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PubMed1997

Tumours of the posterior pharyngeal wall: the use of the platysma flap.

Posterior pharyngeal will tumours are infrequent neoplasms with a very poor prognosis. The 5 year survival rate range from 3% to 32%. Most authors agree that the treatment of choice is surgery with post-operative radiotherapy. The results of treatment of 36 patients (tumour excision plus bilateral neck dissection and post-operative radiotherapy) in which the posterior pharyngeal wall defect was closed with a platysma myocutaneous flap were compared with other forms of repair (13 patients). The 5 year survival rate was 17.2% in the whole group. Laryngeal voice was achieved in 79% of patients having a platysma flap reconstruction. The platysma myocutaneous flap is very satisfactory for the repair of the posterior pharyngeal wall as it is easy to perform, it is oncologically safe and its functional results match well with other forms of reconstruction, with the advantage of laryngeal preservation.

Actuarial Analysis↗

PubMed2000

Bacterial determinants of persistent throat colonization and the associated immune response in a primate model of human group A streptococcal pharyngeal infection.

Group A streptococcal (GAS) pharyngitis and the subsequent bacterial colonization of the human throat elicit an immune response that may precipitate acute rheumatic fever in a susceptible host. To study the bacterial determinants that influence throat colonization and induction of humoral immunity, we characterized the behavior of GAS strains in a baboon model. An M-type 3 clinical isolate of GAS typical of strains that cause pharyngitis and invasive infection was recovered from the pharynx of six out of six baboons for at least 6 weeks after oral inoculation. By contrast, an isogenic mutant deficient in M protein failed to colonize most animals or was rapidly cleared. An isogenic mutant deficient in hyaluronic acid capsule colonized five out of six animals, but only persisted in the pharynx for 14-21 days. Colonized animals developed serum antistreptolysin O (SLO) and anti-M protein immunoglobulin (Ig)G. The kinetics of the antibody responses were similar to those seen after human infection. Peak titres increased with the duration of throat carriage. Colonization with GAS prevented recurrent colonization after challenge with the homologous wild-type strain, but not after challenge with a strain of different M protein type. Early clearance of the M protein-deficient strain was associated with increased susceptibility of this strain to phagocytic killing in non-immune serum, whereas clearance of the acapsular strain was associated with increased susceptibility to phagocytic killing in the presence of specific antibody. These studies support critical and distinct effects of the GAS M protein and capsule on throat colonization and induction of humoral immunity in a model that reproduces important features of pharyngeal colonization and immune response following human infection.

Animals↗

PubMed1997

The effect of erythromycin on resolution of symptoms among adults with pharyngitis not caused by group A streptococcus.

OBJECTIVE: To determine the effect of treatment with erythromycin on the resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Ambulatory setting (hospital-based general internal medicine practices, walk-in clinic, employee health service, and university health service). PATIENTS: One hundred and eighty-six adults who met eligibility criteria and whose chief complaint included sore throat. Patients with positive cultures for GAS were excluded. INTERVENTION: Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo. MEASUREMENTS AND MAIN RESULTS: Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to improvement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Patients given erythromycin had more rapid resolution of sore throat symptoms (hazard ratio 1.43: 95% confidence interval [CI] 1.00, 2.03: p = .049). Cough also resolved more rapidly in patients receiving erythromycin (hazard ratio 2.22: 95% CI 1.01, 4.88: p = .05). There were no differences between the two treatment groups in improvement of activity level or how sick patients felt in general. Most of the benefit in resolution of sore throat was conferred on patients who sought medical care within 2 days of onset. CONCLUSIONS: Our results suggest that the benefit of erythromycin treatment for patients with non-GAS pharyngitis is small and of borderline statistical significance. Because of the small size of the effect and because widespread use of erythromycin could promote drug resistance, we do not recommend routine use of erythromycin in adult patients with this type of pharyngitis.

Adult↗

PubMed2004

Is the incidence of oral and pharyngeal cancer increasing in Finland? An epidemiological study of 17,383 cases in 1953-1999.

