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3.12 Pharyngitis (Sore Throat)


Presentation

The patient with a bacterial pharyngitis complains of a rapid onset of throat pain worsened by swallowing. There is usually a fever, pharyngeal erythema, and a purulent, patchy, yellow, gray or white exudate, tender cervical adenopathy, headache and absence of cough. Viral infections are typically accompanied by conjunctivitis, nasal congestion, hoarseness, cough, aphthous ulcers on the soft palate and myalgias. It is helpful to differentiate pain on swallowing (odynophagia) from difficulty swallowing (dysphagia), the latter being more likely caused by obstruction or abnormal muscular movement.

What to do:

What not to do:

Discussion

The general public knows to see a doctor for a sore throat, but the actual benefit of this visit is unclear. Rheumatic fever is a sequela of about 1% of group A streptococcal infections, and only about 10% of sore throats seen by physicians represent group A streptococcal infections. Post-streptococcal glomerulonephritis is usually a self- limiting illness and is not prevented with antibiotic treatment. Penicillin therapy does avoid acute rheumatic fever and may sometimes reduce symptoms or shorten the course of a sore throat. Antibiotics probably inhibit progress of the infection into tonsillitis, peritonsillar and retropharyngeal abscesses, adenitis, and pneumonia.

Group A streptococcal infection cannot be diagnosed reliably by clinical signs and symptoms. Typically, a quarter of throat cultures grown group A strep, and half of those represent carriers who do do not raise anti-streptococcal antibodies and risk rheumatic fever. Rapid strep screens are less sensitive than cultures. The best approach to the identification and treatment of streptococcal pharyngitis depends on the prevalence of group A streptococcal infection in the patient population, the cost and availability of culture and rapid test methods, the reliability of communication and follow up and the relative values of cost, antibiotic overuse, and adverse outcomes.

References


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD