chronic pharyngitis

WordNet

1. being long-lasting and recurrent or characterized by long suffering; "chronic indigestion"; "a chronic shortage of funds"; "a chronic invalid"
2. of long duration; "chronic money problems" (同)continuing
3. habitual; "a chronic smoker" (同)inveterate

PrepTutorEJDIC

1. (病気が)長期にわたる,慢性の / 《名詞の前にのみ用いて》常習の,癖になった
2. 咽頭(いんとう)炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/15 21:07:04」(JST)

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Pharyngitis
Classification and external resources
Inflamed oropharynx: swollen and red.
ICD-10	J02, J31.2
ICD-9	462, 472.1
DiseasesDB	24580
MedlinePlus	000655
eMedicine	emerg/419
MeSH	D010612

The word pharyngitis /færɨnˈdʒaɪtɨs/ comes from the Greek word pharynx pharanx meaning throat and the suffix -itis meaning inflammation. It is an inflammation of the throat. In most cases it is quite painful, and is the most common cause of a sore throat.

Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic. Pharyngitis can result in very large tonsils which cause trouble swallowing and breathing. Pharyngitis can be accompanied by a cough or fever, for example, if caused by a systemic infection.

Most acute cases are caused by viral infections (40–80%), with the remainder caused by bacterial infections, fungal infections, or irritants such as pollutants or chemical substances. Treatment of viral causes is mainly symptomatic while bacterial or fungal causes may be amenable to antibiotics and anti-fungal medicines respectively.

Classification

Pharyngitis is a type of inflammation, most commonly caused by an upper respiratory tract infection. It may be classified as acute or chronic. An acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the immune capacity of the affected individual. Chronic pharyngitis is the most common otolaringologic disease and may be catarrhal, hypertrophic or atrophic.

If the inflammation includes tonsillitis, it is called pharyngotonsillitis. Another sub classification is nasopharyngitis (the common cold).

Cause

The majority of cases are due to an infectious organism acquired from close contact with an infected individual.

Infectious

Viral

These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral infections.

• Adenovirus – the most common of the viral causes. Typically the degree of neck lymph node enlargement is modest and the throat often does not appear red, although it is very painful.
• Orthomyxoviridae which cause influenza – present with rapid onset high temperature, headache and generalised ache. A sore throat may be associated.
• Infectious mononucleosis ("glandular fever") caused by the Epstein-Barr virus. This may cause significant lymph gland swelling and an exudative tonsillitis with marked redness and swelling of the throat. The heterophile test can be used if this is suspected.
• Herpes simplex virus can cause multiple mouth ulcers.
• Measles
• Common cold: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme pain.

Bacterial

A number of different bacteria can infect the human throat. The most common is Group A streptococcus, however others include Streptococcus pneumoniae, Haemophilus influenzae, Bordetella pertussis, Bacillus anthracis, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.

Streptococcal pharyngitis

A case of strep throat

Streptococcal pharyngitis or strep throat is caused by group A beta-hemolytic streptococcus (GAS). It is the most common bacterial cause of cases of pharyngitis (15–30%). Common symptoms include fever, sore throat, and large lymph nodes. It is a contagious infection, spread by close contact with an infected individual. A definitive diagnosis is made based on the results of a throat culture. Antibiotics are useful to both prevent complications and speed recovery.

Fusobacterium necrophorum

Fusobacterium necrophorum are normal inhabitants of the oropharyngeal flora. Occasionally however it can create a peritonsillar abscess. In 1 out of 400 untreated cases Lemierre's syndrome occurs.

Diphtheria

Diphtheria is a potentially life threatening upper respiratory infection caused by Corynebacterium diphtheriae which has been largely eradicated in developed nations since the introduction of childhood vaccination programs, but is still reported in the Third World and increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but recovery is generally slow.^{[citation needed]}

Others

A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar abscess ("quinsy"), submandibular space infection (Ludwig's angina), and epiglottitis.

Fungal

Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.^{[citation needed]}

Non-infectious

Pharyngitis may also be caused by mechanical, chemical or thermal irritation, for example cold air or acid reflux. Some medications may produce pharyngitis such as pramipexole and antipsychotics.

