Pharyngitis

Pharyngitis is commonly known as sore throat. It causes inflammation of the pharynx and finally results in a sore throat. Pharyngitis is most commonly referred to as a symptom rather than a condition or disease. Pharyngitis is caused by viruses like rhinovirus, influenza, Adenovirus, Coronavirus, and Parainfluenza virus; and less common viruses include Herpes virus, Epstein-bar virus(EBV), Human immunodeficiency virus (HIV), and Coxsakievirus or bacteria like Group A beta-hemolytic Streptococci, Group B and Group C Streptococci, Mycoplasma pneumonia, Chlamydia pneumonia, Haemophilus influenza, Neisseria meningitides, Neisseria gonorrhoeae, Arcanobacterium hemolyticum, Fusobacterium necrophorum, Corynebacterium diptheriae. Smoking and secondhand smoke, exposure to chemical irritants or close contact with individuals who have pharyngitis increases the risk of pharyngitis. It causes symptoms like sore throat, dry and itchy sensation in the throat, pain during swallowing, fever, pus or white patches on the tonsils, generalized body pains, and fatigue. When pharyngitis is caused by a virus, the symptoms resolve within a week and generally do not require any antibiotics as they work only in the case of pharyngitis caused by bacteria. Pharyngitis caused by Epstein-Bar virus is known as infectious mononucleosis and this condition does not require any antibiotics. Whereas, in the case of pharyngitis caused by bacteria, antibiotics like penicillins shall be prescribed for a short period of 10 days to eradicate the bacteria.

Causes of Pharyngitis

  • It is caused by either virus or bacteria.
  • Most common virus that causes pharyngitis include rhinovirus, influenza, Adenovirus, Coronavirus, and Parainfluenza virus; and less common viruses include Herpes virus, Epstein-bar virus(EBV), Human immuno deficiency virus (HIV), and Coxsakievirus.
  • Bacteria that cause pharyngitis include Group A beta hemolytic Streptococci, Group B and Group C Streptococci, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Fusobacterium necrophorum, Corynebacterium diptheriae

Risk Factors of Pharyngitis

  • Flu season – fall and winter season
  • Allergies
  • Day care or crowded schools – viral and bacterial infections spread easily in daycare centers, schools, offices and classrooms.
  • Individuals who often travel by public transport.
  • Frequent and severe sinus infections
  • Smoking or second-hand smoking would cause irritation to the throat
  • Exposure to chemical irritants
  • Exposure or close contact with someone who has pharyngitis
  • Decreased immunity – individuals with HIV, diabetes, asthma,
  • individuals who are on treatment with steroids or chemotherapeutic agents, and have poor diet.

Symptoms of Pharyngitis

Usual symptoms of pharyngitis include:

  • Sore throat
  • Pain, dry  and scratchy sensation in the throat
  • Pain while swallowing (odynophagia)
  • Pain while speaking
  • Swollen glands in the neck area or jaw area
  • White patches or pus on the tonsils
  • Myalgia or muscle pains
  • Generalized weakness

In the majority of cases when pharyngitis is caused by a virus, symptoms include cough, runny nose, pink eye/conjunctivitis, rash and headache.

When pharyngitis is caused by bacteria, symptoms include fever, inflammation of tonsils, enlargement of lymph nodes in the  head and neck(cervical lymphadenopathy)

When pharyngitis is caused by the Epstein bar virus, it is known as infectious mononucleosis.

A few infections that cause sore throat, might lead to other signs and symptoms like fever, cough, runny nose, sneezing, generalized body pains, headache, nausea, and vomiting.

In a few scenarios, pharyngitis could also be a part of some other serious illnesses, which include peritonsillar abscess, retro-pharyngeal abscess, epiglottitis, or Kawasaki disease.

Diagnosis for Pharyngitis

  • Diagnosis requires a physical examination by the health care individual and a laryngoscopy to look at the throat, ears, and nasal passages
  • Examination of the neck, to check for swollen lymph glands
    Throat swab – culture and sensitivity to check for the Streptococcus bacterial infection.
  • PCR-based NAAT tests like respiratory panels would be helpful in faster and more accurate diagnosis in case the virus is the cause of the infection.

Treatments for Pharyngitis

  • Pharyngitis or sore throat caused by the virus usually resolves within 5-7 days and doesn’t require any medications.
  • Antibiotics shall be prescribed only for Group A beta-hemolytic streptococci positive patients, based on a positive culture of throat swab or sputum culture sensitivity or rapid antigen testing method. A 10-day course of oral penicillins would be recommended to eradicate the bacteria and it would also be helpful in the prevention of rheumatic fever(a condition that causes swelling of the skin, heart, joints, and brain).
  • Symptomatic treatments like gargling oral acetaminophen, and inhaled steroids would also be recommended.
  • In the case of infectious mononucleosis(caused by Epstein-bar virus(EBV)), antibiotics should not be used and it is also recommended to avoid any sports for about 6-8 weeks in order to avoid splenic rupture

Preventive Measures for Pharyngitis

  • Influenza vaccine can be taken once every year in-order to prevent influenza(flu). This can be administered to children aged from 2-17 years. All healthy adults are also recommended to be vaccinated with influenza vaccine annually.
  • Individuals who are at higher risk for developing serious influenza complications and health care individuals and people who care for individuals with high-risk influenza complications should be vaccinated for sure.
  • September and October would be generally a good time to be vaccinated for the flu vaccine. But if individuals are at high risk for developing influenza, or have frequent infections, then a vaccine can be taken at any time of the year.

Anal cancer refers to the growth of malignant cells in the tissues of the anus. While it may not be as commonly discussed as other types of cancer, it is crucial to understand its causes, symptoms, and treatment options. It is essential to note that anal cancer can affect both men and women.

