OVERVIEW

What is acute pharyngitis?

Acute pharyngitis refers to acute inflammation of the mucous membrane and submucosa of the pharynx, often involving the lymphoid tissue in the pharynx. It is usually caused by viral infections (such as coxsackievirus, adenovirus, etc.), bacterial infections (such as streptococcus, staphylococcus, etc.), or environmental factors (such as dry air, dust, etc.)^[1].

Acute pharyngitis commonly occurs in cold seasons like autumn, winter, and the transition between winter and spring. It can occur independently or appear after acute rhinitis, acute upper respiratory tract inflammation, or acute tonsillitis. It may also manifest as a symptom of certain systemic diseases or acute infectious diseases in the throat^[1,2].

Is acute pharyngitis common?

This disease is very common in daily life. In the United States, there are approximately 12 million outpatient cases of acute pharyngitis each year, accounting for 1%–2% of all outpatient visits. This means that for every 100 patients visiting outpatient clinics, 1–2 have acute pharyngitis^[3].

The incidence is highest in childhood and adolescence, with about half of the cases occurring in individuals under 18 years old. Most adult cases also occur before the age of 40, after which the incidence declines^[3]. There are no specific epidemiological data for China yet.

What are the types of acute pharyngitis?

Based on severity and pathological changes, it can be divided into the following two types^[4]:

1. Acute simple pharyngitis: The most common type. Systemic symptoms are generally mild. Adults may experience dryness or burning in the throat, while symptoms in young children may be more pronounced, often accompanied by chills, high fever (oral temperature exceeding 39.0°C), headache, or even nausea and vomiting^[5].

2. Acute suppurative pharyngitis: Acute pharyngitis caused by group A beta-hemolytic streptococcus tends to have more severe symptoms. If bacteria enter the bloodstream, systemic symptoms such as high fever (oral temperature exceeding 39.0°C) and chills may occur^[4].

Which department should I visit for acute pharyngitis?

The first step is to identify the cause. Generally, acute pharyngitis can be treated in the otolaryngology (ENT) department. However, if it is confirmed to be caused by an acute upper respiratory tract infection, you may visit the respiratory medicine department. If it is related to a hematologic disease, consultation with the hematology department is recommended.

SYMPTOMS

What are the common manifestations of acute pharyngitis?

The disease is characterized by the rapid development (within days or even hours) of discomfort in the throat.

In the early stages, symptoms include dryness, a burning sensation, and roughness in the throat, followed by noticeable pain, especially when swallowing saliva. Systemic discomfort is generally mild but varies among individuals—some may experience fever (above 37.5°C), headache, loss of appetite, limb soreness, and fatigue.

In cases of acute septic pharyngitis, both systemic and local symptoms are more severe. If the inflammation spreads to the larynx, it may be accompanied by coughing and hoarseness^[1,2].

It is important to note that simple pharyngitis usually does not cause breathing difficulties. If symptoms like difficulty breathing or a choking sensation occur, they may indicate acute epiglottitis, requiring prompt medical attention.

What other diseases can acute pharyngitis cause?

Acute pharyngitis can lead to otitis media, sinusitis, and acute respiratory infections. If combined with Fusobacterium necrophorum infection, it may cause peritonsillar abscess and infectious jugular vein thrombosis.

Additionally, acute septic pharyngitis may lead to systemic complications such as acute nephritis, rheumatic fever, and sepsis^[1,2].

1. Otitis media: Since the ear, nose, and throat are interconnected, inflammation from acute pharyngitis spreading to the ear may cause otitis media, resulting in ear pain and tinnitus.

2. Sinusitis: If the inflammation spreads to the nasal cavity, it may cause sinusitis, leading to nasal congestion and purulent nasal discharge.

3. Acute nephritis: After bacterial infection, bacteria may travel through the bloodstream to the kidneys, causing purulent lesions and resulting in acute nephritis. Symptoms include hematuria (blood in urine) and systemic edema^[6].

