Pharyngitis is a term that doctors use to describe a sore throat, and it accounts for 10-15 percent of all visits to pedestrian offices. Group beta hemolytic streptococcal pharyngitis (GABHS), better known as strep throat, is the main concern of a person with a sore throat. GABHS is more common in children than in adults. In children and adults, viruses are the most common cause of sore throat.
The most important problem in a person with a sore throat is to exclude some serious conditions associated with sore throat, including, most often, GABHS. Certain factors will help to predict whether GABHS is a cause of sore throat or a viral infection. Factors are not perfect, and in many cases it is necessary to use a throat culture to rule out strep throat.
Important factors you need to know about streptococci include:
• It most commonly affects children between the ages of 5 and 15.
• It usually does not affect children under the age of three.
• It has an incubation period of 2-5 days. This means that if you were in contact with someone who is infected and infected, your disease may not appear within 2-5 days.
• Respiratory secretions spread the infection.
Causes of Sore Throat
Viruses cause most sore throat. Bacteria cause 5–15% of sore throat, but in people aged 5 to 15 years, there are higher levels of bacterial causes of sore throat. In this group, 15–30 percent of sore throat can be caused by GABHS.
Certain factors can help determine if a sore throat is caused by bacteria or a virus. Viruses that cause sore throat are often accompanied by a cough, stuffy nose, red eyes and fatigue.
Possible diagnoses
• Viral sore throat - there are over 200 viruses that cause a cold, and each presentation may be slightly different. Many of these viruses are associated with a sore throat. Some specific viruses that cause a sore throat will be discussed below.
• Diseases of the arms and legs. It is caused by a virus called the Coxackie virus. It causes blisters on the hands and feet, as well as in the mouth or throat.
Infectious mononucleosis can also cause sore throat. This sore throat is usually broken and is associated with pus (white spots) in the throat. This disease is associated with swollen lymph nodes, especially the glands on the back of the neck. It sometimes comes with pain in the stomach due to an enlarged liver or spleen. Those treated with penicillin usually develop a rash (90% of the time). This is most common in those who are 10-25 years old, and is accompanied by fatigue and lingering throat.
• HIV is a rare cause of sore throat. Persons who have risk factors for HIV (several sexual partners, men who have sex with men, intravenous drug users) who have a diseased procedure should take this diagnosis into account.
• Bacterial sore throat. The most common cause of bacterial inflammation of the throat is GABHS. Other bacteria can sometimes cause sore throat.
• Fungal infections rarely cause sore throat. Candida infections are a common cause of fungal sore throat. A person will have a sore throat with a white coat on the tongue and mouth that looks like cottage cheese. A white coating will bleed if it is scraped off.
• Diphtheria is a rare cause of sore throat. It is a sore throat, fever, tender lymph nodes in the front of the neck, and serosexual nasal discharge. This may be preceded by normal vaccinations.
• Kawasaki disease is rare, but affects children under the age of five and has sore throat, tender lymph nodes, fever, eye discharge, red oral mucosa, strawberry tongue, chapped red lips, swelling of the hands and feet and a red rash on hands and feet, and then peeling palms.
• Peritonsicular abscess is a serious cause of sore throat and causes fever, wiping sensation, 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, postnasal droplet, secondary to rhinitis, allergies, foreign body and thyroiditis (inflammation of the thyroid gland).
complications
Big sore throat caused by a virus and go away on their own. It is important that all health care consumers know that a sore throat can be severe and when they are probably self-limited.
Death is a risk of life, but it is rarely associated with a sore throat. Flu abscess (purulent infection in the throat) can lead to breathing problems, as a swelling in the throat reduces the ability to breathe. Diphtheria can lead to respiratory failure. Untreated GABHS can affect heart valves and can lead to heart failure.
