Throat infection manifests as the inflammation of the back wall of the throat – the pharynx (pharyngitis), tonsils (tonsillitis) or both (pharyngotonsillitis). The pharynx and/or tonsils appear reddish with some pus (exudate), there may be some ulceration or a membrane formed by the infection. Cervical lymph nodes may also be involved – they become painful and enlarged. In general, most cases of acute pharyngitis are caused by a viral infection and resolve spontaneously in 4-10 days, whereas bacterial infection tends to last longer and cause some serious complications and even life-threatening conditions.
Pharyngotonsillitis may be caused by various bacteria and viruses, although it is recommended to figure out group A β-hemolytic streptococci (GAS) infection at first as it is relatively spread and may cause some serious complications.
- Viruses (adenovirus, enteroviruses, Epstein-Barr virus, influenza and parainfluenza viruses, rhinoviruses, coronaviruses, cytomegalovirus, measles, rubella) are the most common cause of the pharyngitis;
- Bacteria (groups A, B, C and G streptococci, Streptococcus pneumonia, Staphylococcus aureus, Neisseria gonorrhea, Neisseria meningitides, Corynebacterium diphtheriae, Chlamydia trachomatis, etc.);
- Mycoplasma (Mycoplasma pneumonia, Mycoplasma hominis);
- Fungi (Candida spp.);
Throat infection usually occurs suddenly and manifests with fever and sore throat. Other symptoms include nausea, vomiting, headache and occasionally abdominal pain (more common in young children).
Symptoms of throat infection may include:
- Painful swallowing;
- Soreness of the throat;
- Scratchiness in the throat;
- Painful, enlarged cervical nodes;
- Fever and chills;
- General malaise;
- Muscle aches and joint pain;
- Abdominal pain is a rare symptom, usually observed in younger children;
- Cough typically is absent, although in case of pertussis or common cold it may be present;
As a matter of fact, symptoms depend on the causative agents. For example, rhinovirus or coronavirus infections are usually associated with coryza (runny nose). These infections do not cause fever, on the other hand, fever is common in influenza and adenovirus infection. Furthermore, adenovirus pharyngitis also is accompanied by conjunctivitis. Streptococcus pyogenes infection except pharyngitis causes reddish, erythematous rash, strawberry tongue and produce scarlet fever.
Corynebacterium diphtheriae is a bacterium which causes the development of diphtheria – a so-called “bull neck” characterized by the pharyngotonsillitis with a production of a thick grayish membrane on the surface of the tonsils which may be difficult to remove and once done it leaves a bleeding area.
|Symptoms suggestive of group A Streptococcus infection||Symptoms suggestive of viral infection|
|Nausea, vomiting, sometimes abdominal pain||Diarrhea|
|Patches of pus on the tonsils||Ulcers on the tonsils|
|Painful enlarged lymph nodes of the neck|
- Increased white blood cells (WBCs) count with neutrophilia (high neutrophils number) is characteristic of bacterial infection, lymphocytes count increases with viral infection;
- A rapid strep test is performed to detect Streptococcus pyogenes antigens from the pharyngeal swabs;
- There are also rapid tests for certain viruses (influenza, herpes simplex viruses, etc.) available;
- A throat culture is considered the gold standard to diagnose any bacterial infection, although its disadvantage is that it requires a lot of time before the bacteria grow;
- C-reactive protein levels typically are increased in bacterial infection revealing inflammation;
Treatment depends on the culprits of the disease. Antibiotics (penicillin, amoxicillin, erythromycin) should be given only when the bacterial infection was confirmed. The type of antibiotic should be chosen according to the bacteria susceptibility and severity of the disease.
In the case of viral throat infection, the treatment is mostly symptomatic. Antiviral drugs such as amantadine, rimantadine, oseltamivir, and zanamivir are administered for influenza, but it should be started as soon as possible to reach the best results. Herpes simplex virus infection can be treated with acyclovir.