeal mucosa and tonsils
2. Shallow yellow ulcers on the tonsils
3. Palatal petechiae (in 30% of cases)
5. Generalized lymphadenopathy may occur
6. Splenomegaly (in 30% of cases) and hepatomegaly (in 30%
of cases)
(Glandular fever)
Investigations:
1. Blood picture: monocytosis and lymphocytosis
2. Serological tests:
– Positive monospot test
– Positive Baul-Bunnell test: Patient's serum agglutinates
sheep's RBCs.
Treatment:
1. Rest, fluids, analgesics, antipyretics
2. Antibiotics (avoid ampicillin as it may cause
rubelliform skin rash)
3. Steroids
6. Acute Pharyngitis associated with
Blood Diseases
a. Agranulocytosis
Aetiology: Bone marrow depression which may be:
• Primary: Idiopathic
• Secondary: to antibiotics, antimitotics, radiotherapy,
autoimmune
Clinical picture:
1. Fever and sore throat with marked deterioration of
general condition
2. Necrotic ulcers surrounded with little inflammatory
reaction, in the oral
cavity, tonsils and fauces.
Blood Diseases
a. Agranulocytosis
Investigations:
1. Blood picture: Leucopenia (agranulocytosis with
relative lymphocytosis)
2. Bone marrow aspiration is diagnostic
Treatment:
Stop the drug, isolation, blood transfusion,
penicillin, and vitamin B12
Blood Diseases
b. Acute Leukaemia
Aetiology:
Neoplastic proliferation of the precursors of white blood cells in
the bone marrow
Clinical picture:
1. Intercurrent infection with fever and sore throat. Necrotic ulcers
and exudative
membrane on bleeding swollen gums and enlarged tonsils
2. Anaemia, with marked pallor and fatigue
3. Thrombocytopenic purpura, with epistaxis and bleeding
tendency
4. Generalized lymphadenopathy and splenomegaly
5. Sternal tenderness
Blood Diseases
b. Acute Leukaemia
Investigations:
1. Blood picture: marked leucocytosis with
increased blast cells, anaemia, and
thrombocytopenia
2. Bone marrow aspiration is diagnostic
Treatment:
Isolation, fresh blood transfusion, penicillin,
and cytotoxic drugs
II. CHRONIC PHARYNGITIS
A. Non-specific:
Chronic simple pharyngitis
B. Specific:
Scleroma, T.B. and syphilis
Chronic Simple Pharyngitis
Aetiology:
1. Recurrent acute pharyngitis
2. Chronic sinusitis and chronic tonsillitis
3. Nasal obstruction with postnasal discharge and mouth
breathing
4. Alcohol and smoking
5. Reflux oesophagitis
Symptoms:
– Persistent sore throat and sensation of dryness and irritation
in the throat
– Frequent hawking (desire for clearing of throat)
Chronic Simple Pharyngitis
Signs: Three clinical types
a. Catarrhal pharyngitis: Congestion of pharyngeal
mucosa
b. Hypertrophic (granular) pharyngitis. Hypertrophied
lateral pharyngeal
bands and lymphoid follicles on posterior
pharyngeal wall
c. Atrohic pharyngitis: Pharyngeal mucosa is dry and
glazed.
Treatment:
Avoidance and treatment of predisposing factors
CHRONIC Specific PHARYNGITIS
B. Tuberculosis
Aetiology: Secondary to Pulmonary
tuberculosis
Clinical picture:
1. Pallor of pharyngeal mucosa
2. Painful superficial shallow ulcer with bluish
undermined edge and yellow caseous
floor, on the tip of the tongue, palate or fauces
CHRONIC Specific PHARYNGITIS
C. Syphilis
1. Primary syphilis: Chancre; on the tongue, lips
or tonsil (single painless indurated
nodule with cervical lymphadenopathy)
2. Secondary syphilis: Mucous patches; that

coalesce and ulcerate to snail-track ulcers,
on the tongue, cheek and tonsil.
3. Tertiary syphilis: Gumma; on the palate, tongue

or posterior wall (single painless
firm pinkish swelling, that ulcerate to form deep
ulcer with punched-out edges and
necrotic dirty yellow wash-leather floor)

PHARYNGITIS

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PHARYNGITIS

II. Chronic Pharyngitis

B. Specific: Bacterial: Diphtheria,

Pathology: Local: Pseudomembrane

Differential Diagnosis: From other causes of

– Palatal paralysis (the earliest) causes nasal regurgitation

Causative organisms: Two anaerobic organisms:

Symptoms: Mild fever, severe sore throat and

2. Secondary syphilis: Mucous patches; that

3. Tertiary syphilis: Gumma; on the palate, tongue

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