- November 19, 2017
- Posted by: marlenedubois
- Category: CPR Training
Pharyngitis will be the term doctors use to describe sore throat along with also the idea 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 using a sore throat. GABHS will be more common in children than adults. In both kids along with also adults viruses are the most common cause of sore throat.
The most important concern inside the person using 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 also 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:
• the idea most commonly affects children between 5-15 years old.
• the idea does not commonly affect children under three years old.
• the idea has an incubation period of 2-5 days. in which means in which if you have been in contact with someone who will be infected along with also 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, although those between the ages of 5-15 have a higher incidence of bacterial causes of sore throat. In in which 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 in which cause sore throat are more commonly accompanied by cough, stuffy nose, red eyes along with also fatigue.
• Viral sore throat – there are over 0 viruses in which cause the common cold along with also each presentation may be a little different. Many of these viruses are linked to sore throat. Below some specific viruses in which cause sore throat will be discussed.
• Hand-foot along with also mouth disease. in which will be caused by a virus in which will be called the Cocsackie virus. the idea causes blisters on the hands along with also feet as well as inside the mouth or throat.
• Infectious mononucleosis can also cause sore throat. in which sore throat will be typically severe along with also associated with pus (white patches) inside the throat. in which disease will be associated with swollen lymph nodes – particularly the glands on the back of the neck. the idea 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). the idea will be most common in those who are 10-25 years old along with also will be accompanied by fatigue along with also 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 using a sore throat should have in which diagnosis considered.
• Bacterial sore throat. The most common cause of bacterial sore throat will be GABHS. various 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 using a white coat on the tongue along with also inside the oral cavity in which looks like cottage cheese. The white coating will bleed if the idea will be scraped off.
• Diphtheria will be a rare cause of sore throat. the idea presents using a sore throat, fever, tender lymph nodes inside the front on the neck along with also serosanguineous nasal discharge. the idea can be prevented by routine vaccinations.
• Kawasaki disease rarely occurs although affects children under all 5 along with also presents with sore throat, tender lymph nodes, fever, eye discharge, red oral mucosa, strawberry tongue, cracked red lips, swelling of the hands along with also feet along with also red rash on the hands along with also feet, followed by peeling of the palms.
• Peritonsillar abscess will be a serious cause of sore throat along with also presents with fever, feeling wiped out, a hot potato voice, difficulty swallowing, painful swallowing, ear pain along with also 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 also thyroiditis (inflamed thyroid gland).
Most sore throats are caused by a virus along with also go away on their own. the idea will be important in which all health care consumers are aware of when sore throats can be serious along with also when they are likely self-limiting.
Death will be a risk of life, although the idea 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 also 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. the idea occurs after GABHS goes untreated. The general population will be not as greatly affected, as people commonly believe. In fact the idea 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. the idea will be characterized by joint pain along with also swelling, erythema marginatum (pink rings on the trunk, arms along with also legs), heart murmur or subcutaneous nodules (painless, firm nodes over the bones or tendons often seen on the wrist, elbow or knees). If in which will be suspected an immediate evaluation using a health care provider will be essential.
Peritonsillar abscess (pus behind the tonsils) can cause sore throat or can be a complication of GABHS. the idea will be not common although will be characterized by worsening sore throat, ear pain, inability to open the mouth, fever, along with also a hot potato voice.
A rash in which feels rough, like sandpaper, will be red along with also fades when you push in on the idea will be likely scarlet fever. in which rash will last about a week along with also will result in peeling of the skin. in which will be a common manifestation of streptococcal infection
Streptococcal infections hold the potential to attack the kidneys. the idea may present 10-14 days after a strep throat. the idea will be characterized by bloody urine along with also swelling (especially around the eyes). the idea 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 in which 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 also the physical exam will help the health care provider determine the likelihood of streptococcal infection. There are a few key features in which are most predictive of strep throat.
Recent exposure to streptococcus along with also white patches inside the throat or on the tonsils are the two most important factors in predicting strep throat. Tonsils in which are free through swelling or pus along with also 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 also who does not. None of these rules are perfect, along with also the idea 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 all 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 also 14, along with also one point will be taken away if over the age of 45.
Based on the number of criteria in which 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 also utilizing in which 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 also I have been coughing. I woke up in which morning along with also my throat hurt actually badly. I looked in my throat along with also my tonsils were swollen along with also there were white dots on them.
the idea will be also determined in which she did not have a fever. When the doctor felt the front of her neck, he determined in which her lymph nodes were swollen along with also tender.
in which patient receives one point for swollen tonsils with pus along with also one point for swollen lymph nodes. She features 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, the idea will be impossible to rule in or rule out strep throat just by doing an interview along with also physical examination. The CDC recommends in which 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 also some clinicians even choose to treat if there will be a score of 3 or more.
