Herpangina

Definition

Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza. Sore throat may be caused by either viral or bacterial infections or environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent.

Sore throats can be either acute or chronic. Acute sore throats are the more common. They appear suddenly and last from three to about seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Causes & symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever, or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral sore throat

Viruses cause 90-95% of all sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis). Cold symptoms almost always accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age ten and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever usually between 102-104°F (38.9-40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

One other common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection spreads to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30-50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common. It is estimated that by the age of 35-40, 80-95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as monomucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing.

Bacterial sore throat

From 5-10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat. Anyone can get strep throat, but it is most common in school age children.

Pharyngeal gonorrhea, a sexually transmitted bacterial disease, causes a severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious sore throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throat are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test in inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient, viral sore throat is best left to run its course without drug treatment. Antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. Stopping the antibiotic early can lead to a return of the sore throat. Occasionally a single injection of long-acting penicillin G is given instead of 10 days of oral treatment. These medications generally cost under $15.

Because mononucleosis is caused by a virus, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports, and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) will help the illness pass. Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• Taking acetaminophen or ibuprofen for pain. Aspirin should not be given to children because of its association with increased risk for Reye's Syndrome, a serious disease.
• Gargling with warm double strength tea or warm salt water made by adding one teaspoon of salt to eight ounces of water.
• Drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat. Sucking on popsicles is a good way to get fluids into children.
• Eating soft, nutritious foods like noodle soup and avoiding spicy foods.
• Refraining from smoking.
• Resting until the fever is gone, then resuming strenuous activities gradually.
• A room humidifier may make sore throat sufferers more comfortable.
• Antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Alternative treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eycalyptus globulus), sage (Salvia officinalis), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and tumeric (Curcuma longa) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri) internally for infection or drinking ginger (Zingiber officinale) or slippery elm (Ulmus fulva) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions Lachesis, Belladonna, Phytolacca), yellow jasmine (Gelsemium), or mercury.
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long lasting symptoms. Adults may take up to six months to recover. In all age groups fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever, kidney damage, or rheumatic fever. Scarlet fever causes a rash, and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• Washing hands well and frequently
• Avoiding close contact with someone who has a sore throat
• Not sharing food and eating utensils with anyone
• Not smoking
• Staying out of polluted air.

Key Terms

Antigen

A foreign protein to which the body reacts by making antibodies

Conjunctivitis

An inflammation of the membrane surrounding the eye; also known as pinkeye.

Lymphocyte

A type of white blood cell. Lymphocytes play an important role in fighting disease.

Pharynx

The pharynx is the part of the throat that lies between the mouth and the larynx or voice box.

Toxin

A poison. In the case of scarlet fever, the toxin is secreted as a byproduct of the growth of the streptococcus bacteria and causes a rash.

Further Reading

For Your Information

Books

• The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.

  Periodicals

• National Institute of Allergy and Infectious Diseases."Infectious Mononucleosis Fact Sheet." http://www.niaid.nih.gov/factsheets/infmono.htm (September 1997).

Gale Encyclopedia of Medicine. Gale Research, 1999.