- November 23, 2017
- Posted by: marlenedubois
- Category: CPR Training
Pharyngitis will be the term doctors use to describe sore throat along with that will accounts for 10-15 percent of all pediatric office visits. Group A beta-hemolytic streptococcal pharyngitis (GABHS), more commonly known as strep throat, will be a primary concern of a person that has a sore throat. GABHS will be more common in children than adults. In both kids along with adults viruses are the most common cause of sore throat.
The most important concern inside the person that has a sore throat will be to rule out some serious conditions associated with sore throat, including, most commonly GABHS. Certain factors will help predict if the cause of the sore throat will be GABHS or a viral infection. The factors are not perfect along with the use of a throat culture will be needed in many cases in order to rule out strep throat.
Important factors to know about strep include:
• that will most commonly affects children between 5-15 years old.
• that will does not commonly affect children under three years old.
• that will has an incubation period of 2-5 days. This kind of means that will if you have been in contact with someone who will be infected along with are infected your disease may not show up for 2-5 days.
• Respiratory secretions spread the infection.
Causes of sore throat
Viruses cause the majority of sore throats. Bacteria cause 5-15% of sore throats, yet those between the ages of 5-15 have a higher incidence of bacterial causes of sore throat. In This kind of group, 15-30 percent of sore throats may be caused by GABHS.
Certain factors can help determine if the sore throat will be caused by a bacteria or a virus. Viruses that will cause sore throat are more commonly accompanied by cough, stuffy nose, red eyes along with fatigue.
• Viral sore throat – there are over 0 viruses that will cause the common cold along with each presentation may be a little different. Many of these viruses are linked to sore throat. Below some specific viruses that will cause sore throat will be discussed.
• Hand-foot along with mouth disease. This kind of will be caused by a virus that will will be called the Cocsackie virus. that will causes blisters on the hands along with feet as well as inside the mouth or throat.
• Infectious mononucleosis can also cause sore throat. This kind of sore throat will be typically severe along with associated with pus (white patches) inside the throat. This kind of disease will be associated with swollen lymph nodes – particularly the glands on the back of the neck. that will sometimes comes with stomach pain due to an enlarged liver or spleen. Those who are treated with penicillin will usually develop a rash (0% of the time). that will will be most common in those who are 10-25 years old along with will be accompanied by fatigue along that has a lingering sore throat.
• HIV will be a rare cause of sore throat. Individuals who have risk factors for HIV (multiple sexual partners, men who have sex with men, intravenous drug users) who present that has a sore throat should have This kind of diagnosis considered.
• Bacterial sore throat. The most common cause of bacterial sore throat will be GABHS. some other bacteria can sometimes cause sore throat.
• Fungal infections rarely cause sore throats. Candida infections are a common cause of fungal sore throat. The individual will have a sore throat that has a white coat on the tongue along with inside the oral cavity that will looks like cottage cheese. The white coating will bleed if that will will be scraped off.
• Diphtheria will be a rare cause of sore throat. that will presents that has a sore throat, fever, tender lymph nodes inside the front on the neck along with serosanguineous nasal discharge. that will can be prevented by routine vaccinations.
• Kawasaki disease rarely occurs yet affects children under 5 along with presents with sore throat, tender lymph nodes, fever, eye discharge, red oral mucosa, strawberry tongue, cracked red lips, swelling of the hands along with feet along with red rash on the hands along with feet, followed by peeling of the palms.
• Peritonsillar abscess will be a serious cause of sore throat along with presents with fever, feeling wiped out, a hot potato voice, difficulty swallowing, painful swallowing, ear pain along with difficulty opening the mouth.
• Miscellaneous causes of sore throat include: persistent cough, smoking, gastroesophageal reflux, postnasal drip secondary to runny nose, allergies, foreign body along with thyroiditis (inflamed thyroid gland).
Most sore throats are caused by a virus along with go away on their own. that will will be important that will all health care consumers are aware of when sore throats can be serious along with when they are likely self-limiting.
Death will be a risk of life, yet that will will be rarely related to sore throat. Throat abscess (pus filled infection inside the throat) may lead to breathing problems as the swelling inside the throat reduces the ability to breath. Diphtheria can lead to respiratory failure. Untreated GABHS can affect the heart valves along with has the potential to lead to heart failure.
These serious complications are rare. Rheumatic fever will be one of the most common preventable complication of sore throat. that will occurs after GABHS goes untreated. The general population will be not as greatly affected, as people commonly believe. In fact that will takes treating 3000 to 4000 people with antibiotics with strep throat to prevent one case of rheumatic fever. The incidence of rheumatic fever will be about one case per one million people. Treatment with antibiotics do not guarantee prevention of rheumatic fever.