However, patients need not panic excessively. As long as they seek treatment promptly upon experiencing throat discomfort (dryness, pain, burning sensation, etc.), these complications are generally avoidable.

What severe consequences can acute pharyngitis cause?

If left untreated, acute pharyngitis—especially acute septic pharyngitis—may allow bacteria to spread through the bloodstream, leading to purulent lesions in distant organs. This can result in systemic complications such as acute nephritis and sepsis, potentially endangering life^[1,6].

CAUSES

What are the common causes of acute pharyngitis?

1. Viral infections: Commonly caused by Coxsackievirus, adenovirus, and parainfluenza virus, followed by rhinovirus and influenza virus. Patients are usually infected by exposure to virus-containing airborne droplets (expelled by carriers through coughing, sneezing, etc.) or close contact with infected individuals^[1];

2. Bacterial infections: Often caused by streptococcus, staphylococcus, and pneumococcus. Among these, infections by group A beta-hemolytic streptococcus are the most severe and may lead to acute nephritis, sepsis, and other conditions^[1];

3. Non-infectious factors: High temperatures, dust, smoke, irritant gases, gastroesophageal reflux disease, allergic rhinitis, sinusitis, trauma (e.g., intubation), and other factors may also cause acute pharyngeal inflammation^[3].

Who is most susceptible to acute pharyngitis?

Acute pharyngitis can affect anyone, but it is most prevalent in children and adolescents, with about 50% of cases occurring in individuals under 18 years old (for every 100 patients with acute pharyngitis, approximately 50 are under 18)^[3].

However, if acute pharyngitis is caused by streptococcus, it is more common in populations from less developed countries. Group A streptococcus is the most common bacterial cause of acute pharyngitis, accounting for an estimated 5%–15% of cases in adults in developed countries, with higher rates in less developed nations^[3].

Is acute pharyngitis contagious?

Pharyngitis itself is not a contagious disease. However, if it is caused by an acute infectious condition such as influenza, measles, or scarlet fever, the virus can easily spread through droplets (exposure to droplets expelled by carriers via coughing, sneezing, etc.), shared utensils, or direct contact^[1].

DIAGNOSIS

How is acute pharyngitis diagnosed?

Diagnosing acute pharyngitis is not difficult. Doctors typically make a diagnosis based on the following inquiries and examinations^[1,2]:

1. Medical history: Such as recent exposure to people with colds, dust, smoke, etc.;
2. Symptoms: If acute throat pain, burning sensation in the throat, and other discomforts occur simultaneously, gradually developing into pain during swallowing, acute pharyngitis should be highly suspected. In such cases, medical attention should be sought for a doctor's examination;
3. Local examination: Doctors usually use a tongue depressor to observe the throat. If redness and swelling are present, a preliminary diagnosis of acute pharyngitis can be made.

What tests are needed for acute pharyngitis?

Based on the patient's condition, doctors will examine the throat using a tongue depressor or laryngoscope. Generally, a complete blood count (CBC) and throat swab test are required, with additional tests determined by the condition.

Some severe, potentially life-threatening diseases may present primarily as sore throat (e.g., acute myocardial infarction). In such cases, doctors may recommend further tests like electrocardiograms (ECG) and cardiac injury marker tests.

1. Tongue depressor or laryngoscopy: Doctors will visually inspect or use a laryngoscope to check for edema, congestion, follicles, or abnormal purulent discharge in the throat^[1,7].

The gag reflex may cause nausea, vomiting, or a persistent foreign body sensation in the throat during or after the examination. Therefore, patients should maintain oral hygiene before the test and avoid eating too much (fasting is recommended). After laryngoscopy, patients are usually advised to avoid eating for 2 hours.

2. Complete blood count (CBC) and throat swab test: To identify the specific bacteria or virus causing the infection, doctors will use a specialized swab to collect secretions from the throat for culture. The results help guide targeted treatment.

This test may cause discomfort as the swab reaches deep into the throat. Additionally, culture results typically take 1–2 days^[3]. The CBC also helps determine the pathogen and select the appropriate treatment.

