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Black spots in the back of throat: Diphtheria: MedlinePlus Medical Encyclopedia

Diphtheria: MedlinePlus Medical Encyclopedia

Diphtheria is an acute infection caused by the bacterium Corynebacterium diphtheriae.

The bacteria that cause diphtheria spread through respiratory droplets (such as from a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms.

The bacteria most commonly infect your nose and throat. The throat infection causes a gray to black, tough, fiber-like covering, which can block your airways. In some cases, diphtheria infects your skin first and causes skin lesions.

Once you are infected, the bacteria make dangerous substances called toxins. The toxins spread through your bloodstream to other organs, such as the heart and brain, and cause damage.

Because of widespread vaccination (immunization) of children, diphtheria is now rare in many parts of the world.

Risk factors for diphtheria include crowded environments, poor hygiene, and lack of immunization.

Symptoms usually occur 1 to 7 days after the bacteria enter your body:

  • Fever and chills
  • Sore throat, hoarseness
  • Painful swallowing
  • Croup-like (barking) cough

  • Drooling (suggests airway blockage is about to occur)
  • Bluish coloration of the skin
  • Bloody, watery drainage from nose
  • Breathing problems, including difficulty breathing, fast breathing, high-pitched breathing sound (stridor)
  • Skin sores (usually seen in tropical areas)

Sometimes there are no symptoms.

The health care provider will perform a physical exam and look inside your mouth. This may reveal a gray to black covering (pseudomembrane) in the throat, enlarged lymph glands, and swelling of the neck or vocal cords.

Tests used may include:

  • Gram stain or throat culture to identify the diphtheria bacteria
  • Toxin assay (to detect the presence of the toxin made by the bacteria)
  • Electrocardiogram (ECG)

If the provider thinks you have diphtheria, treatment will likely be started right away, even before test results come back.

Diphtheria antitoxin is given as a shot into a muscle or through an IV (intravenous line). The infection is then treated with antibiotics, such as penicillin and erythromycin.

You may need to stay in the hospital while getting the antitoxin. Other treatments may include:

  • Fluids by IV
  • Oxygen
  • Bed rest
  • Heart monitoring
  • Insertion of a breathing tube
  • Correction of airway blockages

People without symptoms who carry diphtheria should be treated with antibiotics.

Diphtheria may be mild or severe. Some people do not have symptoms. In others, the disease can slowly get worse. Recovery from the illness is slow.

People may die, especially when the disease affects the heart.

The most common complication is inflammation of the heart muscle (myocarditis). The nervous system is also frequently and severely affected, which may result in temporary paralysis.

The diphtheria toxin can also damage the kidneys.

There can also be an allergic response to the antitoxin.

Contact your provider right away if you have come in contact with a person who has diphtheria.

Diphtheria is a rare disease. It is also a reportable disease, and any cases are often publicized in the media. This helps you to know if diphtheria is present in your area.

Routine childhood immunizations and adult boosters prevent the disease.

Anyone who has come into contact with an infected person should get an immunization or booster shot against diphtheria, if they have not already received it. Protection from the vaccine lasts only 10 years. So it is important for adults to get a booster vaccine every 10 years. The booster is called tetanus-diphtheria (Td). (The shot also has vaccine medicine for an infection called tetanus.)

If you have been in close contact with a person who has diphtheria, contact your provider right away. Ask whether you need antibiotics to prevent getting diphtheria.

Respiratory diphtheria; Pharyngeal diphtheria; Diphtheric cardiomyopathy; Diphtheric polyneuropathy

  • Antibodies

Centers for Disease Control and Prevention website. Diphtheria. www.cdc.gov/diphtheria/about/index.html. Updated May 26, 2020. Accessed March 8, 2022.

Saleeb PG. Corynebacterium diphtheriae (diphtheria). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 204.