These serious complications are rare. Rheumatic fever is one of the most common preventable complications of sore throat. This happens after GABHS is not treated. The population is not as badly affected as people think. In fact, for the treatment of one case of rheumatic fever, treatment of 3000 to 4000 people with streproate antibiotics is required. The frequency of rheumatic fever is approximately one case per million people. Antibiotic treatment does not guarantee the prevention of rheumatic fever.
Rheumatic fever occurs approximately 3 weeks after untreated GABHS infection. It is characterized by joint pain and swelling, red erythema (pink rings on the torso, arms and legs), heart murmur or subcutaneous nodules (painless, hard knots over bones or tendons that are often found on the wrist, elbow or knees). If this is suspected, an immediate assessment with a health care provider is required.
Peritonsicular abscess (pus in the tonsils) can cause sore throat or may be a complication of GABHS. This is not common, but is characterized by aggravated sore throat, pain in the ears, inability to open the mouth, fever and hot voice of the potato.
A rash that looks coarse, like sandpaper, turns red and disappears when you press it slightly with scarlet fever. This rash will last for about a week and will lead to flaking of the skin. This is a common manifestation of streptococcal infection.
Streptococcal infections can attack the kidneys. It may appear 10-14 days after strep throat. It is characterized by bloody urine and edema (especially around the eyes). It is unclear whether antibiotic treatment reduces the risk of kidney problems after a throat.
Red flags
• Heat
• Unable to process excrements - drooling
• Hard time opening your mouth
• The voice of hot potatoes (muffled voice, it seems that you have a sip of hot potatoes)
• Uvula (a piece of cloth that hangs at the back of the throat), leaning in one direction
• One swollen tonsil
• It's difficult to breathe
Diagnosis of Strep Throat
The main characteristics of the history and physical examination will help the health care provider determine the likelihood of streptococcal infection. There are several key features that are most predictable for strep throat.
The recent effects of streptococcus and white spots in the throat or tonsils are the two most important factors in predicting streptococcus throat. Tonsils that are free of coincident or purulent and non-tender lymph nodes in the neck are the best criteria for excluding streptococci.
Clinical forecasting rules were developed to assist the health care provider in determining who has streptococcus and who does not. None of these rules is perfect and usually requires that the work of the throat culture definitively determine who has strep throat. However, these key features can be helpful in helping patients determine their risk for developing strep throat.
The prediction rule is based on five key criteria.
1. Fever above 100.4 degrees Fahrenheit
2. Swelling of tonsils or pus on tonsils
3. Sore throat with no cough
4. Tender lymph nodes in the front of the neck
5. Age. One point is indicated if the age is between 3 and 14 years, and one point is selected if over the age of 45 years.
Based on the number of criteria available, it can be assumed how likely GABHS is. A person is given a score from -1 to 5, and using this total amount, you can predict the likelihood of strep throat.
For example, if we look at the case study presented in chapter 2: a 20-year-old woman comes to the doctor with tonsillitis. “My nose has been stuffy for the last two days, and I coughed. I woke up this morning and my throat was badly hurt. I looked down my throat, and my tonsils were swollen, and they had white dots.
Also found that she had no fever. When the doctor felt the front of her neck, he decided that her lymph nodes were swollen and tender.
This patient gets one point for swollen tonsils with pus and one point for swollen lymph nodes. She has a total score of 2. Therefore, her risk of streptococcus is about 17%.
Table 1: Percentage change in the presence of GABHS based on the number of clinical criteria
-1 or 0 - 1%
1 - 10%
2 - 17%
3 - 35%
4 or 5 - 51%
As can be seen from the chart, it is impossible to control or rule out streptococcus throat, simply by conducting an interview and physical examination. CDC recommends not administering antibiotics without GABHS in streptococcal culture. When there is a score of 4 or 5, many health professionals will treat instead of doing culture, and some clinicians even prefer to treat if there is a score of 3 or more.
