Sore throat is one of the commonest symptoms in general practice. It canbe cause by either bacterial, virus or fungal infection. It usually involvesthe upper respiratory tract. The most usual cause is a viral pharyngitis oracute tonsillitis where based on National Morbidity Survey (UK) nine episodesper year of both of this disease were diagnosed for every 100 patients and sorethroat itself account for about 5% of consultations in general practice peryear. Pharyngitis is the inflammation of the pharynx or tonsils. Adults withpharyngitis typically complain of sore throat, particularly when swallowing.Fever is often present with bacterial pharyngitis and may occur in associationwith headache or malaise.
Patients may note “swollen glands” or anterior neckpain related to lymphadenopathy.Many patients with viral pharyngitis also have signs and symptomsassociated with a viral upper respiratory infection (nasal congestion, coryza,hoarseness, sinus discomfort or tenderness, ear pain, or cough).The major goal of the evaluation of adults with sore throat or acutepharyngitis is to exclude potentially dangerous causes, to identify anytreatable causes, and to improve symptoms.
Identifying group A streptococcus(GAS) is important because timely treatment with antibiotics helps preventpoststreptococcal complications such as acute rheumatic fever 32. Theevaluation includes a thorough history, focused physical examination, anddiagnostic testing in selected patients.Patients calling in to the physician’s office who can reliably reportthat they have no fever and who have a cough in addition to their sore throatsymptoms would not meet criteria for diagnostic testing. Such patients can beadvised to stay home and monitor themselves for warning signs. They should becautioned to present for evaluation if fever develops, if they have difficultyswallowing or if they develop any unusually severe signs and symptoms(secretions, drooling, dysphonia, muffled “hot potato” voice, or neckswelling).Identifying patients with GASCentor criteria — The Centor criteria are a widely used and acceptedclinical decision tool 38-40.
These criteria are:?Tonsillar exudates?Tender anterior cervical adenopathy?Fever by history?Absence of cough The likelihood of having GAS increases with thenumber of Centor criteria. However, the Centor criteria are most useful inidentifying patients for whom neither microbiologic tests nor antimicrobialtherapy are necessary. Patients with fewer than three (0 to 2) Centor criteriaare unlikely to have GAS and, in general, should not receive either antibiotictreatment or diagnostic testing.Patients who do not have GAS — In the vast majorityof patients with a negative evaluation for GAS, the pharyngitis will resolve ina few days without sequelae and no further diagnostic measures are required2.
Symptomatic treatment should be offeredPatients needing further evaluation — Adults whotest negative for GAS and do not improve with symptomatic treatment within fiveto seven days or who have worsening symptoms, should be reassessed for apreviously unsuspected diagnosis (eg, infectious mononucleosis or primary HIVinfection) or a suppurative complication (eg, peritonsillar abscess).