The causes of sore throat can be divided into two groups: those caused by infection and those caused by non-infection. Those caused by infection can be examined under two main headings: viral and bacterial.
Pharyngitis pharynx region consists of three parts. Nasopharynx (nasal area), oropharynx (roughly the part seen from the mouth), hypopharynx (it is the remaining part of the pharynx above the larynx that cannot be seen directly from the mouth and is seen endoscopically). Infection and inflammation of any or all of the three parts of the pharynx is called pharyngitis. . Infectious pharyngitis in adults is just one of many causes of sore throat. Taking an accurate history for each patient and careful physical examination are critical to make a differential diagnosis between diseases.
Which viruses cause pharyngitis?
The risk of pharyngitis in adults The most common cause (30-60%) is self-limiting viral infections, which are a part of the common cold. On average, adults catch a cold two to four times a year, and 20% of them apply to a healthcare institution due to symptoms of the disease. Rhinoviruses are the viruses that most commonly cause colds. Coronavirus and parainfluenza virus are less common causes of colds. Coronavirus can cause a disease defined as severe acute respiratory syndrome (SARS). In this disease, sore throat and runny nose are seen in only 13-25% of patients. Dryness of the throat is observed rather than redness and swelling in the throat. Lymphadenopathy (swelling of the lymph nodes) is not observed.
Rhinoviruses are transmitted through breathing in the form of droplet infection with large particles. This group of viruses causes inflammation without causing destruction (invasion) in the membrane covering the inner surface of the nose. Some secreted inflammatory mediators cause edema and redness in the intranasal lining, and this redness and swelling progress downwards towards the pharynx. This infection may present with findings similar to beta infection of the throat, but in rhinovirus infections the throat The pain is not that severe and there is no difficulty in swallowing. Patients usually complain of runny nose, nasal congestion, dry cough, hoarseness, low-grade fever. Treatment of colds is symptomatic and rest and drinking enough fluids are sufficient. Sometimes a combination of cold medications can be used. In healthy adults, it heals within a week. Antibiotics are not used, but if secondary bacterial sinusitis (0.5-5%) develops, antibiotics must be used.
Influenza viruses reach the respiratory tract through droplet infection.
They affect the respiratory system. They attack the covering covering (mucosa). If it progresses, it can affect the entire respiratory system up to the lungs. It is generally more common in late autumn and winter. It can cause global epidemics. If it is progressive, it may result in death. Influenza A is more virulent and lethal. It can cause illness enough to require hospitalization in very young patients, while the rate of complications is higher in patients over 50 years of age. The risk of encountering complications increases when there is an underlying disease (immunocompromised conditions, heart-lung diseases, diabetes). The cause of death due to the disease is usually due to pneumonia due to primary viral or secondary bacterial infection. It begins with complaints of sudden fever, headache and myalgia (muscle aches). It then continues with complaints of sore throat, malaise, chills, sweating, dry cough and runny nose. Lymphadenopathy (swelling of the lymph nodes) is not observed. The symptoms usually subside within 3-5 days. In severe cases and in groups with high risk of complications, antiviral drugs (zanamivir, oseltamivir) can be used. If this group of drugs is started within the first 2 days, a regression in the symptoms is observed in the following 2 days. Treatment should be planned according to each patient. The best preventive method is vaccination. The effectiveness of vaccines is between 70-100%. Vaccination is recommended for those with chronic heart-lung disease, those with metabolic disease, those with immune deficiency, those in the 2nd and 3rd trimesters of pregnancy during the flu season, healthcare personnel, and those giving home care to high-risk patients.
Human Immunodeficiecy Virus (HIV):
Acute HIV infection may occur with a mononucleosis-like picture in 40-90% of cases within days or weeks of exposure. This febrile condition has been called acute retroviral syndrome. Because the symptoms are nonspecific, this condition is overlooked even in people at high risk of HIV. Therefore, acute retroviral syndrome should be kept in mind for differential diagnosis in patients with fever of unknown cause. The most common symptoms are fever, lethargy, skin rash, muscle pain, headache, pharyngitis, swollen lymph nodes in the neck area and joint pain. Pharyngitis is seen in 50-70% of patients.
Ulcer lesions in the mouth and candidiasis (thrush) can be seen in the mouth. Diagnosis can be reached with various blood tests. Ulcers in the mouth in AIDS patients may be caused by herpes virus, cytomegalovirus, cryptococcus, histoplasmosis, and mycobacterial infection. Ulcers in the mouth grow larger, cause damage to the surrounding area, and are quite painful. It is usually seen in the cavity where the tonsils are located, in the floor of the mouth and in the epiglottis.
