PHARYNGITIS

(Sore Throat)
Inflammation of the throat

Causes

  • Most cases are viral
  • Bacterial: commonly Group A haemolytic Streptococci, diphtheria in non-immunized children
  • Gonorrhoea (usually from oral sex)
  • May also follow ingestion of undiluted spirits
  • Candida albicans in the immunosuppressed

Clinical features

  • Abrupt onset
  • Throat pain
  • Pain on swallowing
  • Mild fever, loss of appetite, general malaise
  • In children: nausea, vomiting, and diarrhoea
  • The presence of runny nose, hoarseness, cough, conjunctivitis, viral rash, diarrhea suggests viral infection
  • The presence of tonsilar exudates, tender neck glands, high fever, and absence of cough suggest a bacterial
    pharyngotonsillitis

Differential diagnosis

  • Tonsillitis, epiglottitis, laryngitis
  • Otitis media if there is referred pain

Investigations

  • Throat examination with torch and tongue depressor
  • Throat swab for microscopy, C&S
  • Blood: Full blood count
  • Serological test for haemolytic streptococci (ASOT)

MANAGEMENT

Supportive care

Most cases are viral and do not require antibiotics

  • Keep the patient warm
  • Give plenty of (warm) oral fluids e.g., tea
  • Give analgesics, e.g. Paracetamol for 3 days
  • Review the patient for progress

For Streptococcal pharyngitis: see next section

Notes
  • If not properly treated, streptococcal pharyngitis may lead to acute rheumatic fever and retropharyngeal or
    peritonsillar abscess

    • Therefore ensure that the full 10-day courses of antibiotics are completed where applicable