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Sore Throat

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There are many different causes for sore throats. Some causes are easily treated, some require antibiotics, and some cannot be treated at all -- you just have to wait out the cause, although over-the-counter medicines can help relieve the pain.

Sore Throat Due to Dry Air

This is actually quite common -- I get them a lot myself in the winter, especially in cold weather when I forget to fill up the humidifier tanks with water. If the air is dry, your throat can dry out a bit with your breathing and become sore. Solution: drink plenty of fluids and make sure your house is humidified properly. (Older furnaces' humidifiers do not do a very good job of keeping the house properly humid, but the humidifiers newer high-efficiency furnaces seem to work much better. Even with a furnace humidifier you may still need table-top humidifers to stay comfortable.)

Sore Throat Due to Coughs, Colds, and Runny Noses

Coughing by itself can make your throat feel sore. So can postnasal drip -- mucus from the nose dripping down the back of the throat.

If you have a dry cough, cough suppressants -- some of which you can buy without a prescription -- can quieten the cough and cut down on throat irritation. If you are coughing because of postnasal drip, I believe you should not use cough suppressants -- I have seen people get pneumonia that way, since if the suppressants work you may not be able to clear your lungs properly. Sometimes decongestants can help reduce the postnasal drip and thus reduce the cough, but with viral colds decongestants may not do very much. Humidity and drinking fluids will help, since they will keep the mucus from getting thick -- thick mucus is much harder to cough out than thin mucus.

Sore Throat Due to Viruses

There are several viruses that attack the mucus membranes of the throat, the tonsils, or both. These viruses will often make your throat feel sore. Some of these viruses, like the adenoviruses, will also cause pus to accumulate on the tonsils just like strep does, and we need to test to see whether strep is the problem. Since there are no antibiotics for viruses, we still need to wait until the body gets rid of the virus itself, although humidity and fluids will soothe the throat and Tylenol will help with the pain.

Sore Throat Due to Streptococcus

(and Scarlet Fever, too...)

Although there are other bacteria that can attack the throat, the most common bacterial cause of strep throat is Streptococcus pyogenes, or "group A strep". (As with other bacteria, there are several different kinds of strep, which are similar overall but differ in some biochemical details -- and, because of those details, in the way they infect people. S. pyogenes, or group A, is the kind that usually infects throats and causes scarlet fever.)

The classic strep throat is very red (the description in some textbooks is "beefy red" or the colour of raw beef). Often you will see white or green "exudates" or pus on the tonsils, which are also swollen. You may also see little dark-red, almost purple, spots on the back of the roof of the mouth and on the uvula (the little "punching bag" that hangs from the center of the back of the mouth). The tongue may be very red with little white spots, like a strawberry (the "strawberry tongue") or white with little red spots, like a strawberry dipped in white chocolate. Sometimes a person with strep throat will have very bad breath, but this is not always true.

Usually a person with strep throat will have swollen and tender lymph nodes at the front sides of the neck, and the throat will hurt so much that even swallowing liquids is painful. Coughing is rare with strep throat, unlike viral or dryness-related soreness. Temperature may go up to 103 or more.

There are other things that can happen with strep throat. Scarlet fever is the best-known: this is a combination of strep throat with a rash, usually on the lower abdomen and spreading from there to the trunk, that consists of fine red bumps with a sandpaper-like consistency. The more important complications of strep throat, which usually do not happen unless the infection is left untreated for a long time, include

Rheumatic Fever and Rheumatic Heart Disease
Rheumatic fever is an inflammation of connective tissues which occurs sometime after an untreated group A strep throat. It can affect joints (hence the term "rheumatic") and one of its hallmarks is swelling and pain of large joints (shoulders, elbows, hips, and knees, for example), but the biggest problem with rheumatic fever is in inflammation of the heart valves, which can ultimately lead to heart failure.
Post-Streptococcal Glomerulonephritis
This is inflammation of the glomeruli (the blood filters of the kidney), again occuring after a strep infection. Often the first symptom is red or cola-coloured urine, since damage to the filter causes red blood cells, either intact or damaged,to appear in the urine. There is no specific treatment that will make the filters heal faster. Treatment is aimed at controlling the symptoms, the most dangerous of which are severe high blood pressure and kidney failure.

Fortunately, group A streptococcal infections are very easy to treat. No one has ever reported a case of strep throat that was not cured by penicillin. Penicillin G or V (the "plain" penicillins) usually work just fine, but have to be given as a shot (penicillin G) or 4 times a day on an empty stomach (penicillin V). Although some infectious disease specialists frown on it, amoxicillin also works well on strep, and has two advantages over penicillin V: it can be given 2 or 3 times a day, and it doesn't matter much if you give it on a full or an empty stomach. (Actually, there's a third advantage: it tastes better than penicillin V. As a pediatrician, that is important: antibiotics don't work well if the patient won't take it.) Other antibiotics, such as erythromycin, will work almost (but not quite) as well as the penicillins and can be used in patients allergic to penicillin.

One final note: although it is usually not associated with strep throat, group A strep can also produce a "necrotizing fasciitis" (the infamous "flesh-eating bacteria"). There is still little known about how group A strep gets this out of hand. The treatment still involves penicillin, but in most cases surgical "debridement" (removing the dead tissue) must also be done to help keep the bug in check.

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PLEASE NOTE: As with all of this Web site, I try to give general answers to common questions my patients and their parents ask me in my (real) office. If you have specific questions about your child you must ask your child's regular doctor. No doctor can give completely accurate advice about a particular child without knowing and examining that child. I will be happy to try and answer general questions about children's health, but unless your child is a regular patient of mine I cannot give you specific advice.

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Copyright © 1998, 2000, 2005, 2007, 2008, 2011 Vinay N. Reddy, M.D. All rights reserved.
Written 03/06/98; last revised 09/01/11 counter