One fact that does not know very well is that the arrow's throat will disappear by itself. Well, this is not quite true. The symptom of a sore throat will change, but the bacteria can still persist. It has the potential to go to the heart and cause rheumatic fever, there it is important to treat strep throat, although the sore throat will go away.
When the sore throat persists for five days, strep throat is unlikely. Most likely, mononucleosis, sinus infection, allergy or postnasal drip.
Diagnostic testing
Who is a candidate for diagnostic testing?
1. All children with sore throats
2. Selected adults with a sore throat. This includes adults with at least one characteristic indicating streptococcus throat (swollen tonsils, pus on the tonsils, fever above 100.4 degrees Fahrenheit, swollen lymph nodes, sore throat in the absence of cough)
What type of testing should be performed?
1. The rapid streptococcus test is indicated for the majority of patients with sore throats and throat reconstructions.
If the rapid test is considered positive, it is quite reliable. If he reads negative, he may not be so reliable. Due to the possibility of testing the missed diagnosis, it is recommended that the health worker receive a backup culture, which is sent to the laboratory to confirm each negative test for rapid streptococcus. Some experts believe that for adults you do not need a backup culture, but my experience suggests that you should create a backup culture for adults.
The quick test should not be used in those who have had a positive streptococcus test in the last 30 days, as there may still be fragments of streptococcus antigen hanging around that can give a false positive test.
Other sore throat tests
When the sore throat persists, another diagnosis is considered mononucleosis. This is most common in those 10-25 year olds. It can be tested by testing blood for antibodies to Epstein-bar virus. During the first week of illness, the test may not raise the illness, but in the second week the test takes the disease in more than 80% of cases.
Testing for HIV and other sexually transmitted diseases can be justified in people at high risk. Persons who have oral sex may need a throat checked for gonorrhea.
Some cases of sore throat guarantee a broad culture that seeks other causes of the disease, such as other bacteria.
treatment
Most cases of sore throat are caused by a virus or GABHS. If strep throat is present, antibiotic treatment is essential, and if not, treating the symptoms is all that is needed. Treatment of strep throat will reduce rheumatic fever, abscess formation, transmission and improve comfort. It is always important to be on your guard for other complications of sore throat - although they are rare.
There is a nine-day window in which the clinician must treat strep throat to prevent rheumatic fever after GABHS. The treatment will also speed healing. After starting treatment, you should feel much better within 24-48 hours. Ideally, treatment should begin within 48-72 hours.
Some clinicians prefer to treat patients while they wait for the culture to return. Understanding that resolution will be faster, and this will provide comfort for some patients.
This is not a reasonable strategy for all patients. This requires some professional judgment by the attending physician. Those suspected of having streptococcus are the best candidates for this treatment. The goal is to avoid excess exposure to antibiotics. When antibiotics are prescribed without a confirmed diagnosis, the patient should be advised to immediately stop antibiotics if the culture returns negative.
In the United States there is no resistance to penicillin, so it is the drug of choice. Ten days of pills or shots are equally effective in controlling it. People who will not take all medications should get a shot.
Amoxicillin, which is a type of penicillin, is often used in place of penicillin in children, since penicillin suspension does not have good taste. Amoxicillin suspension has a pleasant taste of dessert gum.
Persons who do not have angioedema (swelling deep in the skin near the eyes and lips) or hives, since their allergic reaction to penicillin can be treated with first or second generation cephalosporins. If they are, they must be carefully controlled, since allergic reactions with penicillin often lead to an allergic reaction to cephalosporins.
Erythromycin is recommended for patients with severe penicillin allergology. Because of the side effects — mainly of the gastrointestinal tract — azithromycin or clarithromycin is sometimes replaced.
Repetitive GABHS can be treated with amoxicillin-clavulanate (Augmentin). It is usually not selected as a first-line medicine, since it is more expensive and has a wider spectrum of activity. A broader spectrum of activity means that it is able to cover many other types of infections. The usual use of a broad-spectrum antibiotic for simple infections may increase the risk of antibiotic resistance.
