Sore Throat and Upper respiratory tract infections
Upper respiratory tract infections are one of the most regular reasons people go to the emergency room today. These diseases affect the sinuses, nasal passages, pharynx, and larynx, which are all parts of the upper airway. In the U.S., upper respiratory tract infections are a typical reason for kids to miss school, and they tend to happen in the fall and winter (Madran et al., 2019). Sore throat is one of the diseases that affect the upper airway and cause inflammation of the pharynx and other structures nearby. Most sore throats don’t need medical help because they are caused by viruses. But a sore throat that lasts more than a week needs to be checked out by a doctor and may need medicines.
Tells about the case
I met a 12-year-old girl who had a sore throat and a cough. The mother said this was the second time they had met in the past three weeks. In the last time they met, the mother said she used Ibuprofen to relieve pain, and it worked great. But after a week, the sore throat came back and kept getting worse. During the test, I found that the patient had a dry mouth and said it hurt to swallow. She said her pain was a 7 on a scale from 0 to 10. The mother also said that it hurt to swallow so much that she hadn’t eaten for a day.
The patient’s medical history showed that she had seasonal allergies in the fall and took loratadine during those times. During the exam, the patient only said that she had some pain in her throat, a small headache, and pressure in her sinuses. The mother said that her fever the night before was between 37.8°C and 38.1°C. Except for her high fever, her other vital signs were fine. When she spoke, her voice was hoarse, and she said it hurt to speak. A closer look showed that the belly was a little sore. Her shots were all up to date.
Acute Group Children often get a disease called streptococcus pharyngitis (GAS) in the winter and early spring. GAS pharyngitis testing was needed because of the patient’s age, the time of year, and how he or she was acting. Before deciding how to treat the patient, the original plan was to do some tests in the lab and a rapid streptococcus antigen test (Centers for Disease Control and Prevention, 2019). I also knew that a follow-up GAS culture was needed to prove that the illness was caused by bacteria.
The results of the lab tests were normal: Na was 1344, K was 4.6, Creatinine was 0.6, platelets were 333, and BUN was 18. The results of the quick strep antigen test were not positive. Even though the GAS test came back negative, it was wrong to think that the sore throat was caused by a virus. I also noticed that most of the signs pointed to a bacterial infection, like a fever, a slight headache, and tenderness in the abdomen. To prove the diagnosis, the new plan was to do a throat culture. (Centers for Disease Control and Prevention, 2018) Throat cultures must be kept warm for at least 18 to 48 hours to be sure that strep germs are present. In the meantime, I had to decide if I should keep taking antibiotics or wait for the test results.
Antibiotics are given to about 70% of people who go to the emergency room with a sore throat, even though most of them don’t have bacterial illnesses. (Centers for Disease Control and Prevention, 2018) I chose to prescribe amoxicillin 250 mg three times a day for ten days. I also gave him 500 mg of aspirin by mouth three times a day for three days to stop the headache and fever. In the meantime, I told the monitor to let me know as soon as the results of the throat culture were ready. At home, the mother was supposed to make sure the child got enough rest and drank enough water. The next day, the GAS culture turned out to be positive, which meant that the patient could keep taking the antibiotics. The patient was much better the next day because her fever had gone down and she was able to eat. When the patient’s symptoms got better, it meant that the medicines were working and that the patient would get better soon.
Evaluation of the ResultsI think the way the patient was taken care of was right based on the signs and symptoms that were there. People say that the fastest way to find group A streptococcal throat infections is with the rapid strep test. This test is very sensitive and specific, and if it comes back clear, a throat culture can be used as a follow-up. The only thing I don’t like about the way it was done is that drugs were given before the results were sure. The throat culture came back positive, which made it important to use amoxicillin. Whether a sore throat is caused by a virus or bacteria, the symptoms can be similar. Oliver et al. (2018) say that a sore throat caused by a virus will also cause coughing, a runny nose, hoarseness, and pink eye. Before giving medicines to a patient with a sore throat, I will make sure to use these differentials.
Centers for Disease Control and Prevention., 2018. Group A streptococcal (GAS)disease: Strep throat. Retrieved from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#:~:text=Penicillin%20or%20amoxicillin%20is%20the,is%20common%20in%20some%20communities.
Centers for Disease Control and Prevention., 2019. Antibiotic prescribing and use in doctor’s office: Sore throat. Retrieved from https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/sore-throat.html
Madran, B., Keske, Ş., Uzun, S., Taymaz, T., Bakır, E., Bozkurt, İ. and Ergönül, Ö., 2019. Effectiveness of clinical pathway for upper respiratory tract infections in emergency department. International Journal of Infectious Diseases, 83, pp.154-159. https://doi.org/10.1016/j.ijid.2019.04.022
Oliver, J., Wadu, E.M., Pierse, N., Moreland, N.J., Williamson, D.A. and Baker, M.G., 2018. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLoS Neglected Tropical Diseases, 12(3), p.e0006335. DOI: 10.1371/journal.pntd.0006335
Sykes, E.A., Wu, V., Beyea, M.M., Simpson, M.T. and Beyea, J.A., 2020. Pharyngitis: Approach to diagnosis and treatment. Canadian Family Physician, 66(4), pp.251-257.
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