- 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.
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.
Patient instructions in general
- Supportive measure: Rest, fluids, analgesics, tantum, oral rinse.
- Return for reassessment in 48 hrs if not better.
- Penicillin.
- Erythromycin, if allergic.
Etiology
- Epstein barr virus.
- Incubation period: Four to eight weeks.
- Prodrome: Malaise, anorexia, fever.
- Few days later: Pharyngitis and lymphadenopathy.
- Signs of Mononucleosis
- Fever up to 40° in 90%.
- Cervical lymphadenopathy in 90%.
- Pharyngitis in most, exudative commonly.
- Maculopapular eruption with ampicillin in 90% of those to whom it’s given.
- Splenomegaly in 50%.
- Others: Hepatomegaly, palatal petechiae, rash, periorbital edema (not common).
- Course: Pharyngitis lasts 7–10 days, Lymphadenopathy 7–14 days, Malaise four weeks or more.
- Elevated hepatic transaminases.
- Heterophile antibodies (Paul Bunnell or Monospot tests).
- Atypical lymphocytosis.
- 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.
- Supportive (rest and acetaminophen).
- Steroids for: Airway obstruction, autoimmune hemolytic anemia/thrombocytopenia.