Penicillin should be used for 10 days with GABHS treatment to ensure that all bacteria are killed and residual bacteria do not remain.
The use of probiotics is one of the strategies that will significantly reduce the risk of Clostridium difficile and other complications of the use of antibiotics. When you are on an antibiotic, it is important to take probiotics to reduce the risk of these complications. Always keep a supply of probiotics on hand, because you never know when you will need to take antibiotics.
Treatment of symptoms
Sore throat pain can be quite debilitating and managing that pain is an important part of treatment. Symptomatic treatment is often associated with a combination of systemic drugs and topical active drugs.
Systemic medications include medications that are taken by mouth that can help relieve a sore throat and can also help other symptoms that accompany a sore throat, such as headache, fever and body aches. Systemic medications include: ibuprofen, acetaminophen, naproxen, or acetaminophen / codeine (in severe cases). The use of medications to reduce pain and fever, in addition to reducing symptoms, can help reduce the course of the disease by one to two days.
Topical medications are available in many recipes, and some can be made at home. A common home remedy is salt rinses, which can be done by adding one quarter of a teaspoon of salt to 6-8 ounces of warm water. This mixture can be rinsed and spat out every 3-4 hours. Sugar-free or regular Popsicles can help relieve discomfort in the throat area.
For the treatment of ulcers, you can use several inscriptions. They come in sprays and cakes.
Certain foods can help your throat feel better. Например, теплые или прохладные жидкости успокаивают и увлажняют горло. Назальный солевой раствор может увлажнять носовой проход и чистую слизь из носа. Это уменьшит количество постназальной капли, что поможет уменьшить дискомфорт в горле. Травяные чаи могут быть полезны при лечении ангины. Горловое пальто - травяной чай - имеет смягчение, которое более эффективно при обеспечении облегчения, чем обычный чай.
Некоторые лекарства, отпускаемые по рецепту, могут помочь больному горлу. Вязкий лидокаин - это лекарство, которое поступает в виде толстой жидкости, которую может назначить поставщик медицинских услуг, который онемеет горло. Его также можно смешивать с другими жидкостями, такими как жидкий бенадрил и / или маалокс, чтобы облегчить дискомфорт.
Стероиды используются у некоторых пациентов с болью в горле. Это рецепт, назначаемый врачом, и может быть дано через рот или в виде выстрела. Стероиды уменьшают воспаление сильно раздутого горла.
Домашние средства для боли в горле:
• Промывание соленой воды, как указано выше.
• Следует использовать холодный увлажнитель. Многие больные горла вызваны или усугубляются сухостью; влажность, которую обеспечивает прохладный увлажнитель тумана, может улучшить симптомы.
• Сосать кислой каплей. Лимонные капли или другой тип капли стимулируют слюну и уменьшают боль в горле
• Пейте чай с медом, так как это будет покрывать горло.
Следовать за
Улучшение боли в горле, вызванное бактериями или вирусом, обычно отмечается через 2-3 дня. Когда нет улучшения или ухудшения симптомов, следует проследить за тем, как ваш врач должен быть квалифицирован, чтобы исключить более серьезный (целлюлит или абсцесс) или другой при условии (мононуклеоз или хронический постназальный капель).
Редко, другие бактерии могут вызывать воспаление горла. Это гораздо чаще встречается у взрослого, чем у ребенка. Это может быть рассмотрено, когда наблюдается не-ответ на антибиотики или отрицательная культура GABHS, и пациент становится все хуже. Поставщик медицинских услуг часто будет иметь более широкую культуру, чтобы искать другие бактерии, которые могут вызывать боль в горле.
Время от времени указываются дополнительные испытания. Это не является обычным явлением, но может возникать в язве, которая не объясняется другими причинами. Его чаще всего выполняют специалист по уху, носу и горлу. Ларингоскоп будет использоваться для поиска рака, инородного тела, кислотного рефлюкса или другой причины боли в горле.
