You may find the sore throat article more useful, or one of our other health articles. Avoid caffeine and alcohol, which can dehydrate you. Sore throat caused by a virus is not treated with antibiotics but instead may be treated with rest, pain medication, and other therapies aimed at relieving symptoms. Make sure to ask for permission before you start each physical exam. Explain the treatment of bacterial throat infections. After generating a differential, you may decide that you would like to expand upon it. Consult your doctor or your childs pediatrician if you or your child has a sore throat and in some instances your doctor may refer you to an ent that specializes in ear, nose and throat disorders, or an allergist that specializes in allergies bring a family member or a close friend with you. All but two of the authors had been involved in implementing sore throat guidelines, nationally or locally. You are going to observe and participate in the clinical encounter of a 17. Dec 11, 2018 pharyngitis is a leading cause of pediatric ambulatory care visits. Pharyngotonsillitis is the most common upper respiratory tract infection for which antibiotics are prescribed in sweden. The differential diagnosis at the time included candidal vaginitis and cellulitis. Differential diagnoses oral and throat infections gponline.
Health history tell me your special concerns today. Understand the complications of pharyngeal infections. A throat swab should be taken when a diagnosis of strep throat is suspected from the clinical and epidemiological findings see table 1 above and the patient is not already taking antibiotics. At those times adding a different strategy often reveals more conditions. Make sure to explain each physical examination in laymans term to your patient. Make sure to use proper draping dont forget to tie back patients gown. Fluids keep the throat moist and prevent dehydration. The pain is described as sharp, 410 in severity, located on the left side of her throat, and worsened with swallowing. The differential diagnosis of this swelling might pose a serious problem to a less experienced clinician. Menachem gross, ron eliashar, in orofacial pain and headache, 2008. Table 301 shows the differential diagnosis with the estimated percentage of cases of sore throat and the associated clinical syndrome. Tonsillitis symptoms, diagnosis and treatment bmj best. With increasing severity, there may be severe pain that increases with swallowing plus. When the examinee presses on your abdomen, say that it hurts a little bit all over.
Viruses commonly implicated include rhinovirus, coronavirus, influenza and parainfluenza viruses and adenovirus. Pharyngitis can involve some or all of these parts of the throat. The problem is that the term sore throat clinically does not distinguish between acute tonsillitis and pharyngitis. Examination of patients who present with sore throat may reveal tonsillitis, tonsillopharyngitis, or nasopharyngitis. Jaw trismus associated with peritonsillar cellulitis or abscess. Which conditions should be included in the differential. Unnecessary prescribing of antibiotics increases the risk of bacterial resistance, which is a threat to modern healthcare. Sore throat due to a viral or bacterial cause is a selflimiting condition which generally resolves within two weeks georgalas et al, 2014. Explain the preliminary differential diagnoses and initial workup plan to the patient. Herpes simplex virus can lead to symptoms of a sore throat especially in adolescents and young adults. Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100. Differential diagnosis for a repiratory disesae outbreak.
Sore throat, exudative tonsillitis, vomiting, abdominal pain, lmphadenopathy, white then red strawberry tongue erythema infectiosum fifth disease human parvovirus type b19 spring 5 10 years none usually in children, may occur in adults none to lowgrade 2 4 starts as slapped cheek, maculopapular. You will have time to record your findings and receive feedback. Oral cavity dry mucous membranes suggest dehydration from odynophagia and indicates severity of symptoms. However, it is important to recognize and treat children with strep throat to prevent the spread of infection and also to prevent potentially serious complications of group a streptococcus gas eg, rheumatic fever. A sore throat pharyngitis is a common problem and usually is caused by a viral or bacterial infection. The pain is described as sharp, 410 in severity, located on the. Management of patients with sore throats in relation to. I also seem to recall the coxsackie viruses causing rashes, but these present with a very severe sore throat that last for about a week.
Diagnosis and management of sore throat guideline keywords. Signs and symptoms of severe sore throat, fever, tender anterior cervical lymphadenopathy, red pharynx with tonsillar swelling with or without exudate, and no cough indicate a higher probability of gas pharyngitis for both adults and children. Use the checklists below for history, physical examination, and communication and. Neck stiffness, limitation of extension suggestive of retropharyngeal abscess. Chronic tonsillitis is characterized by chronic sore throat, halitosis, recurrent tonsillitis and persistent tender cervical lymph nodes.
A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Diagnosis and treatment of streptococcal pharyngitis. The patient reports steadily worsening sore throat over the past 2 days, associated with a sensation of swelling. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Infectious mononucleosis may begin slowly with fatigue, a. It is often recognized by ulcerative lesions which can be seen on the lips, in the anterior.
Usually, a sore throat is the sign of another illness, such as a cold or the flu aamir et al. Describe the laboratory testing available to aid in the diagnosis of pharyngitis. Utilization management, medical and pharmaceutical services, b. At the end of the podcast, listeners will be able to. Credits can be earned by building a differential or looking up a diagnosis. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. Sore throat is a very common complaint for which children and adolescents seek medical care. This framework divides the diagnoses into those caused by infection bacterial and viral and those caused by noninfectious processes. Using a sterile throat swab, contact the posterior pharyngeal wall and the surface of both. Symptoms of heartburn and gerd are a burning feeling in the chest, throat, or mouth, nausea, and more.
Differential dx strategies university of massachusetts. Strep throat is treated with a course of antibiotics. Differential diagnoses infectious mononucleosis im. In patients with sore throat but clear throat, differential diagnosis should include subacute thyroiditis sat, epiglottitis, and deep neck infection. Mar 29, 2020 antibiotic treatment of adults with sore throat by community primary care physicians. Professional reference articles are designed for health professionals to use. If a patient presents with a complaint of a sore throat, a number of differential diagnoses must be considered before determining a final diagnosis. Making a diagnosis of the cause of your sore throat is done during physical exam. Group a betahemolytic streptococci gabhs is the most common cause of acute bacterial pharyngitis, accounting for 515% of sore throats in adults and 2030% in children.
Certain strategies work better for different symptoms. In order to understand the clinical approach to history taking and examination of a child who has a sore throat, a differential diagnosis must be held in mind when approaching the problem. However, it may exist in its own right as a chronic bacterial infection in a patient with or without tonsils. A sore throat, fever and rash wiley online library. Winner of the standing ovation award for best powerpoint templates from presentations magazine.
Pharyngitis is a leading cause of pediatric ambulatory care visits. Dr nigel stollery compares four presentations and offers clues for their diagnosis. A sore throat is usually a symptom of an infective process. Nov 01, 2011 discuss the causes of pediatric throat infections. Patients presenting with fever and swollen lymph glands with complaints of sore throat and recent fatigue provide rationale for this differential diagnosis. Porche, md, and jennifer avegno, md p atients complaining of sore throats account for 1% to 2% of all visits to u. Since the patients skin was nonerythematous and she had vaginal discharge, she was treated for presumed severe candidal vaginitis with fluconazole and clotrimazole 1% cream.
The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as acute sore throat. Sore throat in children clinical considerations and. The published incidence of sore throat varies between 0% and 70%. Make sure to wash your hands or wear gloves before you start physical examination. Warm liquids broth, caffeinefree tea or warm water with honey and cold treats such as ice pops can soothe a sore throat. Sore throat, dry throat, pharyngeal erythema, and minor pharyngeal abrasions have been reported with the lma.
A case of sore throat and fever wiley online library. Acute pharyngitis symptoms, diagnosis and treatment. Oral cavity dry mucous membranes suggest dehydration from odynophagia and indicates severity of. A useful framework for the differential diagnosis of acute sore throat is shown below. In addition to the conditions listed in the differential diagnosis, other. In many cases, a sore throat is associated with the common cold. Sore throat this video format is designed to help you prepare for objective structured clinical examinations, or osces. The organism usually responsible is a group a streptococcus. In a situation of a sore throat, the infective organisms must be considered also.
Strep throat is a particular kind of pharyngitis that is caused by a bacterium known as group a streptococcus gas. Oct 19, 2016 sore throat is usually due to a viral infection. Differential diagnosis for a respiratory disease outbreak. Chronic sore throat an overview sciencedirect topics.