Stechenberg BW. Diphtheria. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 90.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are Tonsil Stones? Causes, symptoms and treatments

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(Image credit: Getty Images)

While tonsil stones may seem like a bad medical hoax, they can be a real problem. Tonsil stones, also known as tonsilloliths or tonsilliths, are benign accumulations of bacteria and debris in the crypts of some people’s tonsils. Though this problem may cause discomfort, it is not dangerous and is usually easily treatable.  


The tonsils are part of a protection system that keeps foreign objects from slipping into the lungs. They are also lymph nodes that filter for bacteria and viruses while producing white blood cells and antibodies, according to the Mayo Clinic. Objects such as food, dirt and other particles can get stuck in the groves on the surface of the tonsils. The grooves, called crypts, also collect old cells and bacteria. 

The body’s white blood cells proceed to attack the foreign objects stuck in the tonsils. When the white blood cells are finished, hard particles remain on the tonsils. Most people simply swallow what is left behind and never know that it was there in the first place. If the particles are lodged into the crypts, though, the particles will continue to grow. These growing objects are tonsil stones, which are also called tonsil calculi, according to the Cleveland Clinic.

According to a study published by the journal Otolaryngology–Head and Neck Surgery, tonsil stones are more alive than actual stones. Researchers found that tonsils stones are a living biofilm that breathes oxygen. A biofilm is a collection of microorganisms, such as bacteria, fungi and protists, that form a robust layer.

According to Dr. Alan Greene, a pediatrician and author, tonsil stones are most common in teens and those with large tonsils. Those with poor dental hygiene may also experience tonsil stones.


According to Dr. Alan Greene, a pediatrician and author, tonsil stones are most common in teens and those with large tonsils. Those with poor dental hygiene may also experience tonsil stones.

People with throat stones can also feel like they have something stuck in their throats, according to Dr. Erich P. Voigt, an associate professor of otolaryngology at NYU-Langone Medical Center. Other symptoms can include chronic, mild sore throat and reoccurring tonsillitis.

Related links

Tonsil stones can often be seen in the mirror. The tonsils won’t seem smooth. “Instead, they look like prunes, with crevices where bacteria can accumulate,” said Chetan Kaher, a dentist in London.

Typically, tonsil stones can be seen as white, yellow or grey nodes on the tonsils. This isn’t always the case, though. Many tonsil stones aren’t visible because they are burrowed down inside of the tonsil, said Dr. Ileana Showalter, an otolaryngologist at Mercy Medical Center in Baltimore, Maryland. 

Tonsil stones can grow to 1 to 2 millimeters across. But they can be up to 1 centimeters across, according to the Australian Government Department of Health.

A tonsil stone in a patients mouth.  (Image credit: Getty Images)


One of most common treatments to cure tonsil stones is simply scraping them off with a toothbrush. If that doesn’t work, there are several other at-home options which are recommended by the Cleveland Clinic. “Gargling with salt water can help dislodge them. Using a cotton swab to express them from the little small cavities that are visible is another option,” said Showalter. A water flossing device such as a Waterpik can also be used to power wash the debris out of the tonsils.  

Sometimes the tonsil stones are so deeply embedded that they cannot be removed at home. In this case, an ear, nose and throat specialist can often remove the stones. If a person gets tonsil stones often, then the patient and doctor may discuss removing the tonsils.

“A last resort cure of this problem is tonsillectomy. However, this surgery carries risks of anesthesia, pain and bleeding, as well as other risks, thus a decision of this type must be balanced by a risk/benefit discussion,” said Voigt. 


Preventing the formation of tonsil stones is as simple as good dental hygiene. The Mayo Clinic suggests brushing teeth and tongue after meals, at bedtime and first thing in the morning. Flossing teeth daily can also help by cleaning out bacteria. Voigt also suggested gargling daily suing commercial gargles, or a homemade solution of hydrogen peroxide and water. The Mayo Clinic advises against using a mouthwash that contains alcohol.