Rheumatic fever occurs about 3 weeks after an untreated GABHS infection. that will will be characterized by joint pain along with swelling, erythema marginatum (pink rings on the trunk, arms along with legs), heart murmur or subcutaneous nodules (painless, firm nodes over the bones or tendons often seen on the wrist, elbow or knees). If This kind of will be suspected an immediate evaluation that has a health care provider will be essential.
Peritonsillar abscess (pus behind the tonsils) can cause sore throat or can be a complication of GABHS. that will will be not common yet will be characterized by worsening sore throat, ear pain, inability to open the mouth, fever, along that has a hot potato voice.
A rash that will feels rough, like sandpaper, will be red along with fades when you push in on that will will be likely scarlet fever. This kind of rash will last about a week along with will result in peeling of the skin. This kind of will be a common manifestation of streptococcal infection
Streptococcal infections develop the potential to attack the kidneys. that will may present 10-14 days after a strep throat. that will will be characterized by bloody urine along with swelling (especially around the eyes). that will will be unclear if treating with antibiotics reduces the risk of kidney problems after strep throat.
• High fever
• Unable to handle secretions – drooling
• Difficult time opening the mouth
• Hot potato voice (muffled voice, sounds like you have a mouthful of hot potatoes)
• Uvula (piece of tissue that will hangs down inside the back of the throat) deviating to one side
• One swollen tonsil
• Difficultly breathing
Diagnosing strep throat
Key features of the history along with the physical exam will help the health care provider determine the likelihood of streptococcal infection. There are a few key features that will are most predictive of strep throat.
Recent exposure to streptococcus along with white patches inside the throat or on the tonsils are the two most important factors in predicting strep throat. Tonsils that will are free through swelling or pus along with non-tender lymph nodes inside the neck are the best criteria for ruling out strep throati.
Clinical prediction rules have been developed for helping the health care provider determine who has strep along with who does not. None of these rules are perfect, along with that will usually requires the work of a throat culture to definitively determine who has strep throat. None-the less, these key features can be useful in helping patients determining their risk for strep throat.
The prediction rule has been based off of 5 key criteria.
1. Fever above 100.4 degrees Fahrenheit
2. Swelling of the tonsils or pus on the tonsils
3. Sore throat inside the absence of cough
4. Tender lymph nodes inside the front of the neck
5. Age – One point will be given if the age will be between 3 along with 14, along with one point will be taken away if over the age of 45.
Based on the number of criteria that will are present one can take a guess as to how likely GABHS will be. The person will be given a score of -1 to 5 along with utilizing that will point total one can predict the likelihood of strep throat.
For example, if we look at the case study presented in chapter 2: A 20 year-old female comes to her doctor with tonsillitis. “My nose has been stuffy for the last couple of days along with I have been coughing. I woke up This kind of morning along with my throat hurt truly badly. I looked in my throat along with my tonsils were swollen along with there were white dots on them.
that will will be also determined that will she did not have a fever. When the doctor felt the front of her neck, he determined that will her lymph nodes were swollen along with tender.
This kind of patient receives one point for swollen tonsils with pus along with one point for swollen lymph nodes. She includes a point total of 2. Therefore, her risk of strep will be about 17%.
Table 1: Percent change of having GABHS based on number of clinical criteria
-1 or 0 – 1%
1 – 10%
2 – 17%
3 – 35%
4 or 5 – 51%
As you can see through the chart, that will will be impossible to rule in or rule out strep throat just by doing an interview along with physical examination. The CDC recommends that will antibiotics not be given unless GABHS will be found on strep culture. When there will be a score of 4 or 5 many health care providers will treat instead of doing a culture along with some clinicians even choose to treat if there will be a score of 3 or more.
One fact that will will be not well know will be that will strep throat will go away on its own. Well, that will will be not entirely true. The symptom of sore throat will remit, yet the bacteria may still persist. that will has the potential to go to the heart along with cause rheumatic fever, that will will be therefore important to treat strep throat even though the sore throat will go away.
When sore throat persists beyond 5 days strep throat will be not likely. that will will be more likely mononucleosis, a sinus infection, allergies or post-nasal drip.
Who will be a candidate for diagnostic testing?
1. All children that has a sore throat
2. Selected adults that has a sore throat. This kind of includes adults with at least one feature suggestive of strep throat (swollen tonsils, pus on the tonsils, fever above 100.4 degrees Fahrenheit, swollen lymph nodes, sore throat inside the absence of a cough)
What type of testing should be done?
1. A rapid strep test will be indicated for most patients that has a sore throat that has a back up throat culture
If the rapid test reads positive, that will will be quite reliable. If that will reads negative that will may not be that will reliable. Because of the tests ability to miss the diagnosis, that will will be recommended that will the health care provider get a back up culture that will will be sent to the lab to confirm every negative rapid strep test. Some experts suggest you do not need a back up culture inside the adult, yet my experience suggests that will you should do a back up culture inside the adult.