One fact in which will be not well know will be in which strep throat will go away on its own. Well, in which will be not entirely true. The symptom of sore throat will remit, although the bacteria may still persist. the idea has the potential to go to the heart along with also cause rheumatic fever, the idea will be therefore important to treat strep throat even though the sore throat will go away.
When sore throat persists beyond all 5 days strep throat will be not likely. the idea will be more likely mononucleosis, a sinus infection, allergies or post-nasal drip.
Who will be a candidate for diagnostic testing?
1. All children using a sore throat
2. Selected adults using a sore throat. in which 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 using a sore throat using a back up throat culture
If the rapid test reads positive, the idea will be quite reliable. If the idea reads negative the idea may not be in which reliable. Because of the tests ability to miss the diagnosis, the idea will be recommended in which the health care provider get a back up culture in which 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, although my experience suggests in which 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 in which could give a false positive test.
various other testing for sore throat
When sore throat persists another diagnosis to consider will be mononucleosis. in which will be most common in those 10-25 years-old. the idea 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 although by the second week the test picks up the disease over 80% of the time.
Testing for HIV along with also various 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 in which looks for various other causes of sore throat such as various 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 also if the idea will be not present treatment of the symptoms will be all in which will be necessary. Treatment of strep throat will reduce rheumatic fever, abscess formation, transmission along with also improve comfort. the idea will be always important to stay alert for various other complications of sore throat – even though they are rare.
There will be a nine-day window in which 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 started off within 48-72 hours.
Some clinicians choose to treat patients while they wait for the return of the culture. Realizing in which resolution will be faster along with also the idea will provide comfort to some patients.
in which will be not a wise strategy to implement for all patients. in which requires some professional judgment of the treating health care provider. Those who are suspected of having strep are better candidates with in which 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 the idea 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 features a pleasant tasting bubble gum flavor.
Individuals who do not have angioedema (swelling deep inside the skin near the eyes along with also 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 using 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). the idea will be not usually picked as a first line medication as the idea will be a more expensive along with also features a wider spectrum of activity. A wider spectrum of activity means in which the idea will be able to cover many various 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 in which all the bacteria are killed along with also no straggling bacteria remain.
The use of probiotics are one strategy in which will significantly reduce the risk of Clostridium difficile along with also various other complications of antibiotic use. When you are on antibiotic the idea will be critical to take probiotics to reduce the risk of in which 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 also managing in which pain will be a critical part of treatment. Symptomatic treatment often involves a combination of systemic medications along with also local acting medications.
Systemic medications include medications in which are taken by mouth in which can help relieve the pain of the sore throat along with also may also help various other symptoms in which accompany sore throats such as headache, fever along with also body aches. Systemic medications include: ibuprofen, acetaminophen, naproxen or acetaminophen/codeine (in severe cases). The use of medications to reduce pain along with also 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 also 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. in which concoction can be gargled along with also 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 also lozenges.
Certain foods can help the throat feel better. For example, warm or cool liquids soothe along with also moisturize the throat. Nasal saline can moisturize the nasal passages along with also clean mucus out of the nose. in which 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 – features a demulcent in which will be more effective at providing relief than regular tea.
Certain prescription medications hold the potential to aid a sore throat. Viscous lidocaine will be a medications in which comes as a thick liquid in which the health care provider can prescribe in which will numb the throat. the idea can also be mixed with various other liquids such as liquid Benadryl along with also/or Maalox to ease the discomfort.
Steroids are used in some patients with sore throats. in which will be a prescription given by the doctor along with also 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 in which 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 also reduce throat pain
• Drink tea with honey as in which 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, various other bacteria can cause sore throat. in which will be much more common inside the adult than the child. in which may be considered when there will be a non-response to antibiotics or a negative GABHS culture along with also the patient will be getting worse. The health care provider will often take a more broad culture to look for various other bacteria in which may be causing the sore throat.
At times further testing will be indicated. in which will be not common, although may occur inside the sore throat in which will be not explained by various other causes. the idea will be most often carried out by an ear, nose along with also 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 the idea will be considered treatment failure. The main causes of in which 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, the idea means in which 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, although 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 also Adenoidectomy
Tonsils along with also adenoids are often removed, although 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 also nose along with also keep the infection through spreading.
There are risks with in which procedure. Bleeding will be the most common complications along with also can occur up to eight days after surgery. Sore throat after the procedure will be common. The voice sometimes adjustments after the procedure. The most worrisome complication will be death, although in which only occurs in one of every 250,000 operations.
The tonsils along with also/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 also those over 3-years-old, greater than 6 episodes a year will be an indication for the tonsils along with also adenoids to be removed.
• Obstructive sleep apnea
• A severe infection in which 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 brand new toothbrush should be used after 24 hours.
• Complete the entire course of antibiotics or resistance to in which antibiotic may occur.
• Symptoms in which do not improve by 72 hours or get worse after 48 hours require a medical evaluation.
• Do not take any antibiotics in which 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 in which you are recommending along with also the current medications in which I am on or any various 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 also how will they show up?