OBJECTIVE: The aim of this study was to describe the occurrence of oral and pharyngeal cancer in Finland over the last half century. MATERIALS AND METHODS: The study included all lip, oral and pharyngeal cancer cases diagnosed in Finland and reported to the nation-wide Finnish Cancer Registry between 1953 and 1999. RESULTS: The study comprised 17,383 new cancer cases: 11,666 in males and 5717 in females. Of these, 83% were squamous cell carcinomas. By the end of the study, 1999, the mean age at diagnosis had increased to 63 years for males and 67 for females. The age-adjusted incidence of oral and pharyngeal cancer decreased in males from 12.5 per 10(5) to 8.4 per 10(5) while it increased in females from 3.0 per 10(5) to 3.9 per 10(5). This was because of a decrease in lip cancer incidence in males, while the incidence of tongue, mouth and salivary gland cancers increased in both genders. The annual number of new oral cancer cases increased, however, in both genders. CONCLUSION: The incidence of lip cancer decreased in males, probably because of a decrease in smoking and in outdoor work. The incidence of intra-oral cancers increased in both genders, possibly because of increased alcohol consumption.

Age Factors↗

PubMed1999

[Adult-onset Still's disease. Differential diagnosis in recurrent pharyngitis, fever of unknown original and excessive hyperferritinemia].

HISTORY AND PHYSICAL EXAMINATION: Six weeks before admission a 43-year old previously healthy woman got right-sided pharyngitis, accompanied with Herpes labialis and oral candidiasis. Two weeks later she travelled to a holiday in the Caribbean. During the first week of holiday she developed pharyngitis again, this time accompanied with fever and arthralgies. Therapeutic trial with antibiotics, antimalaric drugs and antiamoebics, given at the holiday resort, did not reduce fever. Immediately after return to Germany a therapeutic trial with imipenem was was attempted, without any apparent improvement. At admission, the patient was febrile, had pinky patchy exanthema and arthralgias. EXAMINATIONS: At admission, abnormal findings included anaemia (Hb 8.8 mg/dl), severe leukocytosis (35.3/nl), increased ESR (43/89 mm), CRP (24.2 mg/dl) and ferritin (5751 micrograms/l). Ultrasound examination revealed mild splenomegaly. Computed tomography of the abdomen and chest were without apparent abnormalities. TREATMENT AND CLINICAL COURSE: Infection, autoimmune diseases and neoplasia were ruled out. The diagnosis of adult onset Still's disease was established on the basis of a typical triad of symptoms (fever, exanthema, arthritis). Treatment with 100 mg/d prednisolon (started intravenously) was beneficial for fever and arthralgia, and resulted in the normalisation of laboratory findings. After gradual reduction in the corticosteroid dosage, maintenance treatment with 20 mg/d prednisolon was continued over following months. CONCLUSION: Recurrent prodromal pharyngitis and excessive hyperferritinaemia are, in addition to the triad fever-exanthema-arthritis, further important diagnostic criteria of adult onset Still's disease.

Adult↗

PubMed1993

Pharyngitis in children.

Although the group A beta-hemolytic streptococcus is the most important treatable cause of pharyngitis, other organisms, including viruses and groups C and G streptococci, should always be considered in the diagnosis of pharyngeal symptoms. Clinical findings and a rapid strep test aid in making the diagnosis of group A streptococcal pharyngitis. In nonallergic patients with the latter, penicillin V potassium is the antibiotic of choice; for those allergic to penicillin, erythromycin is my preferred alternative.

Adolescent↗

PubMed2002

Daily reduction in C-reactive protein values, symptoms, signs and temperature in group-A streptococcal pharyngitis treated with antibiotics.

C-reactive protein (CRP) value is usually elevated in patients with group A streptococcal (GAS) pharyngitis. The aim of this study was to describe the daily changes in CRP value after start of antibiotic treatment and to compare these changes with commonly used outcome measures in GAS pharyngitis. Eleven adult patients with sore throat and confirmed GAS infection were examined daily by specially trained medical students who registered symptoms and signs, performed a CRP test (NycoCard) and measured body temperature. At baseline, the mean CRP value was 100.3 mg/L (SD 80.9). The mean reduction after one day was 34.1% (SD 15.3), after two days 60.1% (SD 14.1) and after three days 75.3% (SD 12.5). Corresponding reductions were found for sign and symptom scores and temperature, but the standard deviations for these measures were much larger. The CRP value was significantly associated with both the symptom score and the number of days after start of treatment (p < 0.01), but not with the sign score and body temperature, as shown by multiple regression analysis for repeated measurements. The CRP test seems to be a valid test for monitoring the clinical course in GAS pharyngitis.

