Pharyngitis (Sore Throat)
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Inflammation of the throat
Cause
- Most cases are viral
- Bacterial: commonly Group A haemolytic Streptococci, diphtheria in non-immunized children
- Gonorrhoea (usually from oral sex)
- May also follow ingestion of undiluted spirits
- Candida albicans in the immunosuppressed
Clinical features
- Abrupt onset
- Throat pain
- Pain on swallowing
- Mild fever, loss of appetite, general malaise
- In children: nausea, vomiting, and diarrhoea
- The presence of runny nose, hoarseness, cough, conjunctivitis, viral rash, diarrhea suggests viral infection
- The presence of tonsilar exudates, tender neck glands, high fever, and absence of cough suggest a bacterial pharyngotonsillitis (see next section)
Differential diagnosis
- Tonsillitis, epiglottitis, laryngitis
- Otitis media if there is referred pain
Investigations
- Throat examination with torch and tongue depressor
- Throat swab for microscopy, C&S
- Blood: Full blood count
- Serological test for haemolytic streptococci (ASOT)
ManagementTreatment
Supportive care
Most cases are viral and do not require antibiotics
- Keep the patient warm
- Give plenty of (warm) oral fluids e.g., tea
- Give analgesics, e.g. Paracetamol for 3 days
- Review the patient for progress
For Streptococcal pharyngitis: see next section
Notes:
- If not properly treated, streptococcal pharyngitis may lead to acute rheumatic fever and retropharyngeal or peritonsillar abscess
- Therefore ensure that the full 10-day courses of antibiotics are completed where applicable