August
2007
Strept Throat - Say Ah!
Acute Pharyngitis is the medical term for new onset of sore throat. Only 10% of patients who see the doctor for a sore throat have Group A Streptococcus (GAS) – which is #1 treatable bacterial infection. Other strept infections are Group C and Group G. STD bugs N. gonorrhoeae and Chlamydia can cause sore throats. Mycoplasma (which causes walking pneumonia) is an atypical bacteria. So these bacteria just named consist of only 15-30% cases seen by doctors that will respond to antibiotics. C. diphtheriae is pretty rare because tetanus-diphtheriae vaccines. The rest of infections don’t respond to antibiotics – in particular viruses, which consist of 50% of cases of sore throats in a doctor’s office.
Pharyngitis caused by a virus will not be cured with antibiotics. Virus include Epstein-Barr virus (mononucleosis) and HIV acute infection. Other viruses include rhinovirus (common cold), adenovirus, parainfluenza, coxsackievirus (hand, foot and mouth disease), coronavirus, echovirus, CMV (mono as well), and herpes simplex. Influenza can be treated with Tamiflu.
30% cases a pathogen is not found on throat culture.
Clinical: Sore throat comes on pretty quickly. Tonsils are swollen with exudate (pus or discharge) + Lymph nodes in neck + Fever make the triad for strept throat + lack of cough. If there are other symptoms like stuffy runny nose, sneezing, ear congestion, and coughing then it is likely a virus infection and not strept.
But still studies show doctors often don’t know which patients will have a positive throat culture for GAS if they have the classic signs of strept throat. On the other hand, if 3/4 signs are negative for strept, then about 80% of the time the patient doesn’t have strept throat.
So the rapid strept test is used because the strept culture takes 24-48 hours. But the rapid strept test isn’t perfect: only 80% sensitive. A blood test called ASO can aide in diagnosis but that takes a day as well.
GAS needs to be treated with antibiotics to help prevent acute rheumatic fever, which can cause heart valve damage and kidney damage. Also early treatment with antibiotics can help prevent an abscess forming.
Worst case scenarios for sore throat include an abscess, swollen epiglottis, or parapharyngeal space infections. It might be a bad sign to have drooling, dysphagia (difficulty swallowing) and neck swelling and might require emergency treatment
Symptoms can be reduced with common things like: warm salt water gargles, Listerine, herbal teat with licorice root. NSAIDs like Tylenol (if no liver problems) and ibuprofen (risk of higher blood pressure and stomach ulcers)
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drjohnhong 
Uncategorized, infection 
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