Conditions: Throat Infection (Pharyngitis)
The throat (pharynx) is a common site of infection. Symptoms may range from a nuisance to severe pain and/or blockage of the airway. Tonsils, adenoids, and lingual tonsils are a part (but not all) of the throat.
Pharyngitis
Pharyngitis means inflammation of the pharynx, typically due to infection. Because the inflammation is uncomfortable, this condition is often called a “sore throat.” Although infection of the pharynx is often located specifically in the adenoids, tonsils, or lingual tonsils, and when this is the case, the specific terms “adenoiditis,” “tonsillitis,” or “lingual tonsillitis” may be used, the term “pharyngitis” is simply used to indicate the more general area, the pharynx, is infected.
Viral versus bacterial is a relevant question for a sore throat. Essentially, a sore throat of less than one week’s duration is statistically likely to be viral, for which no antibiotics are given. An exception is when a throat swab for Strep (Streptococcus bacterium) is positive, which indicates starting antibiotics.
tonsils and adenoids
Tonsils (formally known as palatine tonsils) are the bulges on each side of the throat when you look in the mirror. Adenoids (formally nasopharyngeal tonsil) are the same type of tissue located at the very back of the nose and the top of the throat, rendering them out of sight without special instruments. Lingual tonsils are the same type of tissue located on the back of the tongue.
Mononucleosis (“mono”)
Mononucleosis (properly termed infectious mononucleosis), is an infection caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness. Most people recover in two to four weeks; however, feeling tired may last for months. The liver or spleen may also become swollen, and potential rupture of the spleen with abdominal trauma is the reason for restricting activities like contact sports in this situation.
Mononucleosis is primarily spread through saliva but can rarely be spread through semen or blood. Spread may occur by objects such as drinking glasses or toothbrushes or through a cough or sneeze. Those who are infected can spread the disease weeks before symptoms develop. Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. The monospot test is still sometimes used for convenience, but generally not recommended due to poor accuracy.
There is no vaccine for EBV yet. Infection can be prevented by not sharing personal items or saliva with an infected person. Mono generally improves without any specific treatment. Symptoms may be reduced by drinking enough fluids, getting sufficient rest, and taking pain medications such as acetaminophen and ibuprofen. If the tonsils become so swollen that breathing is impaired, corticosteroids (e.g. prednisone) may be used.
Mononucleosis most commonly affects those between the ages of 15 to 24 years in the developed world, and younger in the developing world. In those between 16 and 20 it is the cause of about 8% of pharyngitis. About 45 out of 100,000 people develop infectious mono each year in the United States. Nearly 95% of people have had an EBV infection by the time they are adults.
Bacterial superinfection
A superinfection is a second infection superimposed on an earlier one, especially by a different microbe, that is resistant to the treatment being used against the first infection. In the pharynx, the most common scenario is when a virus causes pharyngitis, and then bacteria take advantage of one’s decreased defenses to set up a bacterial infection. This transition from one infection to another may be apparent by a change in symptoms, such as having a sore throat that is improving around day 3-5 but then worsens again thereafter.
Abscesses (including peritonsillar abscess, retropharyngeal abscess, and parapharyngeal abscess)
An abscess is a collection of infected pus. When this happens, one’s ability to resolve the infection is hindered because the pocket of pus has no blood flow within it, so the immune system cannot deliver its weapons to the center of the abscess. In the throat, a peritonsillar abscess is one between the back wall of the tonsil and the throat constricting muscles. A retropharyngeal abscess is roughly midline behind the muscles constricting the throat, and has the potential to expand downwards into the chest. A parapharyngeal abscess is in a deep pocket on a side of the neck near the carotid artery and internal jugular vein.
This is a baby with oral thrush.
Fungal pharyngitis (thrush, candidiasis)
A fungal (yeast) infection may occur in the pharynx. When it does, the mouth is often also affected. Usually, the type of fungus is in the Candida genus, so the infection may be called “candidiasis” as well. Symptoms may include soreness and problems swallowing. Signs include white patches on the tongue or other areas of the mouth and throat. Infections of the mouth are most common among children less than one month old, the elderly, people using inhaled corticosteroids [such as budesonide (Pulmacort), fluticasone (Flovent) and others], people not eating or drinking by mouth, those with weak immune systems, and in people treated with radiation therapy to the throat. Conditions that result in a weak immune system include HIV/AIDS, the medications used after organ transplantation, diabetes, and the use of systemic (pill or intravenous) corticosteroids. Other risks include dentures, following antibiotic therapy, and breastfeeding.
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