Sore throat

Question 1

Key points - sore throat

Answer 1

Viral pharyngitis is the most common cause of sore throat in children
Group A streptococcus (GAS) is the most frequently implicated bacterial pathogen. It is usually self-limiting, difficult to distinguish from viral infection and empiric antibiotic therapy is not required for most patients
Children identified to be at high-risk for acute rheumatic fever (ARF) should be treated with antibiotics if they develop a sore throat (irrespective of other clinical features)

Question 2

MCC of sore throat in children

Answer 2

Viral

Question 3

Cx ofGAS pharyngitis

Answer 3

non-suppurative complications (acute rheumatic fever, post-streptococcal glomerulonephritis) and suppurative complications (peritonsillar abscess, retropharyngeal abscess)

Question 4

Hx - sore throat paeds

Answer 4

Age and ethnicity
Oral intake
Associated viral features (cough, coryza, conjunctivitis, oropharyngeal ulcers, diarrhoea, typical viral rash)
Infectious contacts (see Invasive group A streptococcal infections: management of household contacts)
Household crowding
Immunosuppression (increased risk of iGAS and suppurative complications)
Immunisation status (in particular HiB vaccination)
High-risk groups for developing acute rheumatic fever (see Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease):
Aboriginal and/or Torres Strait Islander people
Māori and/or Pacific Islander people
Personal history of rheumatic fever or rheumatic heart disease
Those living in communities with high rates of ARF

Question 5

Examination sore throat paeds

Answer 5

Children with signs of acute upper airway obstruction should have minimal examination to not upset the child further

Hydration status
Fever
Oral/pharyngeal ulcers
Tonsillar exudates, hypertrophy, asymmetry
Uvula deviation
Tender anterior cervical lymphadenopathy
Hepatosplenomegaly (EBV, CMV)
Features of scarlet fever (GAS toxin response):
blanching, erythematous, sandpaper-like rash, usually more prominent in skin creases
flushed face/cheeks with peri-oral pallor
red strawberry tongue
confluent petechiae in skin creases (Pastia lines)

Question 6

Red flags - sore throat paeds

Answer 6

Unwell/toxic appearance
Respiratory distress
Stridor
Trismus
Drooling
“Hot potato” voice (muffled voice associated with pharyngeal/peritonsillar pathology)
Torticollis
Neck stiffness/fullness

In the acutely unwell child consider alternative diagnosis and/or complications of GAS pharyngitis

Question 7

Mng sore throat paeds

Answer 7

https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/Sore-throat-management.png

Supportive management is adequate for most sore throats
Supportive management
Simple analgesia
Corticosteroids-Consider in children with severe pain unresponsive to simple analgesia
dexamethasone 0.15 mg/kg (max 10 mg) oral/IV/IM as a single dose, or
prednisolone 1 mg/kg (max 50 mg) oral as a single dose
Hydration

ABX if suspected GAS pharyngits

Question 8

Ix -s ore throat paeds

Answer 8

Throat swab is not routinely recommended for sore throat
Consider other investigations if:
suspected suppurative complications (eg relevant imaging)
hepatosplenomegaly (FBE, EBV serology, +/- monospot)
Streptococcal serology has no role in diagnosis of GAS pharyngitis

Question 9

ABx for GAS pharyngitis

Answer 9

Phenoxymethylpenicillin
Amoxicillin

Question 10

Suppartive cx - sore throat

Answer 10

Peritonsillar abscess
Retropharyngeal abscess
Epiglottitis