Brief introduction about sore throat

1. Sore Throat
Made By : Niteesh Kumar

2. Introduction
 Sore throat is one of the most common symptoms encountered.
 It is disease of upper respiratory tract infection.
 Patients use the term to describe almost any feeling in the throat,
ranging from dryness to actual pain – important to ascertain
the precise nature of sore throat & severity early in clinical
history.
Severity – dysphagia for solid?, liquids?, saliva?

3. Etiology of Sore Throat
• Most common cause of sore throat : Viral infection
• Most common bacteria causing sore throat : Streptococcus pyogenes
• The majority of sore throats in children are of viral origin.
• Pharyngitis (Sore Throat) is an inflammatory condition with may
be along with/without tonsilitis so pharynx and associated
area are inflamed , red , painful, swollen & show exudates.
 Most common streptococcal disease.

4. Bacteria Viruses Other Causes
• Group A ß-haemolytic
Streptococcus pyogenes
• Groups C,G and F
streptococci
• Arcanobacterium
haemolyticum
• Neisseria gonorrhoeae
• Treponema pallidum
• Chlamydia pneumoniae
• Mycoplasma pneumoniae
• Mycobacterium
tuberculosis
• Francisella tularensis
• Corynebacterium
diphtheriae
• Yersinia enterocolitica
• Yersinia pestis
• Trichomonas vaginalis
• Rhinovirus
• Coronavirus
• Para-influenza
• Influenza types A and B
• Human immunodeficiency virus
• Adenovirus
• Epstein-Barr virus
• Herpes simplex virus types 1 and 2
• Cytomegalovirus
Fungal Cause :
• Candida albicans
• Abscess (peritonsillar, parapharyngeal,
retropharyngeal)
• Epiglottitis
• Cancer (squamous cell carcinoma,
lymphoma)
• Autoimmune (Behçet’s disease, benign
mucous membrane pemphigoid,
sarcoidosis)
• Laryngopharyngeal reflux
• Postnasal drip
• Eagle’s syndrome
• Glossopharyngeal neuralgia
• Crohn’s disease
• Toxoplasmosis
• Foreign body
• Trauma

5. Viral Mechanisms :
 Coxsackie virus causes small vesicles to form with erythematous
bases that can ulcerate and spread over the anterior
tonsillar pillars, palate and pharyngeal wall.
 Herpes simplex virus is normally associated with a ‘cold sore’. It affects
older children and young adults, and may cause exudative or
non-exudative pharyngitis.
 EBV infection can lead to very rapid enlargement of tonsils
(sudden onset of snoring in patient with large dirty-gray tonsils).

6. The sore throat associated with influenza may be
distinguished from streptococcal pharyngitis by several
features:
• Presence of influenza cases in the community (epidemic)
• Association with cough
• Myalgias.

7. Pharyngitis due to Group A β-haemolytic
streptococci (GABHS)
• Sudden onset
• Sore throat
• Fever
• Headache
• Nausea, vomiting, and abdominal pain
• Inflammation of pharynx and tonsils
• Patchy discrete exudate
• Tender, enlarged anterior cervical nodes
• Patient aged 5 - 15 years
• Presentation in winter or early spring
• History of exposure

9. Acute Pharyngitis
Etiology –
Virus Bacteria Fungi Others
• Rhinovirus
• Coronavirus
• Para-influenza
• Influenza types A
and B
• Human
immunodeficiency
virus
• Adenovirus
• Epstein-Barr virus
• Group A ß-
haemolytic
Streptococcus
pyogenes
• Groups C,G and F
streptococci
• Arcanobacterium
haemolyticum
• Neisseria
gonorrhoeae
• Candida
albicans
• Chlamydia
trachomatis
Toxoplasmosis

11. Investigation :
Culture of throat swab
• Diagnosis of bacterial pharyngitis
• Can detect 90% of Group A Streptococci
**Failure to get any bacterial growth suggests a
viral aetiology

12. Chronic Pharyngitis
It is a chronic inflammatory condition of the pharynx
• Pathologically:
Hypertrophy of mucosa, seromucinous glands,
subepithelial lymphoid follicles and muscular coat of
pharynx
Two types :
1. Chronic Catarrhal Pharyngitis
2. Chronic Granular Pharyngitis

13. Etiology

14. Symptoms :
• Discomfort or pain in the throat
Specially in the morning
• Foreign body sensation in throat
Has constant desire to swallow or clear his throat to get rid of ‘foreign
body’
• Tiredness of voice
Cannot speak for long, voice lose quality and may crack
• Cough
Tendency to cough as throat is irritable

