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Viral Pharyngitis - Causes, Symptoms, Diagnosis and Treatment

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Pharyngitis is an inflammation of the throat (pharynx). Read the article below to learn more about how to combat the infection.

Written by

Dr. Sowmiya D

Medically reviewed by

Dr. Shyam Kalyan. N

Published At March 24, 2022
Reviewed AtMay 2, 2024

Introduction:

Pharyngitis is an upper respiratory tract infection that causes inflammation of the mucous membrane of the oropharynx (the middle part of the throat behind the oral cavity). It is also known as cobblestone throat or sore throat. It usually causes pain, scratchiness in the throat, and difficulty swallowing. The symptoms vary according to the affected individual's causative agent and immune capacity.

What Are the Causes of Viral Pharyngitis?

The infection most commonly spreads through direct contact with saliva or nasal secretion. The most common cause of pharyngitis is a viral infection, which can be due to rhinovirus, influenza virus, parainfluenza virus, coronavirus, enterovirus, respiratory syncytial virus, cytomegalovirus, human immunodeficiency virus (HIV), adenovirus, influenza virus, Epstein-Barr virus (EBV), herpes simplex virus, or viruses that cause the common cold. This can also be due to a bacterial infection, such as Streptococcus pyogenes. The other less common causes include fungal infections and non-infectious causes like allergies, trauma, cancer, acid reflux, medications, and other toxins such as those from smoking. In younger children, the infection is less severe. It rarely presents as acute pharyngitis. There is mucopurulent rhinitis (pus discharge from nose) and low-grade fever.

What Are the Symptoms of Viral Pharyngitis?

The following are symptoms of a viral infection that is different from a bacterial infection, which include:

  • Cough.

  • Runny nose.

  • Hoarseness of voice.

  • Conjunctivitis (inflammation of the conjunctiva in the eye).

  • Earache and headache.

  • In particular, adenovirus causes fever, sore throat, difficulty swallowing, and conjunctivitis. This is called pharyngoconjunctival fever. It directly invades the pharyngeal mucosa, which is not true in the case of rhinovirus. Rhinovirus causes increased mucous secretion and swelling of the nose's mucous membrane.

  • Epstein-Barr virus causes edema (swelling due to excess fluid) and hyperemia (increased blood in the blood vessels) of the tonsils and pharynx, inflammatory exudate (the fluid that leaks out of blood vessels), fatigue, skin rash, and excessive growth of lymphoid tissue in the nasopharynx.

  • Acute herpetic pharyngitis (sore throat) is the most common manifestation of the first episode of herpes simplex virus-1 (HSV-1) infection.

  • Influenza A virus causes severe pharyngitis and sore throats. It also includes headaches, fever, chills, and a dry cough.

  • The parainfluenza virus and coronavirus cause common cold-like symptoms.

  • The initial manifestation in an HIV-affected individual will include pharyngitis along with fever, sweats, malaise, lethargy, and myalgias (muscle pain).

  • Enteroviruses cause viral pharyngitis in children. Coxsackievirus causes herpangina (sore throat, difficulty swallowing, blister-like bumps in the oral cavity), acute lymphonodular pharyngitis (inflammation of the pharynx), hand, foot, and mouth disease (low-grade fever, sores in the mouth, and rashes on the hands and feet).

When Should a Person Call a Doctor for Viral Pharyngitis?

One should call a doctor if they experience any symptoms of viral pharyngitis that persist longer than expected or last more than a week. The doctor should also be consulted if one has swollen lymph nodes, white patches and pus on the back of the throat, a rash, and blood in the phlegm or spit.

How to Diagnose Viral Pharyngitis?

The diagnosis and treatment of pharyngitis will depend on the etiology. If the patients give apparent viral symptoms, there is no need for group A streptococcal testing. When the signs are unclear, the clinician can use a rapid antigen detection test (RADT) or throat culture to confirm the bacterial infection. A throat culture is the gold standard diagnostic test. A complete blood test may provide information on the underlying disease.

The total WBC (white blood cell) count may initially be elevated, followed by a decrease to fewer than 5000 cells per microliter after four to seven days of illness in about 50 percent of the cases. Atypical lymphocytosis (excess lymphocytes activated to respond to a viral infection) is seen in EBV and CMV (cytomegalovirus) infections. Specific virological diagnosis is unnecessary for practical purposes. Cultures of nasal secretions, serological tests, and polymerase chain reaction techniques can be used for specific virological diagnoses.

What Is the Treatment for Viral Pharyngitis?

Pharyngitis usually resolves within a week. In a few cases, it can be recurring and termed chronic. Antibiotics are not helpful in cases of pharyngitis caused by viral infections. Symptomatic treatment is needed in such cases. Pain medication and medication to relieve fever, such as Acetaminophen, are the drugs of choice.

Aspirin should not be used in children or adolescents, especially with influenza, because of its association with Reye syndrome (a rare but serious medical condition causing liver failure, swelling in the brain, and confusion). Anesthetic gargles and lozenges like Benzocaine can be used for symptomatic relief. In case of severe throat pain and difficulty in swallowing, hospitalization for administering fluids for hydration through veins may be necessary.

Amantadine and Rimantadine are approved to treat the influenza A virus but are no longer used due to resistant strains. Hence, antiviral treatment with Oseltamivir or Zanamivir is necessary for patients with a higher risk for influenza complications. It is recommended that treatment be started within 48 hours for better results.

Prevention of Viral Pharyngitis:

Pharyngitis is contagious and can be prevented by

  • Avoid contact with the affected individuals.

  • Avoid sharing personal things.