A sore throat, also called a throat infection or pharyngitis, is a painful inflammation of the back part of the throat pharynx. We present a systematic approach to differential diagnosis of painful thyroid disorder. By 1 week, approximately 85% of people are symptomfree. It may also be a symptom of influenza, or of infectious mononucleosis glandular fever. Rapid antigen detection tests allow immediate pointofcare assessment of group a streptococcus gas pharyngitis the goal of treatment of gas is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission. Chronic sore throat may be a symptom of other disorders, such as sinusitis. Pain in the throat is one of the most common symptoms. Mar 07, 20 17 yearold female presenting to the pediatric ed with sore throat for 2 days.
Consult your doctor or your childs pediatrician if you or your child has a sore throat and in some instances your doctor may refer you to an ent that specializes in ear, nose and throat disorders, or an allergist that specializes in allergies. When evaluating a patient with a sore throat, it is important to differentiate pharyngitis caused by group a streptococcus gas from that caused by other pathogens. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. A sore throat will spontaneously resolve by 3 days in about 40% of people. Identify the usual clinical presentation of pharyngitis in children. In the following 36 hours a maculopapular rash had developed on his neck, becoming more florid and extending to his trunk and arms prior to presentation.
A polymicrobial bacterial population is observed in most cases, with. Rapid diagnostic tests are available to confirm this diagnosis. It refers to a painful problem of the child, usually in the pharynx and often begins as a swallowing complaint. Sore throat usually resolves on its own without complications in adults, although it is important to know when to seek medical attention. Infectious mononucleosis may begin slowly with fatigue, a general ill feeling, headache, and sore throat. Patients with chronic sore throat, those who do not have signs of infection, or those who do not respond to treatment should be evaluated for noninfectious causes of sore throat.
The emergency clinician must sort through the broad differential for this complaint using a systematic approach that protects against early closure of the diagnosis. Mild abdominal pain, in the absence of other gastrointestinal symptoms, and gen. A sore throat is a painful, dry, or scratchy feeling in the throat. Pdf the differential diagnosis of painful thyroid disorders. Viral pharyngitis is a sore throat caused by a virus, and causes throat pain and coldlike symptoms. Sore throat and left ear pain mdedge family medicine. Antibiotic treatment of adults with sore throat by community primary care physicians. This paper considers three examples of potential diagnoses for this condition with an explanation of why such a diagnosis might be appropriate if other symptoms apply. Tonsillitis is painful swelling in the tonsils, causing sore throat, red tonsils, pain, fever, and more. Alex soto, a 19yearold male, comes to the urgent care clinic because of a sore throat. The diagnosis of strep throat in adults in the emergency room. However, it is important to recognize and treat children with strep throat to prevent the spread of infection and also to prevent potentially serious complications of group a. Although current guidelines for the management of pharyngotonsillitis differ between countries, all guidelines recommend the use of. It accounts for more than million visits to doctors offices each.
Viruses can cause a sore throat and other upper respiratory infections, such as the common cold. If such patient has severe pain and poor dental hygiene, lemierres disease should be considered. Sore throat in children introduction to the clinical problem. The validity of a sore throat score in family practice. Symptoms often include the abrupt onset of sore throat with high fever and myalgias. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. When evaluating a patient with a sore throat, it is important to differentiate pharyngitis caused by group a streptococcus gas from that caused by. Pharyngitis is primarily caused by bacteria and viruses. Mononucleosis can also cause this, but since you didnt mention extreme fatigue, i wouldnt include this in the differential diagnosis. They are written by uk doctors and based on research evidence, uk and european guidelines. Navigating the differential diagnosis two case histories demonstrate the vital importance of staying on your toes when dealing with this routine complaint.
251 672 61 1056 519 244 1276 158 876 345 1380 219 1129 1072 226 1224 358 206 1349 449 647 91 369 813 418 1360 4 755 442 1249 572 1488 318 1384 206 1104 1138 1402 94 742 604 726 657 1492