If you suspect you or someone else is experiencing Anal cancer, it is crucial to seek immediate medical attention by calling emergency services or consult with a Cancer Specialist.

Causes of Anal Cancer

  • Human Papillomavirus (HPV) Infection: The most significant risk factor for anal cancer is a persistent infection with certain types of HPV, particularly HPV types 16 and 18. HPV is a sexually transmitted virus that can cause changes in the cells of the anus, leading to cancer over time.
  • Weakened Immune System: People with a weakened immune system, such as those living with HIV/AIDS or individuals who have received organ transplants, are at a higher risk. This is because their immune system may not be able to fight off HPV infections effectively.
  • Anal Intercourse: Individuals who engage in receptive anal intercourse are at a higher risk of contracting HPV, which increases the likelihood of developing anal cancer.
  • Smoking: Smoking increases the risk of anal cancer. The chemicals in tobacco can damage the cells in the body and make it easier for HPV to cause cancerous changes.
  • Age: The risk of anal cancer increases with age, particularly in people over 50. However, it can occur at any age.
  • Chronic Inflammation: Chronic conditions like inflammatory bowel disease (IBD) can increase the risk of developing anal cancer due to prolonged inflammation in the area.
  • History of Other Cancers: A history of certain cancers, such as cervical, vulvar, or vaginal cancer, can increase the risk of developing anal cancer, especially in women.
  • Multiple Sexual Partners: Having multiple sexual partners increases the risk of contracting HPV, which can contribute to the development of anal cancer.
  • Genetic Factors: While rare, some individuals may have a genetic predisposition to cancer, making them more likely to develop anal cancer.

Risk Factors of Anal Cancer

  • Human papillomavirus (HPV) infection – Particularly types 16 and 18
  • Weakened immune system – Due to conditions like HIV/AIDS or immunosuppressive drugs
  • Anal intercourse – Increases HPV exposure
  • Multiple sexual partners – Elevates risk of HPV infection
  • History of other cancers – Especially cervical, vulvar, or vaginal cancers
  • Age – Risk increases with age, especially over 50
  • Smoking – Increases the risk of developing anal cancer
  • Chronic anal inflammation – Conditions like Crohn’s disease or ulcers
  • History of sexually transmitted infections (STIs) – Increases risk of HPV and cancer

Symptoms of Anal Cancer

  • Bleeding from the anus or rectum
  • Pain or discomfort in the anal area
  • Itching or discharge from the anus
  • A lump or mass near the anus
  • Changes in bowel habits (e.g., diarrhea, constipation)
  • Unexplained weight loss
  • Fatigue
  • Swollen lymph nodes in the groin area

Diagnosis for Anal Cancer

  • Medical History and Physical Exam: Review of symptoms, lifestyle factors, and family history; physical examination of the anal region.
  • Digital Rectal Exam (DRE): Physical examination of the anal canal and rectum to check for abnormal lumps or masses.
  • Anoscopy: A procedure using a small tube (anoscope) to examine the inside of the anal canal for abnormal areas.
  • Biopsy: Removal of a small tissue sample from suspicious areas for laboratory testing to confirm the presence of cancer cells.

Imaging Tests:

  • CT Scan: To detect the spread of cancer to other parts of the body.
  • MRI: To assess the extent of cancer within the anal region and surrounding tissues.
  • PET Scan: To identify cancer spread and detect distant metastases.
  • Pap Smear (Anal Pap Test): Screening for abnormal cells in the anal region, especially for individuals at high risk.
  • HPV Testing: Testing for high-risk strains of Human Papillomavirus (HPV), often associated with anal cancer.
  • Endorectal Ultrasound: An imaging technique used to evaluate tumor size and involvement of surrounding tissues.
  • Blood Tests: To assess general health and detect possible markers of cancer (e.g., elevated levels of certain proteins).

Treatments for Anal Cancer

  • Chemoradiation: Combination of chemotherapy and radiation therapy, typically the first line of treatment for localized anal cancer.
  • Radiation Therapy: High-energy rays to target and kill cancer cells or shrink tumors.
  • Chemotherapy: Use of drugs to kill or stop the growth of cancer cells, often combined with radiation.

Surgery:

  • Local Excision: Removal of small, localized tumors in the anal canal.
  • Abdominoperineal Resection (APR): Removal of the anus, rectum, and surrounding tissues, often used for advanced cases.
  • Lymph Node Dissection: Removal of affected lymph nodes if the cancer has spread.
  • Targeted Therapy: Drugs that target specific molecules involved in cancer cell growth, used in some advanced cases.
  • Immunotherapy: Strengthening the immune system to fight cancer, often for advanced or recurrent cancer.
  • Supportive Care: Pain management, nutritional support, and psychological support during and after treatment.

Preventive Measures for Anal Cancer

  • HPV Vaccination: Vaccination against human papillomavirus (HPV) to reduce the risk of infection by high-risk strains linked to anal cancer.
  • Regular Screening: Anal Pap tests for individuals at high risk, such as those with a history of anal warts or HIV-positive individuals.
  • Safe Sexual Practices: Use of condoms and limiting the number of sexual partners to reduce the risk of HPV transmission.
  • Smoking Cessation: Avoiding tobacco use, as smoking increases the risk of anal cancer.
  • Healthy Lifestyle: Maintaining a healthy diet, regular physical activity, and a healthy weight to strengthen overall immunity.
  • Early Detection of HPV Infections: Regular monitoring and treatment of anal HPV infections to prevent cancer development.
  • HIV Management: For HIV-positive individuals, maintaining a strong immune system with antiretroviral therapy (ART) to reduce cancer risk.