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====Evaluation====
====Evaluation====
Shown below is an algorithm summarizing the diagnosis of [[sore throat]] in adults:
Shown below is an algorithm summarizing the diagnosis of [[sore throat]] in adults<ref name="pmid11255529">{{cite journal| author=Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR, American Academy of Family Physicians. American College of Physicians-American Society of Internal Medicine | display-authors=etal| title=Principles of appropriate antibiotic use for acute pharyngitis in adults. | journal=Ann Intern Med | year= 2001 | volume= 134 | issue= 6 | pages= 506-8 | pmid=11255529 | doi=10.7326/0003-4819-134-6-200103200-00018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11255529  }} </ref>:
{{Family tree/start}}
{{Family tree/start}}
{{familytree | | | | | | | | A01 |A01= Are Alarming clinical signs for upper airway obstruction or deep neck infection present?
{{familytree | | | | | | | | A01 |A01= Are Alarming clinical signs for upper airway obstruction or deep neck infection present?

Revision as of 19:16, 15 August 2020

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

Sore throat in adults resident survival guide

Overview

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). [1][2][3]
  • Group A streptococcal (GAS) infection
  • Group C and G Streptococcus infection[4]
  • Arcanobacterium haemolyticum[4]
  • Fusobacterium necrophorum[5]
  • Mycoplasma and Chlamydia species[1]
  • Corynebacterium diphtheriae
  • Acute HIV infection[6]
  • Neisseria gonorrhoeae
  • Epstein-Barr virus and other herpes viruses cytomegalovirus (CMV) and herpes simplex virus (HSV)[7]
  • allergic rhinitis, sinusitis
  • gastroesophageal reflux disease
  • smoking
  • inhalation of dry air (particularly in winters)
  • Vocal strain[8]
  • Medications: Angiotensin-converting enzyme inhibitors, chemotherapeutic drugs[8]

Evaluation

Shown below is an algorithm summarizing the diagnosis of sore throat in adults[9]:

References

  1. ↑ 1.0 1.1 Huovinen P, Lahtonen R, Ziegler T, Meurman O, Hakkarainen K, Miettinen A; et al. (1989). "Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms". Ann Intern Med. 110 (8): 612–6. doi:10.7326/0003-4819-110-8-612. PMID 2494921.
  2. ↑ Bisno AL (2001). "Acute pharyngitis". N Engl J Med. 344 (3): 205–11. doi:10.1056/NEJM200101183440308. PMID 11172144.
  3. ↑ Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR; et al. (2020). "Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility". N Engl J Med. 382 (22): 2081–2090. doi:10.1056/NEJMoa2008457. PMC 7200056 Check |pmc= value (help). PMID 32329971 Check |pmid= value (help).
  4. ↑ 4.0 4.1 Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G; et al. (2012). "Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America". Clin Infect Dis. 55 (10): 1279–82. doi:10.1093/cid/cis847. PMID 23091044.
  5. ↑ Centor RM, Atkinson TP, Ratliff AE, Xiao L, Crabb DM, Estrada CA; et al. (2015). "The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study". Ann Intern Med. 162 (4): 241–7. doi:10.7326/M14-1305. PMID 25686164.
  6. ↑ Tindall B, Barker S, Donovan B, Barnes T, Roberts J, Kronenberg C; et al. (1988). "Characterization of the acute clinical illness associated with human immunodeficiency virus infection". Arch Intern Med. 148 (4): 945–9. PMID 3258508.
  7. ↑ McMillan JA, Weiner LB, Higgins AM, Lamparella VJ (1993). "Pharyngitis associated with herpes simplex virus in college students". Pediatr Infect Dis J. 12 (4): 280–4. doi:10.1097/00006454-199304000-00004. PMID 8387178.
  8. ↑ 8.0 8.1 Renner B, Mueller CA, Shephard A (2012). "Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat)". Inflamm Res. 61 (10): 1041–52. doi:10.1007/s00011-012-0540-9. PMC 3439613. PMID 22890476.
  9. ↑ Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR, American Academy of Family Physicians. American College of Physicians-American Society of Internal Medicine; et al. (2001). "Principles of appropriate antibiotic use for acute pharyngitis in adults". Ann Intern Med. 134 (6): 506–8. doi:10.7326/0003-4819-134-6-200103200-00018. PMID 11255529.
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
Uncertain
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Apply Centor criteria for patient's clinical signs and symptoms. Is score ≥3?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
 
 
Negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform throat culture in patients with any of the following risk factors:
  • Patient with weak immune system or history of complications of GAS infection i.e. acute rheumatic fever.
  • Patients in close contact with individuals who have a high risk of complications (i.e. infants and immunocompromised elderly population)
  • Young adults living in close proximity (i.e. college dormitories)
  • Patients residing in endemic areas of acute rheumatic fever
  • Patient with negative RADT but with Centor criteria scores ≥3
 
 
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