Infections of
Pharynx
Acute tonsillopharyngitis caused by group A streptococci (Streptococcus pyogenes) is the most
frequent organism cultured in infectious pharyngitis. The disease predominantly
occurs in children, adolescents, and young adults with hypertrophic tonsils and
a history of recurrent infections. Symptoms of headache, chills, throat pain,
and fever may develop abruptly.
The tonsils are enlarged and inflamed, with a cheesy, rarely coalescing exudate visible in the tonsillar crypts. The infection is usually bilateral; the local lymph nodes are tender and enlarged. Edema of the uvula produces thick, muffled speech and pooling of saliva in the oral cavity. The adenoid tissue and the lingual and pharyngeal tonsils are very frequently involved in the inflammatory process of the infection. A throat culture for the streptococcal organism is the gold standard in the diagnosis; however, a rapid antigen detection test is most often the diagnostic test of choice because of convenience, even though its sensitivity is lower. The infection is self- limiting and resolves in several days; antibiotic therapy will reduce complications and the disease duration, however.
The tonsils are enlarged and inflamed, with a cheesy, rarely coalescing exudate visible in the tonsillar crypts. The infection is usually bilateral; the local lymph nodes are tender and enlarged. Edema of the uvula produces thick, muffled speech and pooling of saliva in the oral cavity. The adenoid tissue and the lingual and pharyngeal tonsils are very frequently involved in the inflammatory process of the infection. A throat culture for the streptococcal organism is the gold standard in the diagnosis; however, a rapid antigen detection test is most often the diagnostic test of choice because of convenience, even though its sensitivity is lower. The infection is self- limiting and resolves in several days; antibiotic therapy will reduce complications and the disease duration, however.
Scarlet fever is a nonsuppurative complication of an
acute tonsillitis caused by Streptococcus pyogenes, which can produce an
erythrogenic toxin responsible for the exanthema and enanthema.
A local complication of acute
or chronic tonsillopharyngitis is a suppurative process of the peritonsillar
area. A peritonsillar abscess, also known as quinsy, may begin to
develop during the acute stage of the tonsillitis; however, more often it
develops when all symptoms suggest that the patient is recovering from the
acute infection. Soreness on swallowing, trismus, marked edema of the uvula and
displacement of the uvula to the side opposite to the abscess, ipsilateral
earache, and increasing tenderness of the lymph nodes are the early
characteristic signs of abscess development, followed by a visible bulge of the
anterior pillar of the fauces and soft palate. Occasionally, the swelling may
occur in the posterior pillar and displace the tonsil forward. Palpation with
the finger and the feeling of fluctuation in the swelling establishes the
diagnosis. Spontaneous rupture or surgical drainage brings rapid relief, and
antibacterial therapy treats the associated bacterial infection.
Diphtheria, caused by Corynebacterium diphtheriae
(Klebs-Löffler bacillus), is characterized by membranous inflammation of
the pharyngeal mucosa (though many other mucosal surfaces may be a primary site
of the infection). The membrane, a raised, yellowish white patch, which may
later become brownish and putrid, leaves a raw, bleeding surface if detached.
The process is not limited to the tonsillar crypts, as in follicular
tonsillitis, but may involve the tonsillar pillars, soft palate, nose, and
larynx. The diagnosis can always be made by a smear from the exudate, in which
the Cory-nebacterium diphtheriae can be identified morphologically or,
more reliably, by culture. Antitoxin therapy is the treatment of choice; it is
supported by antibiotics if necessary. Although cardiopulmonary complications
are rare, they are life threatening; therefore, primary prevention through
immunization is preferred over secondary disease treatment. Since the diphtheria-pertussis-tetanus
vaccine was introduced for young children, the number of cases in the United
States had been reduced significantly; recently, however, there has been an
increase in cases because of adults not receiving a booster to the vaccine and
parents opting out of the vaccination program.
With the anginal type of
glandular fever, infectious mononucleosis, small discrete patches
surrounded by an area of erythema are dispersed throughout the throat. They
disappear as the infection subsides but may last from 2 to 3 weeks and may
recur. Although the adenopathy is generalized, the cervical glands are most
often predominantly involved.
Epiglottitis is an acute and often life-threatening
infection of the epiglottis, aryepiglottic folds, and adjacent supraglottic
structures. Haemophilus influenzae type B is the primary infectious
agent involved in this process; it invades the pharynx directly or by
hematologic spread. The infection most often produces subglottic swelling,
which presents as stridor and difficulty breathing. Direct or indirect
visualization of the edematous epiglottis is pathognomonic, but the examination
may trigger laryngospasm and rapid decompensation. Therefore, lateral neck
films may be used to show an enlarged epiglottis protruding from the anterior
wall of the hypopharynx (thumb sign). Airway management is the primary
step in treatment, followed by supportive care. Since the initiation of a
vaccination protocol, the number of patients presenting with this infection has
decreased significantly.