Additional resources

Check out the Mayo Clinic’s self-care steps may help prevent tonsil stones from returning and The American Academy of Otolaryngology’s webpage “Tonsils and Adenoids Patient Health Information“, for advise on tonsil stones.  


Paul Stoodley, et al, “Tonsillolith: not just a stone but a living biofilm”, Otolaryngology, Volume 141, September 2009. 

Matthew Ferguson, et al, “Halitosis and the Tonsils: A Review of Management”, Otolaryngology, Volume 151, August 2014, https://doi.org/10.1177/0194599814544881

Balaji Babu, et al, “Tonsillolith: A Panoramic Radiograph Presentation”, Journal of Clinical & Diagnostic Research, Volume 7, October 2013. 

“Surgical treatments for tonsil stones”, NHS: Kent and Medway Policy Recommendation and Guidance Committee, March 2020.

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Alina Bradford is a contributing writer for Live Science. Over the past 16 years, Alina has covered everything from Ebola to androids while writing health, science and tech articles for major publications. She has multiple health, safety and lifesaving certifications from Oklahoma State University. Alina’s goal in life is to try as many experiences as possible. To date, she has been a volunteer firefighter, a dispatcher, substitute teacher, artist, janitor, children’s book author, pizza maker, event coordinator and much more.

Pharyngitis – what is it? Causes, symptoms, treatment

What is pharyngitis?

This is an inflammation of the mucous membrane of the pharynx and its lymphoid tissue. With pharyngitis, the throat is ticklish, sore and irritated. The pain is aggravated by swallowing. Usually pharyngitis develops with influenza and SARS. Viral pharyngitis usually goes away on its own. Some other less common forms of pharyngitis may require treatment.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-treatment! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan for a consultation!


  • sore throat;
  • pain worse when swallowing;
  • difficult to swallow;
  • swollen cervical lymph nodes;
  • white spots or streaks on tonsils, posterior pharynx;
  • hoarse or hoarse voice.

Accompanying symptoms of SARS or flu can be: cough, sneezing, runny nose, stuffy nose, fever, pain in the head and body, nausea or vomiting.

When to go to the doctor?

Take the child to the doctor if the child’s sore throat does not go away after breakfast.

Call an ambulance immediately if:

  • the child is having difficulty breathing;
  • he cannot swallow;
  • the infant is unusually drooling, which may indicate an inability to swallow saliva.

If an adult has pharyngitis, see a doctor if:

  • severe or prolonged (more than a week) sore throat;
  • sore throat often;
  • difficulty breathing, swallowing or opening the mouth;
  • earache;
  • joint pain;
  • rash;
  • fever above 38.3 for more than three days;
  • blood in saliva or sputum;
  • pain when turning head;
  • nodes and tumors on the neck;
  • hoarseness, hoarseness lasts more than two weeks.


As a rule, it is a viral infection (ARVI), in some cases it is bacterial (streptococcus, pneumococcus). In addition, the cause of pharyngitis can be:

  • Allergic to dust, mold, pet hair, plant pollen. Since allergies cause a runny nose, fluid can drain down the back of the nasopharynx and irritate the throat;
  • dryness of the air, especially in the morning;
  • tobacco smoke, chemical irritants;
  • overexertion of the vocal cords (long performances, loud screams at sports competitions, etc.)
  • gastroesophageal reflux – reflux of stomach contents back into the esophagus. May be accompanied by heartburn, lump in the throat, hoarseness.
  • HIV. Pharyngitis may be a sign of a recent HIV infection in the body. Also, people who have long been infected with HIV may experience secondary acute and chronic pharyngitis caused by cytomegalovirus, oral candidiasis, and common viruses that cause SARS. These complications in HIV-positive people can be dangerous.
  • malignant tumors of the throat, tongue, trachea can also be manifested by pharyngitis, coupled with hoarseness, breathing noise, blood in saliva and sputum, a “knot” on the neck.

