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Infections of Pharynx


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.
Infections of Pharynx, Epiglottitis, Diphtheria, Scarlet fever

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.

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