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Sore Throat acute

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few signs of infection visible but the patient complains of soreness lower down ... A red punctate skin eruption with sandpaper-like texture ... – PowerPoint PPT presentation

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Title: Sore Throat acute


1
Sore Throat (acute)
  • Lawrence Pike

2
Definitions
  • Pharyngitis
  • predominantly inflammation of the oropharynx, but
    not the tonsils.
  • Tonsillitis
  • when the tonsils are particularly affected.
  • Laryngitis
  • few signs of infection visible but the patient
    complains of soreness lower down the throat often
    with a hoarse voice.

3
Causes
  • Viral (70-80)
  • Group A beta-haemolytic streptococcus (20-30)

4
Incidence
  • Sore throat is estimated to account for 10 of
    all general practice consultations
  • Asymptomatic carriage of streptococcus
  • is common with rates of 6 - 40
  • Carriers have low infectivity and are not at risk
    of developing complications such as rheumatic
    fever

5
Symptoms
  • Sore throat
  • Pain on swallowing
  • Fever
  • Headache
  • Malaise
  • Hoarseness if laryngeal involvement

6
Signs
  • Redness of the pharynx and tonsils
  • Presence of exudate
  • Enlarged tonsils
  • Swollen tender neck glands.
  • Note that a streptococcal sore throat is
    impossible to diagnose on clinical grounds alone.

7
Scarlet Fever
  • A red punctate skin eruption with sandpaper-like
    texture
  • Usually begins on chest and spreads to abdomen
    and extremities
  • Prominent in skin creases
  • Flushed face with circumoral pallor
  • Strawberry tongue
  • These indicate a streptococcal infection

8
Investigations?
  • Throat swabs cannot differentiate between
    "infection" and "carriage", are poorly sensitive,
    and are therefore of limited value. Results take
    up to 24 - 48 hours to be reported, and the test
    is relatively expensive.
  • Rapid antigen tests to detect streptococcal
    antigen on a throat swab are not easily
    available.
  • Anti-streptolysin O (ASO) titres can help to
    identify whether a patient has recently been
    infected with streptococcus, and may be useful
    for patients who remain unwell or develop
    complications.

9
Differential Diagnosis
  • Infectious mononucleosis (glandular fever)
  • Epiglottitis (requires urgent admission)
  • Gonococcal pharyngitis (rare)
  • Diphtheria (very rare in U.K)
  • Neutropaenia (e.g. ensure patient not on
    carbimazole)

10
Complications
  • Otitis media
  • Sinusitis
  • Peritonsillar abscess (quinsy)
  • Suppurative cervical adenopathy
  • Rheumatic fever
  • Post streptococcal glomerulonephritis

11
Management
  • Sore throat (pharyngitis, tonsillitis,
    laryngitis) is usually a self-limiting illness,
    whether due to viral or bacterial infection.
  • Explanation, reassurance and advice on
    symptomatic treatment is frequently all that is
    necessary when a patient consults with a sore
    throat, as only a third clearly want or expect an
    antibiotic.

12
Management
  • Prescription of an antibiotic increases patient
    reattendance rates for further episodes of sore
    throat.
  • The patient is also exposed to the risk of side
    effects
  • Increased risk of bacterial resistance in the
    community.
  • Antibiotic therapy of sore throat reduces
    duration of symptoms by about 8 hours, although
    it is not known if symptom severity is also
    affected. The absolute benefit is small, with 90
    of both treated and untreated patients symptom
    free within one week.

13
Management
  • Antibiotic therapy has a small protective effect
    on the risk of developing sinusitis, otitis media
    and possibly peritonsillar abscess (quinsy).
  • 30 children and 145 adults need treatment to
    prevent one case of acute otitis media.

14
Management
  • Benefit in reducing the incidence of rheumatic
    fever or post streptococcal glomerulonephritis is
    likely to be low.
  • The incidence of rheumatic fever and post
    streptococcal glomerulonephritis has fallen in
    industrialised countries and does not appear to
    be related to antibiotic use. Although early
    studies showed that antibiotic treatment
    decreased the risk of these complications more
    recent studies have not shown benefit.

15
Management
  • Suggested indications for antibiotics are
  • severely inflamed throat with marked systemic
    upset
  • confirmed streptococcal infection
  • scarlet fever
  • patients with impaired immunity (splenectomy)
  • past history of rheumatic fever or
    post-streptococcal glomerulonephritis.
  • Antibiotic treatment is also usually advised
    during outbreaks of streptococcal infection in
    communities such as schools, hostels or prison
    (public health).

16
Management
  • If an antibiotic is necessary
  • Penicillin is the treatment of choice, with
    erythromycin in patients with penicillin allergy.
    10 days treatment is recommended in order to
    eradicate possible streptococcus infection. DTB
    1995
  • Tonsillectomy is occasionally recommended for
    recurrent attacks of tonsillitis. Consider only
    if seven documented throat infections in the
    preceding year, or three in each of three
    successive years.
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