Symptoms usually vary depending on whether it is a viral or bacterial infection. They may also vary from mild to severe.

In case of viral pharyngitis, the symptoms include the following:

• Sore throat
• Redness of eye
• Cough and hoarseness
• Abdominal pain
• Runny nose

Patients suffering from bacterial pharyngitis usually present with the following features:

• Fever
• Body ache
• Generalized body sickness
• Enlarged tonsils with white spots
• Swollen, tender lymph nodes in front of the neck
• Edema, erythema and lymphoid hyperplasia may also be present.

Children usually present with diarrhea, loss of appetite, conjunctivitis, cough, and fever as high as 105 F [5]. In severe cases, there may be dysphagia for fluids and even for saliva [6].

Patients with fungal infections present with oral thrush in most of the cases.

A complete history with thorough examination of the mouth, throat, nose, ears and lymph nodes in front of the neck is necessary. It is hard to differentiate between a viral and bacterial cause based on symptoms alone; however, Centor criteria is helpful in the diagnosis of streptococcal pharyngitis [7] [8].

The following investigations are necessary to establish the diagnosis.

• White blood cell (WBC) count will be raised with predominance of polymorphs.
• Throat culture is the primary method for the diagnosis of streptococcal pharyngitis and the most reliable means of differentiating streptococcal from viral pharyngitis.
• Non-specific tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are of very little importance [9].

The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, viral and fungal infections.

Medications

Antibiotics: The treatment of choice for streptococcal pharyngitis is oral penicillin V (250mg) given 3 times daily for 10 days. This is helpful if bacterial infection is the cause of sore throat [10]. Antibiotics have no effect for a viral infection. Non-compliant patients may be given a single intramuscular injection of benzathine penicillin G, which provides adequate penicillin levels for 10 days. The usual dose is 600,000 units for children weighing less than 25 kg and 1,200,000 units for children weighing 25 kg or more.

Penicillin-allergic patients may be given any of the several alternative antibiotics:

• Oral erythromycin (50 mg/kg/day in three divided doses for 10 days). Or
• Oral cephalosporins such as cephradin or cephalexin (50-100 mg/kg/day in three divided doses for 10 days). Or
• Oral clarithromycin (15 mg/kg/day in two divided doses for 10 days).

If the patient has had three or more documented infections within 6 months, consider daily penicillin prophylaxis during the winter season.

Analgesics: They help reduce soreness of the throat. Most effective analgesics include non-steroidal anti-inflammatory drugs and acetaminophen.

Steroids: They are helpful in severe pharyngitis. Dexamethasone is often used for this purpose.

Idocaine: It helps to relieve pain by numbing the mucous membrane.

Surgery

Surgery should be considered when the patients have frequent episodes of pharyngitis or when the persistently enlarged tonsils cause chronic upper airway obstruction.

Almost all the people with viral and bacterial streptococcal pharyngitis recover completely without complications; so the overall the prognosis is excellent. Streptococcal infection of the throat should always be treated carefully as untreated cases may develop rheumatic fever [4].

There can be infectious or non-infectious causes of pharyngitis.

Infectious

Acute pharyngitis is an oropharyngeal infection. The disease most commonly spreads via contact with infected individuals and droplet infection. The infectious agents may be bacterial, viral or fungal in nature [1].

Viral: These comprise about 40-60% of all the infectious cases. The different kinds of viruses include:

• Adenovirus: This is the most common of the viral causes of pharyngitis in the children below 3 years of age.
• Orthomyxoviridae: This can cause influenza, high grade fever, headache and generalized body ache.
• Herpes simplex virus: It is responsible for mouth ulcers.
• Other viruses include measles, rhinovirus, coronavirus and respiratory syncytial virus.

Bacterial: The different kinds of bacteria include:

• Streptococci: Group A beta-hemolytic streptococc are the most common bacterial cause of acute pharyngitis. Common symptoms include fever, sore throat and large lymph nodes.
• Fusobacterium necrophorum: These organism are normal inhabitants of oropharyngeal flora. However, they may cause peritonsillar abscess in some cases [2].
• Diphtheria: This is a life threatening upper respiratory infection caused by Corynebacteria diphtheria.

Fungal: Sometimes, the oral thrush caused by Candida albicans may extend to involve the pharynx.

Non-infectious

Non-infectious cases of acute pharyngitis result from mechanical, chemical or thermal irritation including cold air or acid reflux. Neoplastic conditions can also cause pharyngitis [3].

Streptococcal pharyngitis is one of the most common respiratory infections of the childhood. The disease is uncommon under the age of 1 year. The peak incidence occurs in children between the age of 5 and 15 years. Pharyngitis in children younger than 2 years of age is often viral. The incidence is higher in the winter and early spring. It is estimated that it affects more than 1.9 million people a year.

Etiologic agents may directly invade or cause irritation to the pharyngeal mucosa, resulting in localized inflammatory reaction or cause secondary irritation.

The following are the known ways of preventing pharyngitis.

• Frequent washing of the hands.
• Avoidance of the sharing of eating utensils or cups with anyone who has a sore throat, flu, common cold or bacterial infection.
• Avoiding both active and passive smoking.
• Using a humidifier if the surrounding air is dry.
• Using vitamin C supplements may also be helpful as it improves components of human immune system such as natural killer cell activity.
• Supplementation of zinc may also be essential as it may be involved directly in antibody production to help you fight infections.

Pharyngitis is the inflammation of the pharynx commonly caused by upper airway infection. The disease can be acute or chronic. In most of the cases, it is quite painful and results in enlarging of the tonsils which cause trouble in swallowing or even in breathing. Due to systemic infection, it may also be associated with cough and fever. Pharyngitis can be viral or bacterial. The most common and clinically significant bacterial cause of acute pharyngitis are group A beta-hemolytic streptococci.

Pharyngitis is the inflammation of the throat (pharynx). Pharyngitis is most often caused by viruses, but can also result from bacterial infection. The main symptom is a dry and sore throat. Other common symptoms include fever, swollen lymph nodes in the neck, cough, headache, pain in the ears and hoarseness. The treatment depends on the cause.

1. Mostov PD. Treating the immunocompetent patient who presents with an upper respiratory infection: pharyngitis, sinusitis, and bronchitis. Primary care. Mar 2007;34(1):39-58.
2. Kushawaha A, Popalzai M, El-Charabaty E, Mobarakai N. Lemierre's syndrome, reemergence of a forgotten disease: a case report. Cases journal. 2009;2:6397.
3. Alcaide ML, Bisno AL. Pharyngitis and epiglottitis. Infectious disease clinics of North America. Jun 2007;21(2):449-469, vii.
4. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Mar 24 2009;119(11):1541-1551.
5. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatric clinics of North America. Jun 2005;52(3):729-747, vi.
6. Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. The Journal of pediatrics. Mar 2012;160(3):487-493 e483.
7. Wagner FP, Mathiason MA. Using centor criteria to diagnose streptococcal pharyngitis. The Nurse practitioner. Sep 2008;33(9):10-12.
8. Centor RM, Allison JJ, Cohen SJ. Pharyngitis management: defining the controversy. Journal of general internal medicine. Jan 2007;22(1):127-130.
9. Group ESTG, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. Apr 2012;18 Suppl 1:1-28.
10. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. The Cochrane database of systematic reviews. 2006(4):CD000023.