🌟 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.

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Sore throat

📊 Causes of Sore Throat

🔍 Clinical Approach

💊 Management Principles

🧑‍⚕️ Case Scenarios

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