Pharyngitis is a term used by doctors to explain throat pain, accounting for 10-15% of pedestrian office visits. Group A β-hemolytic streptococcal pharyngitis (GABHS), more commonly known as sore throat, is a major concern of those with sore throat. GABHS is more common in children than adults. In both children and adults, viruses are the most common cause of sore throat.
The most important concern for a sore person with a sore throat is to exclude a critical condition related to sore throat including the most common GABHS. Certain factors can help predict whether the cause of the throat is GABHS or viral infection. These factors are not complete and in many cases the use of throat culture is required to eliminate throat and throat.
The important elements to know about strep are as follows.
• Most commonly, it affects children aged 5 to 15.
• Children under the age of 3 are generally not affected.
• There is an incubation period of 2 to 5 days. In other words, if you are in contact with an infected person, the disease may not appear for 2 to 5 days.
• Respiratory secretions spread infection.
Cause of sore throat
The virus causes most pharynx. Bacteria cause 5 to 15% of sore throat, but those of 5 to 15 years old have high bacterial incidence of sore throat. In this group, 15 to 30% of sore throat may be attributed to GABHS.
Certain factors help determine if the throat is caused by bacteria or viruses. Viruses that cause sore throat are accompanied by cough, stuffy nose, red eyes, fatigue.
Possible diagnosis
• Viral pharyngitis - There are more than 200 viruses that cause common colds, and each presentation may be slightly different. Many of these viruses are connected to the throat. Discussed under some specific viruses that cause sore throat.
• Limbs and mouth disease. This is caused by a virus called Coxackie virus. It causes blisters on your hands and feet, mouth and throat.
Infectious mononucleosis can also cause sore throat. This sore throat is typically severed and associated with throat pus (white spots). This disease is associated with swollen lymph nodes, especially glands in the back of the neck. Liver and spleen may expand and abdominal pain may appear. People treated with penicillin typically develop a rash (90% of the time). It is most common among people aged 10-25 years and is accompanied by fatigue and sore throat pain.
• HIV is a rare cause of sore throat. Affected people with HIV risk factors (multiple sex partners, men with sex acts with men, intravenous drug users) must take this diagnosis into account.
• Bacterial sore throat. The most common cause of bacterial sore throat is GABHS. Other bacteria sometimes cause throat.
• Fungal infections rarely cause sore throat. Candida infection is a common cause of fungal pain in fungi. An individual will have a throat with a white coat in the oral cavity that looks like a cottage cheese on the tongue. When white paint film is scratched off, it is painted white.
• Diphtheria is a rare cause of sore throat. It presents sore throat, fever, soft lymph nodes in the front of the neck and serous nasal discharge. Prior to this you can do regular vaccinations.
• Kawasaki Disease occurs infrequently but suffers from children under 5 years of age and is suffering from sore throat, swollen lymph nodes, fever, eyeball drain, red oral mucosa, strawberry tongue, cracked red lip, swelling of limbs, Red rash After that, peeled the palm.
• Peritoneal abscess is a significant cause of sore throat, accompanied by fever, wiping mood, hot potato voice, difficulty swallowing, painful swallowing, ear pain, and difficulty opening the mouth.
• Other causes of sore throat include persistent cough, smoking, gastroesophageal reflux, rhinitis secondary to runny nose, allergy, foreign body, thyroiditis (thyroiditis).
Complication
Most throat pain is caused by the virus and leaves themselves. When throat pain can become serious or when there is a high possibility of self-tolerance, it is important that all health care workers notice.
Death is a risk of life, but it is rarely related to sore throat. A throat abscess (infection with pus in the throat) can cause respiratory problems because swelling of the throat lowers respiratory ability. Diphtheria can lead to respiratory failure. Untreated GABHS may affect heart valves and lead to heart failure.
These serious complications are rare. Rheumatic fever is one of the most common preventable complications of pharyngitis. It happens after GABHS ceases to be treated. As people generally believe, the general population has not been affected so much. Indeed, in order to prevent one case of rheumatic fever, antibiotics are treated with strepto proton at 3000 to 4000 people. The incidence of rheumatic fever is about 1 case per million. Treatment with antibiotics does not guarantee prevention of rheumatic fever.
