Related Subjects:
|Acute Epiglottitis
|Croup
|Acute Tracheitis
|Stridor
🌟 Sore Throat: Causes, Assessment & Red Flags
Sore throat is one of the most common reasons for primary care and emergency consultations.
Most cases are viral and self-limiting, but a small proportion may be life-threatening (e.g. epiglottitis, peritonsillar abscess, neutropenic sepsis).
Always assess airway, breathing, circulation first.
⚠️ If stridor, drooling, muffled voice, or respiratory distress → call for senior/anaesthetic/ENT help immediately.
📊 Causes of Sore Throat
| Cause |
Typical Features |
Red Flags / Notes |
| 🦠 Viral Pharyngitis (EBV, CMV, HSV1) |
Fever, sore throat, tonsillar exudate, lymphadenopathy, fatigue, hepatosplenomegaly |
Monospot + if EBV; avoid ampicillin (rash); splenic rupture risk → no contact sports |
| 🧬 HIV Seroconversion |
“Mono-like” illness, mucocutaneous ulcers, rash, lymphadenopathy |
Always ask about risk factors; offer HIV testing in atypical cases |
| 👶 Stomatitis / Herpangina (HSV1, Coxsackie) |
Painful oral ulcers/vesicles, dysphagia, fever (young children) |
Risk of dehydration due to pain on swallowing |
| 🧫 Bacterial Pharyngitis (Strep pyogenes) |
Sudden sore throat, fever >38.3°C, tonsillar exudates, tender anterior nodes |
Use Centor/McIsaac; Scarlet fever rash may occur; antibiotics reduce rheumatic fever risk |
| 💉 Diphtheria |
Grey pseudomembrane, “bull neck”, fever |
Rare in UK (vaccination); can cause myocarditis, neuropathy |
| 😷 Epiglottitis |
Rapid onset, severe sore throat, drooling, muffled voice, tripod posture |
Airway emergency → anaesthetic + ENT input; thumbprint sign on X-ray |
| 🪶 Croup (Laryngotracheobronchitis) |
Infants/toddlers, barking cough, stridor, hoarseness |
Parainfluenza commonest; unlike epiglottitis, no drooling |
| 🧪 Bacterial Tracheitis |
Post-viral, stridor, fever, toxic appearance, purulent secretions |
Mimics epiglottitis; airway compromise risk |
| 🧴 Chemical/Caustic Injury |
Ingestion history, oral burns, drooling, severe throat pain |
Urgent ENT + endoscopy; airway risk |
| 🧬 Lemierre’s Syndrome |
Severe sore throat, fever, neck pain/swelling |
Septic IJV thrombophlebitis → septic emboli to lungs; IV antibiotics ± anticoagulation |
| 🗣 Laryngitis |
Hoarseness, mild sore throat, normal throat exam |
Usually viral; persistent hoarseness → exclude malignancy |
🔍 Clinical Approach
- 🧾 History: Onset, severity, systemic features (fever, rash, malaise), swallowing difficulty, airway symptoms.
- 👄 Examination: Throat inspection (if safe), lymph nodes, hydration status, chest auscultation.
- 🧪 Investigations: FBC (look for neutropenia), throat swabs if bacterial suspected, Monospot for EBV, HIV testing if risk factors, lateral neck X-ray if epiglottitis suspected.
💊 Management Principles
- Most viral causes → supportive (hydration, analgesia, rest).
- Strep throat → consider antibiotics if Centor ≥3 or severe/systemic features.
- Airway emergency (epiglottitis, tracheitis, caustic ingestion) → urgent ENT/anaesthetics.
- Lemierre’s → IV antibiotics ± anticoagulation.
- Educate patients on red flags: drooling, difficulty breathing, stridor, persistent fever.
🧑⚕️ Case Scenarios
Case 1:
18-year-old with fever, sore throat, tonsillar exudates, cervical nodes, hepatosplenomegaly.
→ Likely EBV mononucleosis. Avoid ampicillin. Advise no contact sports.
Case 2:
4-year-old with barking cough, stridor, hoarse voice after viral prodrome.
→ Croup. Manage with oral dexamethasone ± nebulised adrenaline if severe.
Case 3:
45-year-old sore throat, fever, “bull neck”, grey membrane in throat.
→ Diphtheria. Notify public health, airway management, antitoxin + antibiotics.
Case 4:
22-year-old with sore throat, neck pain, fever, septic emboli on CXR.
→ Lemierre’s syndrome. Needs IV antibiotics + urgent ENT/ID input.
