Viral Pharyngitis Follow-up

  • Author: KoKo Aung, MD, MPH, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 26, 2011
 

Deterrence/Prevention

Washing hands frequently, using disposable tissues, and limiting human contact are important preventive measures for the common cold syndrome and other viral pharyngitis. No consistent benefit was demonstrated in preventing a common cold with large doses of vitamin C.

Live adenovirus vaccines have been successfully used in military populations but are not available for civilian use.

Administration of influenza vaccine to high-risk individuals and those who want to prevent influenza is the major preventive measure. Amantadine may be used to prevent influenza A during outbreaks.

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Complications

The complication rate of viral pharyngitis associated with a common cold is quite low. Purulent bacterial otitis media and sinusitis may occur.

Infectious mononucleosis may be complicated by tonsillar and peritonsillar abscess, necrotic epiglottitis, airway obstruction, hepatic dysfunction, splenic rupture, hypersplenism, encephalitis, pneumonitis, pericarditis, and hematologic disorders.

Herpetic pharyngitis may lead to necrotizing tonsillitis, epiglottitis, and recurrent disease.

Influenza may be complicated by secondary bacterial pneumonia. Pneumococcal pneumonia is most common. Staphylococcal pneumonia is most serious.

RSV infection, particularly in infants, elderly persons, and patients with underlying COPD, may be complicated by pneumonia and respiratory failure.

Complications of HIV infection are beyond the scope of this article. For more information, see the eMedicine article HIV Disease.

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Prognosis

The prognosis of a patient with a common cold is excellent. Most adults recover in less than a week, and most children in less than 2 weeks.

In patients with infectious mononucleosis, fever disappears in approximately 10 days. Lymphadenopathy and splenomegaly disappear in approximately 4 weeks. Debility sometimes remains for approximately 2-3 months, and the condition is occasionally fatal because of splenic rupture, hypersplenism, or encephalitis.

The duration of uncomplicated influenza is 1-7 days. Prognosis is excellent. Most fatalities are due to secondary bacterial pneumonia.

Enteroviral pharyngitis is usually benign and self-limited.

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Patient Education

Patient education should emphasize the natural course of viral infection and that it takes several days to feel better. Patients must understand that antibiotics are not needed for sore throats of viral origin. Risk of allergic reactions, fungal superinfection, and bacterial resistance should be discussed.

Patients should be reassured that certain measures, including pain relievers, throat sprays or lozenges, and gargling with warm salt water, improve symptoms without antibiotics. It is often challenging to reassure that antibiotic therapy is unnecessary.[2]

Fever persisting for more than 5 days, extreme throat pain causing dysphagia, inability to open the mouth wide, or fainting spells when standing should prompt a visit to a doctor.

For excellent patient education resources, visit eMedicine's Cold and Flu Center, Bacterial and Viral Infections Center and Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Colds, Sore Throat, Mononucleosis, and Tonsillitis.

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Contributor Information and Disclosures
Author

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Ambrish Ojha, MD  Staff Physician, Department of Internal Medicine, Texas Tech University Health Sciences Center

Ambrish Ojha, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Carson Lo  MD, Consultant, West Houston Infectious Disease Associates

Carson Lo is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory William Rutecki  MD, Professor of Medicine, University of South Alabama Medical School

Gregory William Rutecki is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gordon L Woods, MD  Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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