Rheumatic fever occurs approximately 3 weeks after untreated GABHS infection. It is characterized by pain and swelling, erythema (pink ring of the arm and leg), heart murmur and subcutaneous nodules (firm wrists without bone and tendon pain common in the wrist, elbow, knee). If this is suspected, immediate evaluation with a health care provider is essential.
Peritoneal abscess (pus after amygdala) can cause sore throat or complication of GABHS. Although it is not common, it is characterized by sore throat, ear pain, open mouth, fever, and potato voice.
Rough tea like black sandpaper is red and spicy. This rash lasts about a week and the skin peels off. This is a common symptom of streptococcal infection
Streptococcal infection can attack the kidney. It may be present 10-14 days after the Streptococcal pharynx. It is characterized by bloody urine and swelling (especially around the eyes). Whether antibiotic treatment reduces the risk of kidney disease after pharyngopharyngeal pain is unknown.
Red flag
• High fever
• Can not handle secretions - Spiral
• It is difficult to open your mouth
• Hot potato voice (muddy voice, you have a bite-like potato sound)
• Ubra (tissue piece hanging at the back of the throat) is shifted to one side
• swollen tonsils
• Difficult breathing
Diagnosis of throat throat
The main feature of history and physical examination helps medical staff to judge the possibility of streptococcal infection. There are several important functions that best predict the throat pharynx.
In recent years, white spots on Streptococcus, larynx and tonsils are the two most important factors in predicting pharyngeal pharynx. Matching of the neck and tonsils without pus or non flexible lymph nodes are the best criteria for eliminating throat and throatitis.
Clinical prediction rules have been developed to help determine who is suffering from who the healthcare provider is and who is not. None of these rules is perfect, typically requiring throat culture work to definitively determine who has a pharyngeal pharynx. These important features help the patient to determine the risk of pulmonary throat throat.
Forecasting rules are based on five important criteria.
1. Fever over 100.4 degrees Fahrenheit
2. Swelling of tonsils or abscesses to tonsils
3. Sore throat with no cough
Soft lymph node in the front of the neck
5. Age - 1 point is deprived if age is 3 to 14 years, 1 point is taken if age is over 45 years.
Based on the number of existing criteria, we can infer the possibility of GABHS. The person is given a score of -1 to 5, and all the people can predict the possibility of the pharyngeal throat using that point.
For example, looking at the example introduced in Chapter 2, a 20 - year - old woman comes to his doctor with tonsillitis. "My nose was packed for the past few days and I was coughing.I wake up this morning and my throat really badly hurts.I peeped into my throat and the tonsils swollen,
Also, she is judged to have no fever. When the doctor felt the front of the neck, he judged the lymph nodes swollen and soft.
This patient receives 1 point against swollen tonsils with abscess and 1 point to swollen lymph nodes. Her point total is 2. Therefore, the risk of her illness is about 17%.
Table 1: Change in GABHS based on the number of clinical criteria
-1 or 0 to 1%
1 to 10%
2 to 17%
3 to 35%
4 or 5 to 51%
As you can see from the chart, it is impossible to eliminate or eliminate the throat pharynx just by interviewing and physical examination. CDC recommends antibiotics not given without GABHS to be found on strep cultures. If the score is 4 or 5, many health care providers will treat instead of doing the culture and some clinicians even treat them if the score is 3 or more.
One fact that I do not know well is that the pharyngeal pharynx separates itself. Well, that is not totally true. Symptoms of sore throat appear, but bacteria may still persist. It can go to the heart and cause rheumatic fever. Even if my throat is gone, it is important to treat my throat.
If sore throat lasts longer than 5 days, pharyngeal pharynx is unlikely to occur. This is more likely to be mononucleosis, sinus infection, allergy, or intranasal drip.
Diagnosis test
Who is the candidate for the diagnostic test?
1. Child of all throat pain
2. Selection of adults with sore throat. This includes adults with at least one characteristic suggestive of gonarthritis (tonsilorosis, a colitis on the tonsils, fever over 100.4 degrees F, lymphadenopathy, cough without sore throat).
What type of test should I do?
1. Rapid strep test is indicated for most patients with sore throat with throat culture
If quick test is positive, it is pretty reliable. If it is negative it may not be reliable. Due to its ability to miss diagnosis, healthcare providers are encouraged to obtain a backup culture that is sent to the laboratory to confirm all negative acute thymititis tests. Some experts recommend that you do not need adult backup culture, but my experience suggests that you should do an adult backup culture.