Adult↗

PubMed2000

Pyopneumothorax: a complication of Streptococcus pyogenes pharyngitis.

A 20-y-old African-American female with Streptococcus pyogenes pharyngitis presented with tension pyopneumothorax. Her illness began with fever and sore throat that persisted for several days. She then developed a left neck swelling, followed by difficult swallowing and cough. Subsequently, she developed shortness of breath that became severe. On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. Chest X-ray revealed left side pneumothorax, air-fluid level and near-complete collapse of the left lung with displacement of the heart and trachea to the right. Computed tomography scan of the neck revealed swelling and enhancement of the sternocleidomastoid muscle with loculated fluid collection, inflammation in the left anterior medial neck displacing the trachea extending into the mediastinum and the left apex. Thoracentesis revealed purulent fluid; Gram stain showed Gram-positive cocci in chains; culture yielded pure growth of Streptococcus pyogenes. She was treated with high dose penicillin, several chest tubes and intra-pleural injections of streptokinase with gradual resolution. This complication has not been described previously in Streptococcus pyogenes pharyngitis.

Adult↗

PubMed2001

Distribution of streptococcal inhibitor of complement variants in pharyngitis and invasive isolates in an epidemic of serotype M1 group A Streptococcus infection.

Streptococcal inhibitor of complement (Sic) is a highly polymorphic extracellular protein made predominantly by serotype M1 group A Streptococcus (GAS). New variants of the Sic protein frequently appear in M1 epidemics as a result of positive natural selection. To gain further understanding of the molecular basis of M1 epidemics, the sic gene was sequenced from 471 pharyngitis and 127 pyogenic and blood isolates recovered from 598 patients living in metropolitan Helsinki, Finland, during a 37-month population-based surveillance study. Most M1 GAS subclones recovered from pyogenic infections and blood were abundantly represented in the pool of subclones causing pharyngitis. Alleles shared among the pharyngitis, pyogenic, and blood samples were identified in throat isolates a mean of 9.8 months before their recovery from pyogenic infections and blood, which indicates that selection of most sic variants occurs on mucosal surfaces. In contrast, no variation was identified in the emm and covR/covS genes.

Alleles↗

PubMed2003

Internalization-associated proteins among Streptococcus pyogenes isolated from asymptomatic carriers and children with pharyngitis.

Sixty-two strains of Streptococcus pyogenes isolated from 30 asymptomatic school children and 32 children with pharyngitis were characterized to analyze the involvement of 2 fibronectin-binding proteins (F/SfbI and PrtF2/PfbpI) in S. pyogenes colonizing asymptomatic carriers and to determine the possible association between these proteins and the genes associated with macrolide resistance. In this study, we demonstrated that the proportion of S. pyogenes strains carrying the pfbpI gene was significantly higher among asymptomatic carriers (80%) than among children with pharyngitis (53%; P<.05). With regard to the proportion of prtF1-positive strains, no significant differences were found between the 2 groups (70% vs. 69%, for asymptomatic carriers and children with pharyngitis, respectively). Another important finding is the significant association between macrolide resistance and protein F/SfbI (P<.001) in both groups. These results suggest that the presence of the pfbpI gene can be linked to the ability of S. pyogenes to persist in the throat of asymptomatic carriers.

Adhesins, Bacterial↗

PubMed2003

Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study.

