Categories
ORGAN SYSTEMS Otolaryngeal system (ENT)

Sore throat

Cover image: Viral pharyngitis, the most common cause of a sore throat. | CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=960953

Acute Tonsillopharyngitis or sore throat is thoat pain due to acute inflammation of pharynx (pharyngitis) and tonsils (tonsillitis).


Aetiology

Viral infections (M/C cause):

  • Adenovirus
  • Influenza
  • Parainfluenza virus
  • Enterovirus
  • Epstein-Barr virus

Bacrerial infection:

  • S. pyogenes esp. group A beta-hemolytic Streptococci
  • Mycoplasma pneumoniae
  • Candida albicans
  • As disease prodrome:
    • Measles
    • Rubella

Clinical features

  • Sore throat
  • Tonsils
    • Swollen and covered with exudates
  • Fever
  • Malaise
  • Headache
  • Nausea

Viral infection:

  • Cough and rhinitis more common
  • Gradual onset and less toxemia

Streptococcal infection:

  • Enlarged cervical lymph nodes
  • Acute illness with high fever
  • Absence of nasal discharge or conjunctivitis

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Complications

  • Acute glomerulonephritis
  • Rheumatic fever
  • Otitis media
  • Sinusitis
  • Peritonsillar and retropharyngeal abscesses
  • Spread down the tracheobronchial tree:
    • Tracheobronchitis
    • Pneumonia

Diagnosis

Investigations

  • Group A beta-hemolytic Streptococcus:
    • Throat swab culture
    • Rapid antigen detection test (RADT)
  • Enzyme immunoassays

Differential diagnosis

  • Herpangina
    • Acute febrile illness due to group A Coxsackie virus
    • Dysphagia, sore throat and papulovesicular lesions surrounded by erythema over the tongue, pharynx, anterior tonsillar pillars and soft palate.
    • Pharynx appears congested.
  • Diphtheria
    • Moderate fever, severe toxaemia, sore throat and membrane formation over the fauces or palate.
  • Pharyngoconjunctival fever
    • Fever, conjunctivitis, pharyngitis and cervical lymphadenitis due to infection with adenovirus type 3
  • Infectious mononucleosis
    • Lymphadenopathy, morbilliform rash, hepatosplenomegaly and sometimes, aseptic meningitis

Management

Supportive management:

  • Warm saline gargles (older children)
  • Sip warm tea/liquids (younger children)
  • Soft food
  • Symptomatic relief:
    • Oral antihistaminics
      • Chlorpheniramine or promethazine
  •  Fever:
    • Paracetamol

Antibiotic therapy:

  • Penicillin V (250 mg q 8-12 hr)
  • Amoxycillin (30-40 mg/kg/day)
  • Erythromycin (40-50 mg/kg/day)
  • Cephalexin (50 mg/kg/day for 10 days)
  • Azithromycin (10-12 mg/kg/ day for 5 days)
  • Noncompliance:
    • Benzathine penicillin (single IM dose)

Recurrent Sore Throat

  • Beta-lactamase producing bacteria:
    • Amoxycillin + clavulanic acid
    • Clindamycin
  • Group A beta-hemolytic streptococcal infection:
    • Penicillin prophylaxis (3-6 months)
  • > 5-6 episodes of tonsillitis in a year or tonsillar or peritonsillar abscess:
    • Tonsillectomy
      • Does not prevent recurrence of pharyngeal infection
      • Other indications:
        • Diphtheria carriers
        • Presence of retention cysts in tonsils
        • Tonsils are a focus of infection for suppurative otitis media

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