Rapid examinations should not be used in the last 30 days for those who have performed positive thymectomy examinations.
Other throat examination
If sore throat persists, another diagnosis to consider is mononucleosis. This is the most common among people aged 10-25. Antibodies against Epstein-Barr virus can be tested by blood test. In the first week of illness, the examination may not pick up the disease, but by the second week the exam will pick up more than 80% of the illness.
Inspection of HIV and other sexually transmitted infections may be done in high-risk individuals. People who are doing oral sex may need throats examined for gonorrhea.
Some cases of sore throat guarantee a broad culture looking for other causes of pain like other bacteria.
Processing
Most of the sore throat is caused by either the virus or GABHS. Treatment with antibiotics is important if a pharyngeal pharynx is present, and treatment of the condition is all necessary unless it exists. Treatment of myositis reduces rheumatic fever, abscess formation, transmission and improves comfort. Regarding other complications of throat pain rarely, it is important to always be careful.
Clinicians have a nine-day window that must treat myositis to prevent rheumatic fever after GABHS. Treatment will speed cure. After starting treatment, it should feel much better in 24-48 hours. Ideally, treatment should be initiated within 48 to 72 hours.
One clinician chooses to treat the patient while the patient waits for the return of culture. Its solution will be faster and will bring comfort to some patients.
This is not a wise strategy to implement for all patients. This requires a professional judgment of the health care provider who is doing the treatment. People suspected of having strep are better candidates for this treatment method. The goal is to avoid excessive exposure to antibiotics. If antibiotics are prescribed without definitive diagnosis, patients should be advised to stop antibiotics immediately if the culture returns to negative.
It is a choiceii medicine because it is not resistant to penicillin in the United States. Ten-day drugs and shots are equally effective for their management. Those who do not take any medicine will be shot.
Amoxicillin, a kind of penicillin, is often used instead of children's penicillin because penicillin suspensions are not palatable. Amoxicillin suspension has a pleasant taste bubble gum flavor.
People who do not have angioedema (deeply swollen in the skin near the eyes and lips) or urticaria as an allergic reaction to penicillin can be treated with first- or second-generation cephalosporins. If so, allergic reactions with penicillin often shift to allergic reactions to cephalosporins, so careful monitoring is necessary.
Erythromycin is recommended for patients with severe penicillin allergy. Side effects - Mainly gastrointestinal - azithromycin or clarithromycin may occasionally be substituted.
Recurrent GABHS can be treated with amoxicillin-clavulanate (Augmentin). It is usually not selected as a first-line drug because it is more expensive and has a broader spectrum of activity. Expanding the range of activities means that you can cover many other kinds of infectious diseases. The routine use of broad spectrum antibiotics for simple infections can increase the risk of antibiotic resistance.
Penicillin should be used for 10 days in the processing of GABHS to ensure that all bacteria have been killed and there are no disturbing bacteria remaining.
The use of probiotics is one strategy that significantly reduces the risk of complications of Clostridium difficile and other antibiotics. When using antibiotics, it is important to take probiotics to reduce the risk of this complication. Do not know when it is necessary to administer antibiotics, so please always continue to supply probiotics.
Treat symptoms
Sore throat can be pretty debilitating and managing that pain is an important part of the treatment. Symptomatic treatment often involves a combination of systemic drugs and topical agents.
Systemic medications include mouth taken medicines that can help relieve pain of sore throat and can help other symptoms associated with throat pain such as headache, fever, body pain, etc. . Systemic drugs include ibuprofen, acetaminophen, naproxen or acetaminophen / codeine (severe cases). In addition to alleviating the symptoms, the use of drugs to reduce pain and fever helps to shorten the course of the disease one to two days.
Local medications are available in many counter ceremonies and some can be done at home. A common remedy for home remedies is a saltwater mouthwash, which can be done by adding 1/4 teaspoon salt to 6 to 8 ounces of hot water. This formula can be spit up and spit every 3 to 4 hours. Sugar free or normal popsicle helps to relieve throat discomfort.
Multiple counter medicines can be used to treat pain. They come in spray or lozenge.
Certain foods help to make your throat feel better. For example, a warm or cold liquid will make the throat smooth and moisturize. The nasal saline can moisturize the nasal passages and clean the mucus from the nose. This reduces the amount of nose drip and helps to reduce throat discomfort. Herbal tea helps in the treatment of sore throat. Sore throat has a more effective analgesic than normal tea.