OBJECTIVE: To investigate the safety and efficacy of Throat Coat) (Traditional Medicinals,) Sebastopol, CA), a traditional demulcent herbal tea, in comparison with a placebo tea in the symptomatic treatment of acute pharyngitis. DESIGN: Multicenter, prospective, randomized, double-blinded, placebo-controlled, two-armed, parallel-group clinical trial. SETTINGS: Three primary care clinics in Duluth, MN, Madison, WI, and Middleton, WI. SUBJECTS: Patients of both genders (>or=18 years of age) with clinical diagnoses of acute pharyngitis. INTERVENTIONS: Patients (n = 60) were randomly assigned to receive 5-8 oz of Throat Coat (n = 30) or a placebo (n = 30), four to six times daily. The study period was 2 to 7 days with a window for the follow-up visit of 2-10 days accounting for the variable duration of sore throat symptoms. OUTCOME MEASURES: Primary efficacy parameter: sum of pain intensity differences (SPID) for pain in throat on swallowing, calculated as the area under the curve (AUC) of pain intensity difference scores (assessed at 1 minute, 5 minutes, 10 minutes, 15 minutes, 20 minutes, and 30 minutes after treatment). Secondary efficacy parameter: total pain relief (TOTPAR), calculated as the AUC from time 0 (baseline) to 30 minutes of pain relief (assessed at 1 minute, 5 minutes, 10 minutes, 15 minutes, 20 minutes, and 30 minutes). RESULTS: Compared to placebo, intensity of throat pain when swallowing was significantly reduced by Throat Coat in intention to treat and valid for efficacy analysis (VEA). Significant differences in change from baseline pain were observed at 5 min (p = 0.007), 10 min (p = 0.005), 15 minutes (p = 0.01), 20 minutes (p = 0.05), and 30 minutes (p = 0.04) after completion of the first dose (VEA analysis). There was a statistically significant improvement of SPID in the Throat Coat-treated group: Least square means +/- standard error of the means (SEM) of SPID were -16.5 +/- 13.9 in the placebo group and -43.8 +/- 11.9 in the Throat Coat-treated group (p = 0.012). TOTPAR was also significantly higher in the Throat Coat-treated group: Least square means +/- SEM of TOTPAR were 32.4 +/- 12.8 in the placebo group and 53.6 +/- 10.9 in the Throat Coat-treated group (p = 0.031). This study shows that Throat Coat is significantly superior to placebo and provided a rapid, temporary relief of sore throat pain in patients with pharyngitis.

Acute Disease↗

PubMedDate not supplied

Do the beta-hemolytic non-group A streptococci cause pharyngitis?

Implication of the beta-hemolytic non-group A streptococci (BHNAS) as pharyngeal pathogens has been based predominantly on reports of a few outbreaks, small case clusters, and anecdotes. These organisms have long been noted to constitute a significant number of the beta-hemolytic streptococcal isolates from throats of symptomatic and asymptomatic patients in a variety of populations. Laboratory studies have demonstrated the usefulness of anaerobic atmosphere and prolonged incubation in maximizing isolation of the BHNAS. More recently, genetic studies have furthered our appreciation of the taxonomy and have defined two major groups: Streptococcus anginosus-milleri group and large-colony BHNAS; the latter can be further separated on the basis of serogrouping and biotyping. Recognition of this diversity gives justification to the reexamination of the epidemiology and disease course of BHNAS pharyngitis. Treatment studies will also be required if all or subsets of these organisms can be confirmed as pharyngeal pathogens.

Carrier State↗

PubMed1992

Streptococcal pharyngitis: current therapy and criteria for evaluation of new agents.

Penicillin has been the recommended drug of choice in most cases of group A streptococcus (GAS) pharyngitis for nearly 40 years based on its efficacy in the prevention of acute rheumatic fever. Since trials of other drugs for the prevention of rheumatic fever are no longer feasible in the United States, eradication of GAS pharyngitis has become the surrogate for their evaluation. On the basis of this criterion, specific therapeutic regimens have been recommended, and numerous other drugs have gained approval as alternatives to penicillin. Current therapeutic issues include possible decreased efficacy of penicillin, timing of the initiation of therapy, and drugs of choice for patients whose treatment fails, who are chronic carriers, or who have frequent infections. Criteria for assessment of new drugs include clinical response, likelihood of prevention of rheumatic fever, rates of relapse and recurrent infection, and drug safety. The establishment of uniform guidelines and definitions of response for new drug evaluations by the Infectious Diseases Society of America should aid in the further assessment of new antibacterial agents as therapy for GAS pharyngitis. However, no data yet suggest that any of these drugs should replace penicillin as the drug of choice.

Anti-Bacterial Agents↗

PubMed1995

Evaluation of short-course therapy with cefixime or rifampin for eradication of pharyngeally carried group A streptococci. The Ontario GAS Study Group.

Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg.d]; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefixime recipients. At 10-14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.

Adolescent↗

PubMed1988

Comparative efficacy and toxicity of roxithromycin and erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis in adults.