Повторяющаяся болезнь
Когда болезнь возвращается в течение одной недели после завершения антибактериальной терапии, это считается неудачей лечения. Основными причинами этого являются:
• Не принимать лекарства по назначению
• Устойчивость к антибиотику
• Повторять инфекции
Для тех, кто, как считается, обладает устойчивым штаммом, можно рассматривать другой антибиотик, такой как цефалоспорин, макролид или амоксициллин-клавуланат.
В случаях повторной инфекции члены семьи должны быть проверены, чтобы определить, являются ли они носителями стрептококков. Если у них есть положительная культура стрептококка, их следует лечить.
Что такое перевозчик?
Удивительное количество людей - от 10 до 25 процентов - колонизировано GABHSviii. Когда человек колонизирован, это означает, что стрептококк живет в горле, заставляя человека болеть. Как правило, тех, кто колонизирован, не нужно лечить, но иногда они это делают. Лечение должно происходить, когда есть:
• Личная или семейная история ревматической лихорадки
• Периодическая передача между близкими контактами
• Значительное беспокойство по поводу GABHS
• Рассмотрение удаления миндалин для искоренения состояния носителя
Тонзилэктомия и аденоидэктомия
Миндалины и аденоиды часто удаляются, но хирургию можно проводить слишком часто. Миндалины есть не просто так. Миндалины, в то время как они часто заражаются, помогают бороться с инфекциями в горле и носу и препятствуют распространению инфекции.
С этой процедурой возникают риски. Кровотечение является наиболее распространенным осложнением и может произойти до восьми дней после операции. Болезненное горло после процедуры является обычным явлением. Голос иногда меняется после процедуры. Самое тревожное осложнение - смерть, но это происходит только в одном из каждых 250 000 операций.
Миндалины и / или аденоиды можно удалить по нескольким причинам, включая:
• Повторные GABHS: для двухлетних детей более 4 эпизодов в год; для трехлетних детей более 3 эпизодов в год; и те, кто старше 3 лет, более 6 эпизодов в год, являются признаком удаления миндалин и аденоидов.
Обструктивное апноэ во сне
• Сильная инфекция, которая не реагирует на антибиотики
• Повторный абсцесс перитонсиллара
• Потенциальный рак
Стойкие дыхательные экстракты могут быть кандидатом на удаление аденоидов
• Постоянные проблемы с глотанием, если они вызваны большими миндалин или аденоидами
Что тебе нужно знать
Если у вас диагностировано стрептококковое горло:
• Не заражайте других. Не вступайте в тесный контакт с другими в течение 24 часов после начала антибиотиков.
• Съемные устные приборы (например, фиксаторы) должны быть полностью очищены.
• Через 24 часа следует использовать новую зубную щетку.
• Завершить весь курс антибиотика или резистентность к этому антибиотику.
• Симптомы, которые не улучшаются на 72 часа или ухудшаются после 48 часов, требуют медицинской оценки.
• Не принимайте какие-либо антибиотики, которые лежат вокруг дома для боли в горле, не посещая врача. Антибиотики аннулируют культуру горла.
Вопросы, чтобы спросить вашего поставщика медицинских услуг
1. Я болею ли горло горла вирусом или бактерией?
2. Нужна ли мне культура, чтобы определить, есть ли бактериальная инфекция?
3. Какие лекарства вы рекомендуете для лечения моих симптомов?
4. Вы рекомендуете какие-либо домашние средства?
5. Будет ли антибиотик помогать моей инфекции?
6. Существуют ли какие-либо потенциальные взаимодействия между препаратами, которые вы рекомендуете, и текущими лекарствами, на которых я работаю, или другими проблемами со здоровьем, которые могут возникнуть у меня?
7. Когда мне следует ожидать улучшения моего состояния?
8. Какие сложности я должен искать и как они появятся?