Certain prescribing medicines may promote sore throat. Viscas lidocaine is a drug that is provided as a thick liquid that a healthcare provider can prescribe and paralyzes the throat. It can also be mixed with other liquids such as liquid Benadryl and / or Maalox to relieve discomfort.
Steroids are used in patients with throat. This is the prescription specified by the doctor and given as mouth or shot. Steroids reduce severely swollen throat inflammation.
Home relief for throat pain:
• Saline water gargles as above.
• Use a cold mist humidifier. Many sore throat pain is caused by drying or exacerbated by drying. The humidity provided by the cool mist humidifier may improve symptoms.
• Suck drink drops. Lemon drops and other types of drops stimulate saliva and reduce throat pain
• Drink honey to cover your throat.
follow up
Improvement of the throat caused by bacteria or viruses is typically shown in 2 to 3 days. If improvement or deterioration of the symptoms is not observed, it is necessary to follow up with the medical staff in order to exclude more serious (cellulitis or abscess) or another condition (mononucleosis or runny nose) there is.
In rare cases, other bacteria can cause throat. This is much more common for adults than for children. This is unresponsive to antibiotics or negative GABHS cultures and can be taken into account when patients are getting worse. Healthcare providers often take a broader culture to find other bacteria that may cause throat pain.
Sometimes further tests are instructed. This is not common, but it may happen to pain that is not explained by other causes. It is done most frequently by ears, nose, and throat experts. Use the laryngoscope to look for another cause of cancer, foreign body, acid reflux or throat.
Recurrent disease
If disease recovers within 1 week after completing antibiotic treatment, it is considered a treatment failure. The main causes of this are as follows.
• You are not taking medication as instructed
· Resistance to antibiotics
• Repeat infection
Different antibiotics such as cephalosporins, macrolides or amoxicillin-clavulanate may be considered for those considered to have resistant strains.
In the presence of repeated infections, families should examine whether they are carriers of streptococcus. If they have positive strep cultures, they should be treated.
What is a career?
GABHSviii is established in surprisingly many people (10-25%). When a person is colonized, it means that people are sick and live in the throat. Typically colonized people do not need to be treated, but sometimes they do. Treatment should be done in the following cases:
• Individual or family history of rheumatic fever
• Retransmit between close contacts
• Serious anxiety about GABHS
• Removal of tonsils to eradicate carrier conditions
Tonsillectomy and adenoidectomy
Although tonsils and adenoids are often removed, surgery can be done too frequently. The tonsils have a reason. The tonsils are often infected, but fight against throat and nose infections to prevent the spread of infection.
There is a risk to this procedure. Bleeding is the most common complication and may occur within 8 days after surgery. Sore throat after surgery is common. Voices may change after the procedure. The most serious complication is death, but this only occurs in one of 250,000 operations.
Amygdala and / or adenoids can be removed for several reasons including:
• Recurrent GABHS: More than four episodes per year for 2 years. Three or more times a year 3 years old Patients over 3 years old and over 6 years old have been shown to remove tonsils and adenoids.
Obstructive sleep apnea
• Severe infections not responding to antibiotics
• Recurrent peritoneal abscess
• Potential cancer
Sustained mouth respirator can be a candidate for removal of adenoid
Sustained dysphagia when caused by large tonsils and adenoids
What you need to know
When you are diagnosed as pharyngeal pharynx:
• Do not infect others. Please do not come into close contact with other people for 24 hours after antibiotic administration.
• Removable oral appliances (eg, retainers) must be completely cleaned.
• New toothbrushes should be used after 24 hours.
• Complete the whole process of antibiotics or resistance to that antibiotic may occur.
• Medical assessment is necessary for symptoms that do not improve by 72 hours or become worse after 48 hours.
• Do not take antibiotics lying around the house for throat without visiting health workers. Antibiotics invalidate throat cultures.
Questions to ask your health care provider
1. Is my throat related to viruses or bacteria?
2. Do you need a culture to determine if there are bacterial infections?
3. Which medicine would you recommend to manage symptoms?
4. Do you recommend relief in your home?
5. Will antibiotics help my infection?
6. Do you have a potential interaction between the medicine you are recommending and the medicine I currently do or other health problems?
7. When do you think my condition will improve?
8. What kind of complications do you see and how do you see it?