The rapid test should not be used in those who had a positive strep test inside the last 30 days as there still may be strep antigen fragments hanging around that will could give a false positive test.
some other testing for sore throat
When sore throat persists another diagnosis to consider will be mononucleosis. This kind of will be most common in those 10-25 years-old. that will can be testing by checking the blood for antibodies to the Epstein-bar virus. During the first week of the illness, the test may not pick up the disease yet by the second week the test picks up the disease over 80% of the time.
Testing for HIV along with some other sexually transmitted diseases may be warranted inside the high-risk individuals. Individuals who have oral sex may need the throat tested for gonorrhea.
Some cases of sore throat warrant a broad culture that will looks for some other causes of sore throat such as some other bacteria.
Most cases of sore throat are either caused by a virus or GABHS. If strep throat will be present treatment with antibiotics will be important along with if that will will be not present treatment of the symptoms will be all that will will be necessary. Treatment of strep throat will reduce rheumatic fever, abscess formation, transmission along with improve comfort. that will will be always important to stay alert for some other complications of sore throat – even though they are rare.
There will be a nine-day window that will the clinician has to treat strep throat to prevent rheumatic fever after GABHS. Treatment will also speed healing. After starting treatment you should be feeling much better in 24-48 hours. Ideally treatment should be commenced within 48-72 hours.
Some clinicians choose to treat patients while they wait for the return of the culture. Realizing that will resolution will be faster along with that will will provide comfort to some patients.
This kind of will be not a wise strategy to implement for all patients. This kind of requires some professional judgment of the treating health care provider. Those who are suspected of having strep are better candidates just for This kind of method of treatment. The goal will be to avoid excessive exposure to antibiotics. When antibiotics are prescribed without a confirmed diagnosis the patient should be encouraged to stop antibiotics immediately if the culture comes back negative.
There will be no resistance to penicillin inside the United States, so that will will be the drug of choiceii. Ten days of pills or a shot will be equally effective in its management. People who will not take all of their medication should receive a shot.
Amoxicillin, which will be a type of penicillin, will be often used in place of penicillin in children, as the suspension of penicillin does not taste not bad. Amoxicillin suspension includes a pleasant tasting bubble gum flavor.
Individuals who do not have angioedema (swelling deep inside the skin near the eyes along with lips) or hives as their allergic reaction to penicillin can be treated with first or second-generation cephalosporins. If they are, they need to be watched closely as allergic reactions with penicillin sometime cross over to an allergic reaction to cephalosporins.
Erythromycin will be recommended in patients that has a severe penicillin allergy. Due to side effects – mainly gastrointestinal – azithromycin or clarithromycin will be sometimes substituted.
Recurrent GABHS can be treated with amoxicillin-clavulanate (Augmentin). that will will be not usually picked as a first line medication as that will will be a more expensive along with includes a wider spectrum of activity. A wider spectrum of activity means that will that will will be able to cover many some other types of infections. The routine utilization of broad-spectrum antibiotics for simple infections has the potential to enhance the risk of antibiotic resistance.
Penicillin should be used for 10 days inside the treatment of GABHS to assure that will all the bacteria are killed along with no straggling bacteria remain.
The use of probiotics are one strategy that will will significantly reduce the risk of Clostridium difficile along with some other complications of antibiotic use. When you are on antibiotic that will will be critical to take probiotics to reduce the risk of This kind of complications. Always keep a supply of probiotics on hand because you never know when you will need to go on antibiotics.
Treating the symptoms
Sore throat pain can be quite debilitating along with managing that will pain will be a critical part of treatment. Symptomatic treatment often involves a combination of systemic medications along with local acting medications.
Systemic medications include medications that will are taken by mouth that will can help relieve the pain of the sore throat along with may also help some other symptoms that will accompany sore throats such as headache, fever along with body aches. Systemic medications include: ibuprofen, acetaminophen, naproxen or acetaminophen/codeine (in severe cases). The use of medications to reduce pain along with fever, in addition to reducing symptoms, may help shorten the course of disease by one to two days.
Topical medications are available in many over the counter formulations along with some can be made at home. A common home remedy will be salt-water gargles, which can be made by adding one-fourth of a teaspoon of salt to 6-8 ounces of warm water. This kind of concoction can be gargled along with spit out every 3-4 hours. Sugar-free or regular Popsicles can help ease the discomfort of a sore throat.
Multiple over the counter medications are available for treating sore throat. They come in sprays along with lozenges.
Certain foods can help the throat feel better. For example, warm or cool liquids soothe along with moisturize the throat. Nasal saline can moisturize the nasal passages along with clean mucus out of the nose. This kind of will reduce the amount of post-nasal drip, which will help reduce throat discomfort. Herbal teas may be helpful inside the treatment of sore throat. Throat coat – a herbal tea – includes a demulcent that will will be more effective at providing relief than regular tea.