Adenovirus:
Adenoviruses are well known to cause pharyngitis (pharyngoconjunctival fever) along with conjunctivitis in children. Adenovirus 3, 4.7 and 21 serotypes can cause outbreaks of febrile respiratory disease in recruits (situations where crowded environments are shared). It can cause disease in patients with compromised immune systems and rarely in healthy adults. Adenoviruses cause pharyngitis, which is part of febrile respiratory disease in adults. Sore throat is seen in 71% of patients. Adenoviruses directly attack the membrane covering the pharynx and cause cellular damage. For this reason, a sore throat is more severe than a cold.
Nasal congestion, dry cough, muscle pain, headache, nausea, vomiting and diarrhea may occur along with a sore throat. The disease mostly resolves spontaneously, and its treatment is symptomatic. The average time for the symptoms to regress is 10 days. It can cause serious problems, especially in people with suppressed immune systems and rarely in healthy adults. In rare cases, the disease can be a cause of death. Adenovirus infections can cause pneumonia and secondary bacterial infections. Very rarely; They can cause meningitis, encephalitis, cystitis, nephritis, colitis and death.
Epstein-Barr virus (EBV):
This virus remains hidden in the human body. . They proliferate intermittently, especially in B-lymphocytes and oropharyngeal mucosa cells. Contagion can be carried through saliva. Another way of transmission, although quite rare, is blood transfusion. 80-90% of the society around the world has encountered this virus. In developing countries, almost all children encounter this virus in the first 6 years of life and become immune. In developed countries, 30% of the population encounters this virus in adolescence or adulthood. 50% of this group have the infection without showing any signs of disease and become immune. EBV is the virus that causes the disease called Infectious Mononucleosus. The initial route of this infection is lymphoid tissues and pharyngeal epithelial cells. The incubation period is 3-7 weeks. Initial symptoms of malaise, fever and chills are followed 1-2 weeks later by sore throat, fever, loss of appetite and lymphadenopathy (swelling of the lymph nodes). Sore throat is seen in 82% of patients and is the most common complaint. In addition, abdominal pain, headache, stiff neck and skin rashes may occur. During the examination, white membrane in the pharynx area, redness and swelling in the tonsils, petechiae at the junction of the soft and hard palate, and ulcers in the pharynx and epiglottis are observed. Swelling of the lymph nodes in the neck area is a distinctive finding. Spleen enlargement and liver enlargement may be observed. Swelling around the eyes can be seen in 30% of patients.
Atypical lymphocytosis is seen in blood examination. Neutropenia (decrease in the number of blood cells, which is an important element of the immune system), thrombocytopenia (decrease in the number of blood platelets that enable clotting) and an asymptomatic increase in liver function tests may occur. Diagnosis is made through blood tests. It is a disease that mostly goes away on its own, but it may cause some complications. These; secondary bacterial infections (especially beta infection of the throat), progressive swelling of lymphoid tissue Upper respiratory tract obstruction due to diarrhea, hepatitis (liver infection, jaundice, ascites, liver failure (very rare). Serious neurological complications can be seen in 1-5% of patients. These are meningitis, encephalitis, neuropathies affecting the cranial nerves, transverse myelitis and Gullian_Barre). syndrome.
Rupture of the spleen, hemolytic anemia, myocarditis, and psychosis are other very rare complications that may occur due to infectious mononucleosis. Treatment consists of supportive treatment, rest, reducing fever, and relieving pain. If there is an enlargement of the spleen, patients see that this situation improves on ultrasonography. They should be warned to avoid contact sports before they are seen. Unless there is a complicated situation, antivirals will not work. Amoxicillin and ampicillin group antibiotics should not be used in this case because they cause skin rash. If there is a secondary bacterial infection, another group of antibiotics should be used.
Herpes Simplex Virus (HSV):
There are two types. HSV_1 usually causes disease in the head and neck region. Although HSV-2 mostly causes disease in the genital area, it can also cause disease in the head and neck region. Direct contact with oral secretions is the mode of transmission of HSV-1. It typically causes pharyngitis. This may or may not be accompanied by gigivostomatitis (gum disease). Recurrent lip herpes is a reactivation of HSV infection rather than a new infection. It can cause sore throat, fever, malaise and swollen lymph nodes. Painful ulcerated lesions may occur in the mouth and pharynx area. It goes away on its own. Antiviral drugs can be used if it causes advanced disease and the patient has an underlying disease. pharyngitis sore throat
What are the bacteria that cause pharyngitis?
One of the common causes of sore throat in adults. 5-10% of pharyngitis is caused by bacteria. Bacterial pharyngitis is more common in children (30-40%). Antibiotics may have been prescribed to 75% of adult patients complaining of sore throat, and a very small portion of the cause of sore throat is bacterial infections, so it will work in a very small number of this patient group. One of the reasons that forces the physician to do this is patient expectations.
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