From the Guidelines
Granular pharyngitis is most likely caused by viral infections, particularly adenovirus, influenza, and Epstein-Barr virus (EBV). The etiology of granular pharyngitis can be attributed to various factors, including viral and bacterial infections. However, the most recent and highest quality study 1 suggests that viral infections are the primary cause of granular pharyngitis.
Etiology of Granular Pharyngitis
The study 1 highlights that patients with symptoms suggesting a bacterial cause should be tested for group A Streptococcus with a rapid antigen detection test, throat culture, or both. However, the majority of cases are caused by viral infections, and treatment should be focused on supportive care.
Treatment and Management
Treatment for granular pharyngitis is primarily supportive care with:
- Rest
- Adequate hydration
- Over-the-counter pain relievers such as acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food)
- Throat lozenges
- Warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water)
- Honey in warm tea
If Group A Streptococcus is confirmed through rapid testing or culture, antibiotic therapy with penicillin V (500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days) is indicated. For penicillin-allergic patients, alternatives include cephalexin (if no anaphylactic reaction history) or macrolides like azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) 1.
Key Points
- Viral infections are the primary cause of granular pharyngitis
- Supportive care is the primary treatment for granular pharyngitis
- Antibiotic therapy is only indicated for confirmed Group A Streptococcus infections
- The characteristic granular appearance of the posterior pharyngeal wall results from lymphoid hyperplasia in response to infection, with the cobblestone-like projections representing enlarged lymphoid follicles as part of the body's immune response to the pathogen.
From the Research
Etiology of Granular Pharyngitis
The etiology of granular pharyngitis is not directly addressed in the provided studies. However, the studies discuss the causes of pharyngitis in general, which can be related to granular pharyngitis.
- The most common cause of pharyngitis is viral infection, but bacterial etiologies, such as group A β-hemolytic Streptococcus pyogenes (GAS), can also be responsible 2, 3, 4, 5.
- Group A streptococcus (Streptococcus pyogenes) is the most important causative agent of pharyngitis, and it can lead to complications such as rheumatic fever and acute poststreptococcal glomerulonephritis if left untreated or not treated aggressively 2, 3, 4, 5.
- Other bacteria, such as C. pneumoniae and M. pneumoniae, can also cause pharyngitis, although the possibility of diagnosing these organisms is limited 3.
- Non-infectious etiologies, such as laryngopharyngeal reflux and periodic fever, aphthous ulcers, pharyngitis, and adenitis syndrome, can also be considered in cases of chronic pharyngitis 4.
Bacterial Etiologies
- Group A β-hemolytic Streptococcus pyogenes (GAS) is a common cause of bacterial pharyngitis, and it can be treated with antibiotics such as penicillin or amoxicillin 2, 3, 4, 5.
- The diagnosis of GAS pharyngitis can be made using a rapid antigen detection test, and the treatment includes a 10-day course of antibiotics 5.
- Recurrent pharyngitis can be caused by reactivation of the primary strain or reinfection with a new strain, and the treatment approach may vary depending on the cause of recurrence 6.