Certain prescription medications develop the potential to aid a sore throat. Viscous lidocaine will be a medications that will comes as a thick liquid that will the health care provider can prescribe that will will numb the throat. that will can also be mixed with some other liquids such as liquid Benadryl along with/or Maalox to ease the discomfort.
Steroids are used in some patients with sore throats. This kind of will be a prescription given by the doctor along with can be given by mouth or as a shot. Steroids reduce the inflammation of a severely inflamed throat.
Home remedies for a sore throat:
• Salt water gargles as outlined above.
• A cool mist humidifier should be used. Many sore throats are caused by or exacerbated by dryness; the moisture that will a cool mist humidifier provides can improve symptoms.
• Suck on a sour drop. Lemon drops or another type of drop will stimulate saliva along with reduce throat pain
• Drink tea with honey as This kind of will coat the throat.
Improvement inside the sore throat caused by a bacteria or virus will be typically noted in 2-3 days. When there will be no improvement or a worsening of symptoms noted a follow up with your health care provider should be attained to rule out a more serious (cellulitis or abscess) or another underlying condition (mononucleosis or chronic post-nasal drip).
Rarely, some other bacteria can cause sore throat. This kind of will be much more common inside the adult than the child. This kind of may be considered when there will be a non-response to antibiotics or a negative GABHS culture along with the patient will be getting worse. The health care provider will often take a more broad culture to look for some other bacteria that will may be causing the sore throat.
At times further testing will be indicated. This kind of will be not common, yet may occur inside the sore throat that will will be not explained by some other causes. that will will be most often carried out by an ear, nose along with throat specialist. A laryngoscope will be used to look for cancer, a foreign body, acid reflux or another cause of sore throat.
When disease returns within one week of completing antibiotic therapy that will will be considered treatment failure. The main causes of This kind of are:
• Not taking the medication as directed
• Resistance to the antibiotic
• Repeat infections
For those who are thought to have a resistant strain, a different antibiotic may be considered such as a cephalosporin, macrolide or amoxicillin-clavulanate.
In cases where there will be repeat infection, family members should be checked to see if they are carriers of strep. If they have a positive strep culture, they should be treated.
What will be a carrier?
A surprising number of people – 10 to 25 percent – are colonized with GABHSviii. When one will be colonized, that will means that will the strep will be living inside the throat with out causing the person to be sick. Generally, those who are colonized do not need to be treated, yet sometimes they do. Treatment should ensue when there will be:
• A personal or family history of rheumatic fever
• Recurrent transmission between close contacts
• Significant anxiety about GABHS
• Consideration of removal of the tonsils to eradicate the carrier state
Tonsillectomy along with Adenoidectomy
Tonsils along with adenoids are often removed, yet the surgery may be done too often. The tonsils are there for a reason. The tonsils, while they often get infected, help fight infections inside the throat along with nose along with keep the infection through spreading.
There are risks with This kind of procedure. Bleeding will be the most common complications along with can occur up to eight days after surgery. Sore throat after the procedure will be common. The voice sometimes modifications after the procedure. The most worrisome complication will be death, yet This kind of only occurs in one of every 250,000 operations.
The tonsils along with/or adenoids can be removed for multiple reasons including:
• Recurrent GABHS: For 2-year olds, more than 4 episodes a year; for three year-olds more than 3 episodes per year; along with those over 3-years-old, greater than 6 episodes a year will be an indication for the tonsils along with adenoids to be removed.
• Obstructive sleep apnea
• A severe infection that will does not respond to antibiotics
• Recurrent peritonsillar abscess
• Potential cancer
• Persistent mouth breathers may be a candidate for removal of the adenoids
• Persistent swallowing problems if they are caused by large tonsils or adenoids
What you need to know
If you are diagnosed with strep throat:
• Do not infect others. Do not come in close contact with others for 24 hours after starting antibiotics.
• Removable oral appliances (e.g. retainers) should be cleaned completely.
• A fresh toothbrush should be used after 24 hours.
• Complete the entire course of antibiotics or resistance to that will antibiotic may occur.
• Symptoms that will do not improve by 72 hours or get worse after 48 hours require a medical evaluation.
• Do not take any antibiotics that will are lying around the house for a sore throat without visiting the health care provider. Antibiotics will invalidate a throat culture.
Questions to Ask Your Health Care Provider
1. will be my sore throat related to a virus or a bacterium?
2. Do I need a culture to determine if there will be a bacterial infection?
3. Which medications do you recommend to manage my symptoms?
4. Do you recommend any home remedies?
5. Will an antibiotic help my infection?
6. Are there any potential interactions between the medications that will you are recommending along with the current medications that will I am on or any some other health problems I may have?
7. When should I expect an improvement in my condition?
8. What complications should I look out for along with how will they show up?