Roxithromycin is a novel oxime ether derivative of erythromycin. Previous studies have demonstrated similar in-vitro activity for roxithromycin and erythromycin. Roxithromycin has improved pharmacokinetic properties and may be a useful alternative agent for infections where erythromycin is indicated. We compared the efficacy and toxicity of roxithromycin and erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis in adults. We also assessed compliance with treatment between the two agents. Roxithromycin and erythromycin ethylsuccinate were equally effective in resolving the symptoms and signs of pharyngitis. Erythromycin ethylsuccinate was superior to roxithromycin in achieving microbiological cure (90% vs. 33%, respectively). No differences were observed in toxicity or compliance with treatment between the two agents. Based on this prespective clinical trial, roxithromycin is not considered to be an acceptable alternative agent for acute streptococcal pharyngitis in adults.

Adolescent↗

PubMed1991

Clarithromycin versus penicillin in the treatment of streptococcal pharyngitis.

The safety and efficacy of oral clarithromycin 250 mg every 12 h treatment and of oral penicillin VK (the potassium salt of phenoxymethylpenicillin) 250 mg every 6 h were compared in the treatment of streptococcal pharyngitis caused by Streptococcus pyogenes in an eight centre in-vivo study. A total of 243 patients were enrolled in the study and 125 patients were evaluated for efficacy; evaluable patients included 67 patients in the clarithromycin treatment group and 58 patients in the penicillin VK group. Both antibiotic regimens were effective in the treatment of streptococcal pharyngitis. The clinical cure rate during the initial post-treatment period (between two and ten days post-treatment) for the penicillin VK treated group was 98% (57/58) and for the clarithromycin treated group was 96% (64/67). The bacteriological cure rate during the initial post-treatment period for the penicillin VK treated group was 97% (56/58) and for the clarithromycin treated group was 100% (67/67). A total of 17 patients reported adverse events; seven patients were in the clarithromycin treatment group and ten patients in the penicillin VK treatment group. One patient in the penicillin VK group was withdrawn because of the severity of the adverse advent (balanitis). No clinically significant differences were reported between the two treatment groups for haematology, blood chemistry, or urinalysis evaluations. Oral clarithromycin 250 mg 12-hourly treatment was as safe and effective as penicillin VK 250 mg 6-hourly in the treatment of streptococcal pharyngitis.

Adolescent↗

PubMed1977

An evaluation of penicillin prophylaxis during an outbreak of foodborne streptococcal pharyngitis.

Between August 16 and 21, 1974, an outbreak of beta-hemolytic group A M-9 T-9 streptococcal pharyngitis affected 49% of a randomly selected group of inmates at a jail in southern Florida. Food-specific attack rates incriminated improperly stored egg salad served at lunch on August 16 as the vehicle of transmission. By August 20, 290 symptomatic inmates had been placed on penicillin or erythromycin; on that day fewer than 5% of throat cultures from 400 allegedly non-penicillin-allergic largely asymptomatic inmates, cultured just before penicillin prophylaxis, were positive for the epidemic strain. At the time prophylaxis was given, secondary transmission had accounted for only 3% of cases. No non-suppurative sequelae were observed but 5% of inmates who received penicillin prophylaxis experienced an adverse reaction to the drug. Although widespread penicillin prophylaxis during outbreaks of group A beta-hemolytic streptococcal pharyngitis will likely prevent transmission of these organisms, prompt treatment of all symptomatic cases may be equally as effective in controlling adult institutional foodborne outbreaks of streptococcal pharyngitis and will likely minimize the number of adverse reactions to penicillin which may be seen.

Disease Outbreaks↗

PubMed1992

Vitamin supplement use and reduced risk of oral and pharyngeal cancer.

Use of vitamin and mineral supplements was assessed in a population-based case-control study of oral and pharyngeal cancer, conducted during 1984-1985 in four areas of the United States. There was no association with intake of multivitamin products, but users of supplements of individual vitamins, including vitamins A, B, C, and E, were at lower risk after controlling for the effects of tobacco, alcohol, and other risk factors for these cancers. After further adjustment for use of other supplements, vitamin E was the only supplement that remained associated with a significantly reduced cancer risk. The adjusted odds ratio of oral and pharyngeal cancer for "ever regularly used" vitamin E was 0.5 (95% confidence interval 0.4-0.6). To the authors' knowledge, this is the first epidemiologic study to show a reduced oral cancer risk with vitamin E use. Although it is not clear that the lower risk among consumers of vitamin E supplements is due to the vitamin per se, the findings are consistent with experimental evidence and should prompt further research on the role of vitamin E and other micronutrients as inhibitors of oral and pharyngeal cancer.

Age Factors↗