Acute pharyngitis is an acute inflammation of the pharyngeal mucosa and submucosal tissues, often affecting lymphoid tissues in the pharynx. It may occur as a primary condition or as a secondary manifestation of acute rhinitis or acute tonsillitis. This condition is more common in autumn and winter, as well as at the transition between winter and spring.
Etiology
Viral Infection
Coxsackie virus and adenovirus are the most common causes, followed by rhinovirus and influenza virus. It may also occur due to infection with the novel coronavirus, with transmission occurring through droplets and close contact.
Bacterial Infection
Group A beta-hemolytic streptococcus, staphylococcus, and streptococcus pneumoniae are commonly implicated. Among these, Group A beta-hemolytic streptococcal infections are the most severe, as they can lead to suppurative complications in distant organs, referred to as acute septic pharyngitis.
Environmental Factors
Factors such as dryness, dust, smoke, harmful gases, or allergens may trigger the condition.
Pathology
The pharyngeal mucosa becomes congested, accompanied by vasodilation and serous exudation. Neutrophilic and lymphocytic infiltration is seen around submucosal blood vessels and mucus glands, leading to mucosal swelling and thickening. In more severe cases, lymphatic follicles on the posterior pharyngeal wall exhibit hyperplasia, marked elevation, and yellowish-white pinpoint exudates. Cervical lymph node enlargement commonly occurs alongside the condition.
Clinical Manifestations
The onset is often sudden, with initial symptoms including dryness, a burning sensation, and coarseness in the throat, followed by significant throat pain that worsens upon swallowing. When the lateral pharyngeal bands are involved, the pain may radiate to the ear. Systemic symptoms are generally mild but vary based on age, immune status, and the virulence of the bacteria or virus involved. Fever, headache, loss of appetite, and limb aches may occur.
Examinations
The oropharyngeal mucosa presents with acute diffuse congestion and swelling. Lymphatic follicles on the posterior pharyngeal wall appear prominent, with yellowish-white pinpoint exudates on the surface. The uvula and soft palate demonstrate edema. Submandibular lymph nodes are enlarged and tender. Acute congestion may also be present in the nasopharynx and laryngopharynx, with severe cases showing epiglottic edema.
Diagnosis
Diagnosis is typically straightforward based on the patient's history, symptoms, and clinical signs. However, it is important to differentiate acute pharyngitis from certain acute infectious diseases, such as measles, scarlet fever, and influenza, especially in children. Throat swab culture, antibody testing, or PCR nucleic acid testing may be performed to identify the causative pathogen. Additionally, in cases of necrotic pseudomembranes in the throat, hematological and systemic testing is recommended to rule out severe systemic diseases such as hematologic disorders.
Complications
The condition may lead to otitis media, sinusitis, or acute respiratory tract inflammation. Acute septic pharyngitis may cause complications such as acute nephritis, rheumatic fever, or septicemia.
Treatment
For cases without systemic symptoms or with mild symptoms, topical treatments, such as antiseptic gargles, or lozenges, may be appropriate. Oral antiviral or antibiotic agents may be considered based on the underlying cause. For patients with more severe systemic symptoms or high fever, treatment includes rest, increased fluid intake, and a liquid diet, alongside the use of intravenous antiviral or antibiotic agents in addition to the aforementioned measures.