Unit V: conti…

Upper respiratory tract infection

Pharyngitis

Shaista khan
Nursing Lecturer
BKMC, Mardan
date 23/07/2020
 DEFINITION
• Inflammation of the pharynx
 Acute pharyngitis (Sore Throat):
 Sudden painful inflammation of the pharynx, the back
portion of the throat that includes the posterior third of
the tongue, soft palate, and tonsils.

 Causes: Environmental exposure to viral agents -

adenovirus, influenza virus, Epstein-Barr virus, and
herpes simplex virus
• Bacterial infection - Ten percent of adults with
pharyngitis have group A beta- hemolytic streptococcus
(GABHS), which is commonly referred to as group A
streptococcus (GAS) or streptococcal pharyngitis
 Causes:
• When GAS causes acute pharyngitis, the
condition is known as strepthroat.
• Other bacterias - Mycoplasma pneumoniae, Neisseria
gonorrhoeae, H. influenzae type B
• Poorly ventilated rooms, viral pharyngitis peaks
during winter and early spring.
• Viral pharyngitis spreads easily in the droplets of
coughs and sneezes unclean hands that have been
exposed to the contaminated fluids.
 CLINICAL FEATURES
• Pain – Body, swallowing
• Dry cough
• Fever
• Vasodilation
• Edema
• Redness and swelling in the tonsillar pillars,
uvula, and soft palate.
• A creamy exudate may be present in the tonsillar
pillars
• Lymph node enlargement
 Pathophysiology
• Transmission is by droplet. Germs infiltrate the epithelial
layer, then the epithelium is eroded, then the superficial
lymphoid tissue inflammatory reaction occurs with the
blocking of polymorphonuclear leukocyte infiltration.
• In the early stages there is hyperemia and edema and
increased secretions. Serous exudate at first, but tends to
become thickened and dry and can be attached to the
pharyngeal wall. By hyperemia, blood vessel walls of the
pharynx to the width. Blockage forms a yellow, white, or
gray present in follicles or lymphoid tissue.
• It appears that the lymphoid follicles and blotches on the
posterior pharyngeal wall or located more laterally to
become inflamed and swollen causing inflammation of the
throat or pharyngitis.
 DIAGNOSIS
• History Collection
• Physical examination
• Culture & sensitivity test
• Blood investigation
• Rapid streptococcal antigen test [RSAT]
 Treatment
• Antibiotics – Doxycycline 100 mg twice daily – 5-7
days
• Once-daily azithromycin may be given for only 3 days
due to its long half-life.
• A 5- or 10-day course of cephalosporin may be
prescribed. Five-day administration of cefpodoxime and
cefuroxime has also been successful in producing
bacteriologic cures.
• Anti inflammatory -ibuprofen
• Potassium permanganate gargles
• Soft, bland and warm diet
 Nutritional Therapy

• A liquid or soft diet.

• Cool beverages, warm liquids, and flavored frozen desserts
such as Popsicles are often soothing. Occasionally, the
throat is so sore that liquids cannot be taken in adequate
amounts by mouth.
• In severe situations, intravenous (IV) fluids may be
needed.
• Otherwise, the patient is encouraged to drink as much
fluid as possible (at least 2 to 3 L per day).
 CHRONIC PHARYNGITIS
• Chronic pharyngitis is a persistent inflammation of the
pharynx. Charecterised by multiple, white elongated
keratinized epithelial outgrowths project from the surface
of tonsil, base of tongue or posterior pharyngeal wall.

• It is common in adults who work in dusty surroundings,

use their voice to excess, suffer from chronic cough
• Habitually use alcohol and tobacco.
 TYPES OF CHRONIC PHARYNGITIS:
• Hypertrophic: characterized by general thickening and
congestion of the pharyngeal mucous membrane
• Atrophic: probably a late stage of the first type (the
membrane is thin, whitish, glistening, and at times
wrinkled)
• Chronic granular (“clergyman’s sore throat”),
characterized by numerous swollen lymph follicles on the
pharyngeal wall
 Clinical Manifestations

• Foreign body sensation

• Constant sense of irritation or fullness in the throat,
mucus that collects in the throat and can be expelled
by coughing, and difficulty swallowing.
•
A sore throat that is worse with swallowing in the
absence of pharyngitis suggests the possibility of
thyroiditis.
 Pharmacological treatment
• Antibiotics. Penicillin is the typical therapy for GABHS
pharyngitis, in conjunction with prevention of dehydration and
supportive care for pain.
• Antipyretics. Antipyretics are usually prescribed for mild fever
and discomfort.
• Corticosteroids. Corticosteroids (e.g., dexamethasone) have been
suggested as an adjunctive therapy to decrease pain and shorten
symptom duration in adults with pharyngitis.
 References
•  King D, Mitchell B, Williams CP, Spurling GK (April 2015). 
"Saline nasal irrigation for acute upper respiratory tract infections"
 (PDF). The Cochrane Database of Systematic Reviews (4):
CD006821.
•  Guppy MP, Mickan SM, Del Mar CB (February 2004). 
""Drink plenty of fluids": a systematic review of evidence for this r
ecommendation in acute respiratory infections"
. BMJ. 328(7438): 499–500. doi:10.1136/bmj.38028.627593.BE. 
PMC 351843. PMID 14988184.
•  Weidner T, Schurr T (August 2003). 
"Effect of exercise on upper respiratory tract infection in sedentary
subjects"
. British Journal of Sports Medicine. 37 (4): 304–6. doi:
10.1136/bjsm.37.4.304. PMC 1724675. PMID 12893713.
THANK YOU