Throat Infection Common Presentations
Please notice the enlarged tonsils with whitish grayish exudate. The strawberry tongue and patchy red bleeding dots (Petechiae).
Note the swollen tender lymph nodes.
The untreated infection can progress to form a pocket of pus pushing the tonsil to the opposite side,note the bulging of the soft palate and the deviated Uvula.
Treatment is surgical drainage of the abscess in ER or OR
Aphthous UlcerSingle or multiple shallow painful ulcer, its cause is not very clear , it can occur without any obvious disease but it may happen with autoimmune diseases or can be a sign of weak immune system such as HIV
Some viral infections cause painful throat with pin head vesicles that turn to ulcers in atypical locations
These conditions are:
Herpangina, Hand, foot and mouth disease and Herpes Simplex I
should be suspected in a teenager who has persistent tonsillitis with enlarged neck lymph nodes (may have enlarged liver and spleen)who fails antibiotics treatment. Cytomegalovirus can have similar presentation.
Pharyngitis & Tonsillitis
- 5 to 15% of throat infections are caused by Bacteria the rest are viral thus most throat infections are viral
- The viral causes are Rhinoviruses, Corona ,Influenza, Parainfluenza and Adenoviruses
- The most common bacterial cause is Streptococcus Pyogenes A
- Strep C & G cause minority of bacterial infections
- Fusobacterium Necrophorum is becoming prevalent among adolescent and young adults
- Throat examination alone is not enough to diagnose or to rule out Strep.
- Strep can cause tonsils swelling with exudate (white gray patches) or just mild throat redness
- Strep Testing is recommended if you have 3 of the following: 1- fever 2-swollen lymph nodes 3- pus on the tonsils 4-lack of cough or cold symptoms
- Oral antibiotics are indicated if you have all 4 symptoms(above) even with negative Strep test
- Treatment for Strep or bacterial infection is best with penicillins or cephalosporins if there is Penicillin allergy Clindamycin NOT Azithromycin is recommended
- A single dose of oral steroids (prednisone) is recommended if there is significant throat swelling
- Some Viral infections like infectious mono can mimic Strep and cause tonsils enlargement with whitish patches.
- Sexually transmitted diseases can cause sore throat ( Herpes ,Gonorrhea and Syphillis)
- Throat bacterial culture is indicated in selected cases not all
- Rarely other bacteria can be the cause of persistent sore throat like C. Diphtheriae
- Peritonsillar abscess is a complication of severe untreated throat infection and requires ER visit and surgical drainage
- Recurrent infection in children with cryptic tonsils(tonsils with pockets that makes infection eradication difficult) my require ENT consultation for possible tonsillectomy.
- Recurrent or chronic Strep infection is associated with increased risk for Rheumatic Fever (heart valve damage) or Glomerulonephritis (Kidney inflammation and damage).