15. Chronic Catarrhal Pharyngitis Chronic Hypertrophic
(Granular) Pharyngitis
• Congestion of posterior
pharyngeal wall
• Engorgement of vessels
• Thickened faucial pillars
• Increased mucus secretion which
cover pharyngeal mucosa
• Pharyngeal wall appears thick
and oedematous with congested
mucosa and dilated vessels
• Post pharyngeal wall may be
studded with reddish nodules
• Lateral pharyngeal bands
became hypertrophied
• Uvula may be elongated and
appears oedematous

16. Chronic Catarrhal
Pharyngitis
Granular pharyngitis :
Reddish nodules on the posterior
pharyngeal wall

17. Treatment
• Aetiological factor should be sought and eradicated
• Voice rest and speech therapy for patients with faulty
voice production
• Hawking, clearing the throat frequently should be
stopped
• Warm saline gargles (especially in the morning) – to
soothe and relieve discomfort

18. Lab Diagnosis
A. SPECIMEN
Throat swab from fauces (part of oropharynx directly behind the mouth
cavity )
B. COLLECTION
*Two sterile swabs should be used , one for direct microscopy and
other for culture
*Swabs should be rubbed over the tonsillar fossa , pseudomembrane if
present and finally the post pharyngeal wall.
*These swabs should include exudate present in the throat , should be
quickly sent to lab ; if not so then swabs should be refrigerated .

19. c. Direct Microscopy
Gram Staining and Albert Staining may be used for staining the smears.
A. GAS is a Gram-positive that
occurs in chains or in pairs
of cells.

20. Corynebacterium dephtheriae

21. Gram stain
demonstrating
Gram-negative
diplococci in pairs
suggestive of
Neisseria
gonorrhoea

22. Culture Morphology
• Culture media are selected according to the organism suspected to be
the causative agent of sore throat. Following media may
be used for culture.
• Blood Agar – All the organisms will grow on this medium
• Crystal violet blood agar- It is selective medium for Str. pyogenes
• Potassium tellurite blood agar - It is selective media for growing
C. diphtheriae
• Sabouraud dextrose agar (SDA) – When suspecting Candida albicans ,
SDA should be included.

23. • These culture media are incubated at 37°C for overnight.
• In case of potassium tellurite blood agar , it should be
incubated for 48 hours.
• After 6-8 hours a subculture should be made from
Loeffler’s serum slope onto potassium tellurite blood
agar , which is then incubated at 37°C for 48 hours.

24. Strept. pyogenes
Pin Point (0.5-1mm) ,
round or convex colonies
with entire margins .
Colour is greyish white ,
no specific odour
Having wide zone of β-
hemolysis

25. Corynebacterium diphtheriae
•On potassium tellurite
blood agar black
coloured round colonies
are seen

26. ELEK TEST
It is an in vitro immunoprecipitation (immunodiffusion) test to
determine whether or not a strain of Corynebacterium diphtheriae is
toxigenic.
Antitoxin diffuses away from
the strip of filter paper where
as toxin produced by
toxin-producing strains
diffuse away from growth.
At the zone of equivalence a
precipitin line is formed.

27. Candida albicans
White or cream
coloured
colonies are
seen

28. (A) Growth of Candida
albicans on Sabouraud
dextrose agar (SDA);
(B) obverse view of C.
albicans on SDA
culture tube;
(C) reverse view of C.
albicans on SDA
culture tube;
(D) C. albicans produces
true germ tubes with
lactophenol cotton
blue (LCB) stain; and
(E) chlamydospores of C.
albicans with LCB
stain.

29. Influenza Virus
1) Specimen : Nasopharyngeal swab kept at 4°C.
2) Isolation of virus
3) Viral antigen detection by direct IF test.
4) Real Time RT-PCR
5) Antibody detection by hemagglutination inhibition test , ELISA,
neutralising test.

30. Epstein Barr Virus
Paul – Bunnell Test
EBV specific antibody detection
 Ab to viral capsid antigen (VCA)
 Ab to early antigen (EA)
 Ab to Epstein Barr nuclear antigen (EBNA)
Detection of EBV DNA
Real Time PCR

31. Complications of Sore Throat
• Tonsilitis, peritonsillar abscess
• Sinusitis
• Mastoiditis
• Ear infection (otitis media)
• Laryngitis
• Rheumatic fever and glomerulonephritis (GABHS)

33. Treatment , Control And Prevention
General measures
• Bed rest
• Plenty of fluids
• Warm saline gargles or pharyngeal irrigations
• Severe case – lignocaine viscous to relieve local
discomfort in throat and facilitate swallowing.
Symptomatic treatment with/without antimicrobials.

35. Thanku You