Rare causes of pharyngitis can be a throat abscess and epiglottitis, a serious condition in which the epiglottis, which is like a petal between the trachea and larynx, becomes inflamed and blocks air from entering the airways. As a rule, epiglottitis in children is caused by a hemophilic infection, against which it is necessary to get vaccinated in time.

Risks and measures to prevent pharyngitis

Children and adolescents get sick more often with pharyngitis, adults also get sick, but somewhat less frequently. Also, the risks of pharyngitis increase with dry air, irritation of the throat with tobacco smoke or chemicals, with allergies, weakened immunity, chronic or frequent infections of the nasopharynx.

You can reduce the likelihood of illness in the same way as with other nasopharyngeal infections: wash your hands, do not drink from the same cup with others, cover your mouth when coughing and sneezing (do not “share” your viruses), wipe the screen and keypads of phones, and other devices, etc.

Diagnosis of pharyngitis

Usually, the ENT examines the patient’s throat, as well as his nose and ears, carefully palpates the lymph nodes, listens to breathing with a stethoscope.

The streptococcal test is a simple and reliable way to diagnose bacterial pharyngitis. The doctor takes a scraping from the child’s throat, and within 24-48 hours the result is ready. Streptococcal pharyngitis will have to be treated with antibiotics.

We have our own laboratory in the clinic, so you can always take all the necessary tests with us!


Viral pharyngitis usually resolves within 5-7 days. The child should be provided with:

  • peace and the opportunity to sleep as long as he wants;
  • drink plenty of water to relieve sore throat and prevent dehydration;
  • humidification;
  • sore throat can be relieved by both warm drinks and cold ice cream, especially popsicles;
  • for sore throats, gargle with a solution of table salt – a teaspoon in 250 ml of warm water;
  • children over 4 years of age can be offered lozenges for sore throats. Do not give lozenges to small children – they may choke;
  • do not smoke around a sick child, avoid strong irritating odors in the throat;
  • Paracetamol and ibuprofen medications can help relieve sore throat and high fever. Do not give children aspirin, which in rare cases causes the deadly Reye’s syndrome in them.

Confirmed bacterial pharyngitis is treated with antibiotics. You should not interrupt or stop the course, because this increases the likelihood of infection spreading to the joints, heart, kidneys and other organs. Continue antibiotics even if symptoms are completely gone.

You can sign up for a consultation by phone: + 7 812 327 03 01.

Hypertrophic pharyngitis symptoms and treatment in Moscow Make an appointment. Treatment at home and in the clinic – Clinic SINAI near the metro station Dobryninskaya, Serpukhovskaya in Moscow

Hypertrophic pharyngitis is one of the varieties of the chronic form of the disease. It begins to appear usually 6-8 months after an acute inflammation has been diagnosed that has not been properly treated. Affected by the hypertrophic form of pathology, not only the back wall of the pharynx, but also its lateral parts.

In pathology, the mucous membrane of the pharynx not only becomes thicker, but also increases its density. These changes are pathological, and as a result of them, it begins to function incorrectly and becomes inflamed. Also, with this disease, the appearance of lymphoid granules, which look like pink grains, is noted. The disease can appear in people of any age, but more often affects adults, since they often do not properly treat the acute form of the disease and carry it on their feet. Gradually, a violation of the condition of the pharyngeal mucosa can also pass to the tongue. Hypertrophic pharyngitis has symptoms that increase with the progression of mucosal damage.