3. Electrocardiogram (ECG): Since heart conditions may sometimes present as throat or tooth discomfort, doctors may perform an ECG on patients suspected of having heart disease.

What diseases can acute pharyngitis be confused with?

1. Measles: Measles patients may also experience throat pain, but white Koplik's spots appear on the oral mucosa, accompanied by typical pale red maculopapular rashes on the face, neck, and limbs^[8].

2. Influenza (flu): Caused by the influenza virus, flu symptoms include sudden onset of dry cough and sore throat. However, patients also exhibit runny nose, cough, and phlegm, allowing doctors to distinguish it clinically^[9].

3. Scarlet fever: Caused by group A β-hemolytic streptococcus, it progresses rapidly with high fever (up to 39°C) and severe sore throat. A characteristic rash appears within 24 hours, aiding diagnosis^[10].

4. Infectious mononucleosis: An acute EBV infection common in children, symptoms include fever (initially low-grade, then rising), sore throat, lymphadenopathy, and hepatosplenomegaly. Blood tests reveal atypical lymphocytes, and swollen lymph nodes are palpable^[11].

5. Leukemic angina: Patients may have throat pain with pale pharynx, swollen tonsils, and ulcerated surfaces that bleed easily, resembling peritonsillar abscess. Blood tests confirm the diagnosis^[6].

6. Acute epiglottitis: Inflammation of the epiglottis and surrounding tissues. Both conditions cause throat pain, but epiglottitis presents more severely with systemic symptoms like fatigue and dyspnea. Laryngoscopy differentiates them.

TREATMENT

What are the treatment methods for acute pharyngitis?

This condition may resolve on its own without treatment, with the course of the disease typically lasting about a week^[7].

1. General treatment: Get plenty of bed rest to promote the body's self-repair^[1].

2. Addressing the cause: If the patient has a contagious disease like the flu, the doctor will isolate the patient (e.g., in a separate room, avoiding visits).

   Eat soft foods (avoid dry crumbs, biscuits, etc.) and drink plenty of water (daily intake of 1500–1700 mL). Patients with significant throat pain or headaches can take antipyretic and analgesic medications such as ibuprofen, acetaminophen, or aspirin.

   Note: Medication must be taken under a doctor's guidance. Although side effects like nausea or vomiting may occur^[12], patients need not worry, as not everyone experiences them. If side effects do occur, patients can seek medical help, and the doctor may change the medication.

3. Local treatment: Gargle with compound borax solution or 1:5000 furacilin solution (the correct method involves tilting the head back, opening the mouth, and making an "ah" sound to allow the solution to clean the posterior pharyngeal wall, but avoid swallowing it).

   Additionally, topical medications (e.g., 1%–3% iodine glycerin or 2% silver nitrate) can be applied (using a sterile cotton swab to gently dab the affected area) to reduce inflammation in the swollen posterior pharyngeal wall^[7].

4. Systemic treatment: Patients with acute streptococcal pharyngitis require a specific dose and duration of antibiotic treatment to eradicate the bacterial infection in the throat.

   Based on blood tests and throat swab results, doctors will prescribe appropriate anti-infection therapy. Common antibiotics include penicillin. For penicillin-allergic patients, alternatives like cephalosporins, clarithromycin, or azithromycin may be used. This can speed up symptom relief. Before administering medication, doctors will perform a skin test to prevent adverse reactions such as chest tightness, pallor, or chills^[12,13].

Can acute pharyngitis heal on its own?

Generally, yes^[7]. Most cases do not require medical attention, but patients with severe symptoms (e.g., difficulty breathing, throat pain affecting sleep) should seek hospital care.

In some cases, acute pharyngitis is a self-limiting condition, and fever and systemic symptoms typically resolve naturally within a week without antibiotics^[7]. However, if symptoms are severe or include difficulty breathing, prompt medical attention is advised.

What are the common side effects of medications for acute pharyngitis?

