Introduction
Pharyngitis is an infection of the throat, and tonsillitis is an infection of the tonsils. If both are affected, then it is known as pharyngotonsillitis. This can spread to others if one has close contact. Viruses and bacterias are responsible for the cause of pharyngotonsillitis.
What Is Pharyngotonsillitis?
PT is an infection of the pharynx and tonsils that cause inflammation. When both the pharynx and tonsils get affected due to infection, the condition is known as pharyngotonsillitis. This condition generally occurs during winter months and among the 5 to 15 years of age group.
PT is characterized by redness, ulceration, the presence of exudate, and covering of membrane on the tonsils. Infection can spread to other parts like the nasopharynx, uvula, soft palate, tonsils, adenoids, and cervical lymph glands that are parts of the Waldeyer ring. The pharynx is served by lymphoid tissues of the Waldeyer ring, and hence infections spread to other parts. Based on duration, PT can be classified into acute, subacute, chronic, or recurrent.
What Are the Causes of PT?
There are many reasons for the infection.
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Viruses are most commonly found.
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Bacteria like Streptococcus.
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Infections of fungi.
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Infections of parasites.
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Smoking cigarettes.
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Others.
The spread of bacteria and viruses occurs in the air through droplets or due to contact with contaminated objects. This generally occurs in crowded environments. Bacterial infections do occur in the winter season, and viral infections occur in the summer and fall. Agents responsible for the majority of cases are group A beta-hemolytic Streptococci (GABHS), adenovirus, influenza, parainfluenza, Epstein-Barr viruses, and enterovirus. Some of the rare causes are due to pertussis, fusobacterium, diphtheria, syphilis, and gonorrhea.
What Are the Symptoms of PT?
Symptoms of PT are based on the cause. Symptoms may appear fast in some and may appear slow in others. Symptoms are
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Fever (low temperature or high temperature).
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Headache.
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Loss of appetite.
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Nausea and vomiting.
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Pain in stomach.
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Pain during swallowing.
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Redness and exudate in the throat.
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Frequent gastrointestinal disturbance.
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Cervical lymph node enlargement and pain.
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Rashes due to scarlet fever.
Symptoms of PT may look like symptoms of other diseases.
How to Diagnose PT?
It is difficult to diagnose physically by observing whether it is due to viruses or bacteria.
To find out the cause, a strep test and throat culture need to be done.
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Strep Test: A throat swab is taken and subjected to rapid testing. This test quickly shows whether group A Strep is present or not. If present can be treated immediately. If it is negative, then throat culturing is to be done.
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Throat Culture: This type of test is done to identify group A Streptococcus bacteria. A throat swab is kept for culture. This culturing of bacteria takes two to three days. Pharyngitis can be identified easily by doing a clinical examination.
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Rhinorrhea (excess drainage from the nose) and cough indicate viral infections.
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Infectious mononucleosis is indicative of cervical lymph node enlargement, hepatosplenomegaly (enlarged liver and spleen), fatigue, malaise (feeling of discomfort), swollen neck, petechiae (pinpoints or round spots) in the soft palate, and tonsillar exudate.
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The thick, tenacious, grey membrane that starts to bleed when detached indicates diphtheria.
Many experts suggest rapid antigen tests or cultures among children.
Four criteria of the modified center score (1) are followed by a few experts. They are
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A history of fever.
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Exudate in tonsils.
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Absence of cough.
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Cervical lymphadenopathy in the anterior region.
It is considered that individuals with one or no criteria are not likely to have GBHS infection and may not be tested. Individuals with two criteria may be tested. Individuals with three-four criteria may be tested or treated for GBHS.
How to Treat PT?
The healthcare provider is the one who decides about the treatment. Treatment depends on the age, medical history, degree of sickness, ability of an individual to tolerate the medicines, procedures, therapies, preference of an individual, duration of the condition, etc.
Treatment options are
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Symptomatic treatment.
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Antibiotics for GBHS.
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Tonsillectomy.
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Supportive treatment.
If PT is due to a virus, then antibiotics are of no use. Following treatment to be prescribed.
Symptomatic Treatment:
Acetaminophen or Ibuprofen is given for pain. These can be given systemically or topically. Some may prefer to give corticosteroids to reduce the duration of symptoms.
Supportive Therapy:
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The individual is instructed to take more fluids.
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Throat lozenges - for a soothing effect.
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Warm water with salt- For gargling. Diluting hydrogen peroxide with water in a 1:1 mixture and gargling helps in improving oral hygiene.
Antibiotics:
If PT is due to bacteria, then antibiotics are prescribed along with the above instructions. The drug of choice for infection by GBHS is Penicillin V. Treatment may be started immediately or after culture. If the culture test is negative, then treatment should be stopped immediately. Follow-up culture is not performed generally.
Tonsillectomy:
This procedure is considered when there is a repeated episode of PT due to GBHS or severe acute infection, which does not subside even though antibiotics are given. Other criteria for tonsillectomy are sleep apnea disorders, recurrent peritonsillar abscess, and when there is a suspicion of malignant neoplasia is present. Some of the surgical techniques used for tonsillectomy are electrocautery, dissection, microdebrider, radiofrequency ablation, and cold dissection.
What Are the Complications of PT?
Generally, there are no complications associated with PT. In some cases, if PT is due to strep bacteria, rare complications are seen, like rheumatic fever, rheumatic heart disease, and kidney disease. These complications can be prevented with the use of proper antibiotics.
Children are more prone to viral infections. Group A beta-hemolytic Streptococci (GABHS) is more commonly seen in two to eight years of age.
Conclusion
Pharyngotonsillitis is an inflammation caused due infection in the pharynx and tonsillitis. This can be very discomforting to an individual if not treated appropriately and on time. Discomfort caused may affect one’s quality of life and difficulty in carrying out day-to-day work. Hence knowing in detail about PT help in identifying the condition at the earliest. Early diagnosis help in getting effective treatment. This, in turn, improves one’s quality of life.