  • Wash hands frequently, especially after coughing or sneezing and before eating.

  • Administration of influenza vaccine to high-risk individuals. Amantadine may be used to prevent influenza A during outbreaks.

What Are the Complications of Viral Pharyngitis?

Viral pharyngitis usually resolves within a week without any complications. But rarely, they may end up with a severe condition that includes:

  • The infection spreads from the throat to other nearby parts, such as an ear infection, sinus infection, or tonsillar or peritonsillar abscess.

  • Necrotic epiglottis leads to airway obstruction.

  • Liver failure, ruptured spleen, overactive spleen.

  • Encephalitis (inflammation of the brain), pericarditis (swelling of the thin saclike tissue surrounding the heart), and hematologic disorders (disorders associated with blood and blood cells).

  • Pneumonia (inflammation of the air sac in the lungs).

  • Secondary bacterial pneumonia, the most common type of pneumonia, may complicate influenza. Pneumococcal pneumonia is the most common, but staphylococcal pneumonia is the most serious.

Conclusion

The complication rate associated with viral pharyngitis is relatively low, and the prognosis is excellent. Most adults recover in less than a week or in less than two weeks. Patients should be educated about the course of infection and reassured that antibiotic therapy is unnecessary. Any fever persisting for more than five days, extreme throat pain, and difficulty swallowing should prompt a visit to a doctor.

Frequently Asked Questions

1.

Does Viral Pharyngitis Last Long?

Viral pharyngitis is an inflammation of the throat behind the oral cavity caused by a viral infection. It often resolves within weeks. However, saltwater gargling several times a day provides symptomatic relief. Antibiotics are not offered for pharyngitis caused by a viral infection. Instead, medications such as Acetaminophen are suggested to get relief from fever and pain. Anesthetic gargles and lozenges also relieve the symptoms.

2.

How Is Viral Pharyngitis Caused?

Viral pharyngitis or sore throat causes discomfort or scratchiness in the middle portion of the throat. It is most commonly caused by the virus that initiates flu and the common cold. The virus that causes pharyngitis are listed down:
- Rhinovirus.
- Influenza virus.
- Human immunodeficiency virus.
- Adenovirus.
- Parainfluenza virus.
- Epstein-Barr virus.
- Cytomegalovirus.
- Herpes simplex virus.

3.

How Does Viral Pharyngitis Differ From Bacterial Pharyngitis?

Pharyngitis is the inflammation of the throat, and it can be caused by viral or bacterial infection. The difference between viral and bacterial pharyngitis are:
- Bacterial pharyngitis: It is most commonly caused by Streptococcus species. It causes swelling and redness of the tonsil. The fever caused by bacterial pharyngitis is higher in degree. Other symptoms include nausea, vomiting, and stomach ache. Cough is an infrequent symptom.
- Viral pharyngitis possesses symptoms similar to that of the common cold. Cough more commonly occurs in viral pharyngitis. Swelling in the throat, hoarseness and runny nose are other characteristic features.

4.

Does Untreated Pharyngitis Cause Complications?

Pharyngitis or strep throat is treated with appropriate antibiotics. It reduces the symptoms, prevents the transmission of infection, and prevents complications. The pharyngitis caused by group A Streptococcus, if left untreated, leads to the following complications:
Acute rheumatic fever affects the joints, heart, skin, and brain.
- Peritonsillar abscess (collection of pus in tissues of throat adjacent to tonsils).
- Mastoiditis (infection of the bone near the ear).
- Airway obstruction.
- Pneumonia.

5.

Does Taking Antibiotic Treats Viral Throat Infection?

Pharyngitis is most commonly caused by viruses of the common cold and flu. The symptoms include runny nose, hoarseness of voice, and cough. It generally resolves within one week. The physician may prescribe drugs like Acetaminophen for symptomatic relief. Antibiotics do not help treat viral pharyngitis. Unnecessary use of antibiotics causes various side effects that are minor rash to significant health issues like diarrhea, intestinal damage, etc.

6.

What Are the Stages of Viral Infection?

A virus requires a host cell to multiply and cause structural and functional changes. The different stages of viral infection are as follows:
- Attachment: The virus attaches to the host cells by a specific protein on its envelope.
- Penetration: The nucleic acid inside the virus enters the cell leaving behind its envelope.
- Replication and Assembly: The virus's nucleic acid then reproduces within the host cell by acquiring proteins and enzymes from the host cell.
- Release: It is the last stage of viral infection. The virus releases its virions into the body and damages the adjacent cells, and starts replicating. Some viruses are attacked by the body, while others remain active.

7.

How Long Is Viral Pharyngitis Contagious?

Sore throat caused by viruses or bacteria is contagious. It spreads through mucus, saliva, or nasal discharge. Most pharyngitis reduces within one or two days; however, it takes five to seven days to resolve completely. Individuals with strep throat are more contagious during the first 48 to 72 hours. If left untreated, it is infectious for three to four weeks. The spread of infection is controlled by avoiding close contact with others and sharing utensils, towels, etc. Washing hands with clean soap and water also prevents the infection spread.

8.

Which Genetic Group Is at Risk of Developing Viral Pharyngitis?

A viral infection mainly causes pharyngitis or sore throat. It is found to affect children below five years more than adults. The parents of school-going children are also involved in pharyngitis. It does not have any sex predilection. Studies also show the incidence is high in countries that use antibiotics more. If a bacterial infection causes it (Streptococcus group A), children between 5 to 15 are affected.
Dr. Shyam Kalyan. N
Dr. Shyam Kalyan. N

Otolaryngology (E.N.T)

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