The disease develops against the background of the fact that negative factors cause excessive activity of the immune system, due to which it begins to provoke the development of a number of neoplasms on the mucous membrane associated with the detection of even minor pathogens. As a result, inflammation develops and tissue changes occur. The main factors causing hypertrophic pharyngitis, in addition to its advanced acute form, are as follows:

  • living in areas with unfavorable environmental conditions;

  • work in hazardous production in violation of safety rules;

  • prolonged regular exposure to a room where the air is very dry and warm;

  • smoking – a negative effect on the mucous membrane and on the body as a whole has not only active, but also passive smoking;

  • alcohol abuse – not even strong, they irritate and damage the tissues of the pharynx, making them more susceptible to pharyngitis;

  • diseases of the cardiovascular system, in which blood circulation in the tissues of the pharyngeal mucosa is disturbed, as well as those that lead to congestion in the respiratory system;

  • serious metabolic disorders, especially against the background of pathologies of the endocrine system;

  • regular occurrence of allergies;

  • violations in the structure of the pharynx;

  • persistent severe vitamin deficiency.

Chronic pathologies of the nasopharynx, such as tonsillitis, sinusitis and rhinitis, can also cause the onset of the disease. Pathogenic bacteria will abundantly penetrate the mucosa and stay in it in a dormant state until the appearance of factors unfavorable for immunity. When they develop an exacerbation of the disease.


This form of the disease can have two types. Depending on which of them is diagnosed, the exact method of treatment is also determined. Granular hypertrophic pharyngitis affects only the posterior pharyngeal wall. With it, swelling of the tissues at the onset of the disease is not so felt, which is why not all patients seek medical help in a timely manner.

Lateral hypertrophic pharyngitis is manifested by more acute pain and difficulty in breathing. It is extremely difficult to ignore it for a long time, which is why treatment most often begins on time. The diagnosis is made after examining the patient’s pharynx.


With timely, complete and systematic treatment of the disease, the prognosis for the patient is favorable. At the same time, it is possible to stop pathological changes in the tissues of the mucosa. After high-quality therapy, exacerbations of the disease are extremely rare.

If treatment is started late, when the sore throat is already quite serious, then the prognosis for the patient is relatively positive, since it will not be possible to provide a long remission, but at the same time the risk of complications will be eliminated.

What not to do

There are certain restrictions during the treatment period, violating which, the patient runs the risk of significantly aggravating his condition. The doctor will not be able to guarantee the patient a positive result of therapy if the following actions are allowed:

  • smoking during treatment;

  • use of alcoholic gargles;

  • eating spicy food;

  • stay in a dusty room;

  • violation of medical prescriptions regarding treatment.

If there are no violations in the course of therapy, then it is possible to stop the disease at the beginning of its development without the use of surgical methods of therapy. Treatment of hypertrophic pharyngitis in adults and children is the same.


Only an external examination of the pharynx is not enough to identify not only the disease itself, but also the causes of its occurrence, as well as the state of the body. Because of this, the doctor, having identified pharyngitis by eye during the initial examination, necessarily prescribes further tests to the patient, which help to get a complete picture of the state of health and choose the most effective treatment.

1. Throat swab followed by culture on a nutrient medium. It is necessary to determine the composition of pathogenic microflora and its sensitivity to certain antibiotics.

2. Biochemical blood test. It requires venous blood. The study reveals the presence of antibodies to certain pathogens of inflammation, hormonal indicators and the presence or absence of malignant cells.

3. Clinical blood test. Finger blood is used. Shows the percentage of the ratio of its main components. The deviation of one or another up or down makes it possible to detect a number of pathologies.

4. Urinalysis. The study of the material allows you to accurately assess the severity of inflammation in the body, as well as whether there are any disturbances in the functioning of the kidneys against its background.

5. Biopsy of tissues of the pharyngeal mucosa. Not always assigned. The procedure is necessary if there is a suspicion of the development of a cancerous process. When examining a taken tissue sample, the presence or absence of malignant (cancerous) cells in the mucosa is determined.

If necessary, an electrocardiogram and x-ray of the sinus area may also be ordered. These procedures are rarely required. They are usually carried out if complications of the disease begin to develop. In young children, an x-ray of the lungs may also be needed, since quite often they develop pneumonia or bronchopneumonia against the background of inflammation of the larynx in a fairly short period of time.