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  • Sore Throat

Sore Throat

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Etiology of Sore Throat
  • Infectious
    Viral: Adenovirus, epstein barr virus, coxsackie a, herpes simplex.
    Bacterial: Group a strep, other streptococci, mycoplasma, arcanobacterium.
    Fungal: Candida.
  • Peritonsillar abscess.
  • Retropharyngeal abscess.
  • Sinusitis.
  • Neoplasm.
  • Gastric reflux.
  • Foreign body.
  • Mouth–breathing.
  • Chronic cough.
Infectious sore throat: Management issues
When to treat with antibiotics? When to do a throat swab?
ICES sore, throat score (an Ontario study). A score which relates to the likelihood of the sore throat being pharyngitis (in adults).

Characteristics the patient have
  • Tonsillar exudate.
  • Enlarged anterior cervical nodes.
  • Fever > 38°.
  • Lack of a cough.
No antibiotics until culture results available.

Patient instructions in general
  • Supportive measure: Rest, fluids, analgesics, tantum, oral rinse.
  • Return for reassessment in 48 hrs if not better.
Antibiotic choices
  • Penicillin.
  • Erythromycin, if allergic.
Mononucleosis
Etiology
  • Epstein barr virus.
Clinical Course
  • Incubation period: Four to eight weeks.
  • Prodrome: Malaise, anorexia, fever.
  • Few days later: Pharyngitis and lymphadenopathy.
  • Signs of Mononucleosis
    1. Fever up to 40° in 90%.
    2. Cervical lymphadenopathy in 90%.
    3. Pharyngitis in most, exudative commonly.
    4. Maculopapular eruption with ampicillin in 90% of those to whom it’s given.
    5. Splenomegaly in 50%.
    6. Others: Hepatomegaly, palatal petechiae, rash, periorbital edema (not common).
  • Course: Pharyngitis lasts 7–10 days, Lymphadenopathy 7–14 days, Malaise four weeks or more.
Lab manifestations
  • Elevated hepatic transaminases.
  • Heterophile antibodies (Paul Bunnell or Monospot tests).
  • Atypical lymphocytosis.
Complications with Mononucleosis
  • Hematologic: Autoimmune hemolytic anemia, thrombocytopenia.
  • Hepatitis.
  • Splenic rupture (no contact sports for eight weeks after onset of illness).
  • Neurological: Cranial nerve palsies, encephalitis.
  • Airway obstruction.
Treatment of Mononucleosis
  • Supportive (rest and acetaminophen).
  • Steroids for: Airway obstruction, autoimmune hemolytic anemia/thrombocytopenia.

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E.N.T.

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