Diagnostic approach

Modified Centor score

Points	Probability of Strep	Management
1 or less	<10%	No antibiotic or culture needed
2	11–17%	Antibiotic based on culture or RADT
3	28–35%
4 or 5	52%	Empiric antibiotics

It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone. Thus often a throat swab is done to rule out a bacterial cause.

The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.

One point is given for each of the criteria:

• Absence of a cough
• Swollen and tender cervical lymph nodes
• Temperature >38.0 °C (100.4 °F)
• Tonsillar exudate or swelling
• Age less than 15 (a point is subtracted if age >44)

The McIsaac criteria adds to the Centor:

• Age less than 15: add one point
• Age greater than 45: subtract one point

The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.

Management

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

Medications

• Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat. (Note: Don't use salicylates, like aspirin, for influenza: Increased risk of Reye's syndrome)
• Steroids (such as dexamethasone) have been found to be useful for severe pharyngitis.
• Viscous lidocaine relieves pain by numbing the mucus membranes.
• Antibiotics are useful if a bacterial infection is the cause of the sore throat. For viral infections, antibiotics have no effect.
• Oral analgesic solutions, the active ingredient usually being Phenol, but also less commonly Benzocaine, Cetylpyridinium chloride and/or Menthol. Chloraseptic and Cēpacol are two examples of brands of these kinds of analgesics.

Alternative

See also: Alternative treatments used for the common cold

Alternative medicines are promoted and used for the treatment of sore throats. However, they are poorly supported by evidence.

Epidemiology

Acute pharyngitis is the most common cause of a sore throat and, together with cough, it is diagnosed in more than 1.9 million people a year in the United States.

References

UpToDate Contents

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• 1. 感染症を繰り返す成人に対するアプローチ approach to the adult with recurrent infections
• 2. 成人における急性咽頭炎の評価 evaluation of acute pharyngitis in adults
• 3. 小児における咽喉痛の評価 evaluation of sore throat in children
• 4. 成人における扁桃摘出：適応 tonsillectomy in adults indications
• 5. アフタ性口内炎、咽頭炎およびリンパ節炎（PFAPA症候群）を伴う周期熱 periodic fever with aphthous stomatitis pharyngitis and adenitis pfapa syndrome

English Journal

• Induction of proinflammatory cytokines in human osteoblastic cells by Chlamydia pneumoniae.

• Rizzo A, Di Domenico M, Carratelli CR, Mazzola N, Paolillo R.SourceDepartment of Experimental Medicine, Section of Microbiology and Clinical Microbiology, Faculty of Medicine and Surgery - Second University of Naples, Naples, Italy.
• Cytokine.Cytokine.2011 Nov;56(2):450-7. Epub 2011 Jul 30.
• Chlamydia pneumoniae is an obligate intracellular Gram-negative bacterium that causes recurrent pharyngitis, pneumonia and chronic inflammation induced by cycles of persistence and productive infection that might also explain the association with chronic diseases. The aim of this study was to determ
• PMID 21803599

Japanese Journal

• 総合病院耳鼻咽喉科における心身症の割合と心療耳鼻咽喉科医の必要性

• 五島 史行,中井 貴美子,小川 郁
• 心身医学 50(3), 229-236, 2010-03-01
• 耳鼻咽喉科において心身医療が普及しているとはいえない.耳鼻咽喉科における心身症,うつ病の割合などについて調べることを目的とした.2006年3?6月の初診患者586例について検討した.心身症と考えられたものは133例(22.7%)であった.咽喉頭異常感症,耳鳴症,眩暈症(メニエール病を含む),慢性咽喉頭炎では心身症の占める割合が高くそれぞれ52.9%,46.4%,42.9%,37.5%であった.治療 …
• NAID 110007574479

Related Links

• Pharyngitis - Wikipedia, the free encyclopedia

It may be classified as acute or chronic. An acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the virulence of the causative agent and the immune capacity of the affected individual. Chronic pharyngitis is the most ...

Related Pictures

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★リンクテーブル★

リンク元	「慢性咽頭炎」
関連記事	「chronic」

「慢性咽頭炎」

　　[★]

英

chronic pharyngitis

ラ

pharyngitis chronica

関

咽頭炎

「chronic」

　　[★]

• adj.

• 慢性の、慢性的な、慢性型の

関

chronically、chronicity