Sandbox:Mydah

Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]

Sore throat in adults resident survival guide

Causes

Life-threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Does not include any known cause

Common Causes

• Viral upper respiratory tract infection (Adenovirus, rhinovirus, coronavirus, enterovirus, influenza A and B, parainfluenza virus, respiratory syncytial virus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
• Group A streptococcal (GAS) infection
• Group C and G Streptococcus infection
• Arcanobacterium haemolyticum
• Fusobacterium necrophorum
• Mycoplasma and Chlamydia species
• Corynebacterium diphtheriae
• Acute HIV infection
• Neisseria gonorrhoeae
• Epstein-Barr virus and other herpes viruses cytomegalovirus (CMV) and herpes simplex virus (HSV)
• allergic rhinitis, sinusitis
• gastroesophageal reflux disease
• smoking
• inhalation of dry air (particularly in winters)
• Vocal strain
• Medications: Angiotensin-converting enzyme inhibitors, chemotherapeutic drugs

Evaluation

Shown below is an algorithm summarizing the diagnosis of sore throat in adults:

References

Are Alarming clinical signs for upper airway obstruction or deep neck infection present? “Hot potato” voice Drooling Stridor Respiratory distress “Tripod position” Fever and chills Severe unilateral sore throat Bulging of the pharyngeal wall or soft palate History of penetrating trauma to the neck Lockjaw Crepitus Neck stiffness

Yes

No

Stabilize ABC and refer patient urgently to emergency or inpatient care unit

Are clinical signs for Viral URTI (including conjunctivitis, coryza, cough, viral exanthem and voice hoarseness) present?

Yes

No

Manage patient with supportive care.

Does patient have clinical features of GAS throat infection? Fever (temperature ≥100.4 degrees F) Acute onset of sore throat Inflammation and edema of tonsillopharyngeal and uvular mucosa Tonsillar and peritonsillar yellow or white exudates Painful cervical lymphadenopathy Scarlatiniform rash History of GAS exposure

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Yes

Uncertain

No

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Apply Centor criteria for patient's clinical signs and symptoms. Is score ≥3?

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Yes

No

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Perform Rapid antigen detection test

Consider other viral, bacterial or noninfectious causes of sore throat. The illness is mostly self-limiting and specific tests for diagnosis are not carried out.