Index
This inflammation mainly affects children between 4 and 15 years of age, especially in the first school years.
As the age group increases into adulthood, the frequency of infections decreases. These infections are more common in the winter time.
Pharyngotonsillitis have been the object of interest in the medical literature since it was observed that there was an increase in their frequency and a worsening of the complications that seemed controlled in most developed countries.
Due to its high incidence and possible morbidity, especially in children of preschool, school and pre-adolescent age, health professionals have been concerned and have conducted research aimed at understanding the etiology, epidemiology, pathogenicity and treatment of this common infection in the upper airway.
Pharyngotonsillitis is an inflammatory condition that affects the pharyngeal wall, characterized by the presence of increased redness and the finding of an exudate, ulceration, or a membrane that covers the tonsils.
Because the pharynx is served by the lymphoid tissues of Waldeyer’s throat ring , an infection can spread to include various parts of the ring such as the nasopharynx, uvula, soft palate, tonsils, adenoids, and cervical lymphatic glands. .
Depending on the extent of the infection, it can be described as pharyngitis , tonsillitis, and nasopharyngitis. The duration of any of these illnesses can be acute, chronic, or recurrent.
Pharyngotonsillitis is an inflammatory process of structures that specifically make up the pharynx and tonsils.
This inflammation is usually caused by viral infection (around 90% of cases), but other agents such as bacteria can be responsible for the clinical picture.
Anatomical description
To better understand pharyngotonsillitis, it is interesting to know the structures they affect, as well as their functions and their location. For this it is necessary to know its anatomy.
By opening your mouth in front of a mirror, you can see the pharynx, adenoids, tonsils, hard palate (known as the “roof of the mouth”), tongue, and uvula.
In pharyngotonsillitis, as the name itself suggests, the affected anatomical structures will be the pharyngeal tonsils (tonsils) and the pharynx. Both when they are inflamed are presented as the main sign, when a sore throat appears.
Adenoides
The adenoid is fully developed in the seventh month of gestation and continues to grow until the fifth or sixth year of life.
Due to its location, the enlarged adenoid can cause nasal obstruction and proliferation of microorganisms, which in turn tends to increase its size even more.
Tonsils
The tonsils are tissues similar to the lymph nodes that confer protection. They are located between the digestive and respiratory tracts and fight microorganisms that enter through the nose and mouth.
The tonsils have 10 to 30 well-developed invaginations called crypts on their surface, unlike the pharyngeal tonsil, which has a well-developed mucous fold, but with few crypts.
Pharynx
The pharynx is an essential organ for the circulation of air and food. It is made up of three parts: nasal, oral, and laryngeal. The pharyngeal mucosa is exposed to contact with microorganisms present in food or suspended in the air, thus causing infections.
Causes of pharyngotonsillitis
Pharyngotonsillitis can be viral or bacterial in origin. The most common are viral. The viral origin corresponds to 75% of acute pharyngotonsillitis.
Viral agents are common in the first two to three years of life and less common after puberty.
The most associated viruses are rhinovirus (20%), coronavirus (5%), adenovirus (5%), herpes simplex (4%), influenza (2%) and parainfluenza (2%), among others ( Coxsackie, cytomegalovirus, Epstein-Barr virus, HIV).
Bacterial pharyngotonsillitis correspond to 20 to 40 percent of cases.
Streptococcus pyogenes is responsible for about 20 to 30% of acute pharyngotonsillitis in school-age children and adolescents.
Mycoplasma pneumoniae can also cause pharyngitis in the population between 9 and 19 years old.
Other bacteria such as Staphylococcus aureus, Haemophilus sp and Moraxella catarrhalis, are responsible for relapses of streptococcal infections.
The main means of acquiring the infection is by contact with the sick individual, since this removes small particles into the air containing the causative agents.
When the healthy person comes into contact with these particles, they become colonized by the agents, which can overcome the body’s natural defense barriers and grow to the point of triggering an inflammatory process.
Contact with objects touched by the sick individual can also be a potential source of transmission, since the habit of scratching the nose or placing the hand in front of the mouth when coughing causes the causative agents to be led by the contaminated hand to glasses, covered , dishes or other objects for personal and collective use.
Symptoms of pharyngotonsillitis
The manifestation of the causative agent can have variable symptoms. Viral infections are usually milder, with a low or no fever, little sore throat, and mild discomfort.
The patient with viral pharyngotonsillitis has mild symptoms. The main ones are sore throat and dysphagia (difficulty swallowing).
Most patients will present with myalgia (muscle pain) and low fever, associated with colds and sneezing. Physical examination shows reddish coloration of the pharyngeal mucosa.
The tonsils may be enlarged, but there is often no discharge (pus).
In viral pharyngomygillitis there are other signs, not restricted to the tonsil area and pharynx, that are common to respiratory tract infections, such as sneezing, coughing, nasal constipation, conjunctivitis, and hoarseness.
Bacterial infections are more intense, as the patient typically has a very high fever and chills, severe sore throat, body aches, malaise, difficulty swallowing, pain in the belly, and vomiting.
Diagnosis of pharyngotonsillitis
The diagnosis of pharyngotonsillitis is made by examining the upper airways, which shows typical alterations of an inflammatory process.
Doctors often choose to initiate treatment based on clinical findings
The request for supplementary exams is rarely necessary. These should be requested only in the most serious cases, with an atypical evolution or when faced with a diagnostic doubt.
Treatment of pharyngotonsillitis
The etiology of the infection (viral or bacterial) will indicate whether the use of antibiotics is necessary or not.
Viral pharyngotonsillitis is a self-limiting condition and medications are commonly prescribed to alleviate the symptoms presented.
The treatment of viral infections is nonspecific and consists of supportive therapies with analgesic and anti-inflammatory drugs, rest in the febrile period, stimulating the ingestion of non-acidic and non-carbonated liquids and foods of a soft consistency, preferably cold or frozen, gargles with warm isotonic saline.
Bacterial infections, in addition to receiving symptomatic therapy, are treated with the use of antibiotics capable of eliminating the bacteria that cause the process.
The specific treatment of pharyngotonsillitis will basically depend on age, general health conditions and medical history, extent of infection and type of infection.
The tolerance of the patient for medications, interactions and procedures, evolution of inflammations and infections and the opinion of the patient and / or family must also be taken into account.
Severe and atypical cases should receive hospital care, where therapeutic behaviors are taken according to medical diagnoses.
The treatments can be clinical, with drugs or surgical depending on the cause, extension, repetition or severity of the pictures.
Complications
Most cases of pharyngitis and tonsillitis will develop without complications. But, if the disease is caused by strep, rare complications can occur. Antibiotic treatment can prevent these complications.
If strep throat (bacteria) is not properly treated, it can cause complications such as:
Scarlet fever
This is derived from the production of endotoxins. Manifestations include papular and erythematous skin rash.
Rheumatic fever
Joint pain and swelling, endocarditis (inflammation of the heart structures), muscle weakness, involuntary and uncoordinated movements are observed.
Glomerulonephritis
There is an inflammation of the glomerulus, a functional unit of the kidney formed by a tangle of capillaries, where blood filtering and urine formation occur.
Streptococcal toxic shock syndrome
This occurs after strep infection or colonization. Hypotension is associated with renal failure, coagulopathy, liver function abnormalities, adult respiratory distress syndrome, extensive tissue necrosis, and erythematous-macular rash.