Penicillin-class drugs commonly cause allergic reactions (e.g., chest tightness, pallor, chills, throat pain), so a skin test is required before each use. Long-term use may also lead to antibiotic resistance^[13]. During penicillin treatment, avoid allergenic foods like fish, shrimp, eggs, and dairy. Intramuscular penicillin injections may cause local pain, redness, or swelling.

Topical treatments like compound borax solution, 1%–3% iodine glycerin, or 2% silver nitrate may trigger allergic reactions, including itching, blisters, or burning at the application site. If symptoms worsen, seek medical help immediately.

Are there any sequelae after acute pharyngitis treatment?

Acute pharyngitis usually leaves no sequelae.

However, if caused by hemolytic streptococcus and left untreated or in patients with low immunity, complications like rheumatic fever or autoimmune neuropsychiatric disorders may occur^[14].

Does acute pharyngitis require hospitalization?

Generally, no. Severe cases may receive outpatient IV therapy for observation. Hospitalization is needed if complications like acute suppurative tonsillitis or life-threatening conditions arise.

Due to subtle symptoms and weaker immunity in young children, doctors may recommend hospitalization for high-risk pediatric patients.

Is follow-up necessary after acute pharyngitis treatment?

Usually not. Symptoms typically improve within a week with proper treatment^[7]. If blood tests were abnormal, a follow-up may be needed. Patients with complications should follow specialist recommendations.

Can acute pharyngitis be cured?

Yes^[12].

With proper, full-course treatment under medical guidance, acute pharyngitis can be fully cured without sequelae.

Can acute pharyngitis be fatal?

Generally, no.

Rarely, complications like acute laryngeal edema or epiglottitis may obstruct breathing, or systemic infections (e.g., sepsis) from severe throat infections can be life-threatening^[1,6].

DIET & LIFESTYLE

What should patients with acute pharyngitis pay attention to in their diet?

1. During the illness, the diet should be light and easy to digest. Avoid greasy, sticky, fried, and spicy foods (such as fried chicken, pork belly, chili, etc.) to prevent aggravating throat pain when swallowing^[7].

2. Since patients often eat less due to throat discomfort, it is essential to stay hydrated (normally, daily water intake should reach 1500–1700 mL)^[15] to avoid symptoms like dehydration and electrolyte imbalance.

What should patients with acute pharyngitis pay attention to in daily life?

1. During the infection, ensure adequate rest, avoid staying up late, and strengthen physical fitness.

2. Patients can use a humidifier to moisten the surrounding environment, preventing dryness that may worsen throat discomfort^[12].

3. Patients should quit smoking and avoid secondhand smoke to prevent exposure to tobacco smoke, which can aggravate throat pain^[12].

4. If a contagious disease (such as acute flu or streptococcal infection) is suspected, avoid visits from family members to reduce the risk of cross-infection. If the patient has streptococcal pharyngitis, they should wait at least one day after completing antibiotics before returning to work or school to minimize the likelihood of spreading the infection^[16].

PREVENTION

How to prevent acute pharyngitis?

1. Develop good living habits, such as washing hands promptly after coughing or sneezing, washing hands after returning home, wearing a mask consciously when family members have a cold, and avoiding kissing or sneezing directly at children, etc.^[14].

2. Since high temperatures, dust, smoke, and certain diseases (gastroesophageal reflux disease, allergic rhinitis, sinusitis) can all trigger acute pharyngitis^[3], patients can prevent it by avoiding high-temperature or dusty environments and treating underlying conditions.

How can acute pharyngitis patients prevent severe complications?

1. Strictly follow medical advice and avoid stopping medication without authorization^[7].

2. Patients can engage in daily exercise, such as outdoor activities (e.g., running, hiking, swimming), to strengthen their physique and reduce the occurrence of illnesses. Outdoor exercise should last at least half an hour, preferably an hour, with intensity adjusted according to personal comfort. Maintain a regular lifestyle^[7,17], avoid staying up late or overexertion, which may weaken immunity.

3. Seek medical attention promptly if symptoms like difficulty breathing or sudden worsening of the condition occur, and avoid self-treatment.