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PubMed2004

Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis.

The severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to be transmitted primarily through dispersal of droplets, but little is known about the load of SARS-CoV in oral droplets. We examined oral specimens, including throat wash and saliva, and found large amounts of SARS-CoV RNA in both throat wash (9.58 x 10(2) to 5.93 x 10(6) copies/mL) and saliva (7.08 x 10(3) to 6.38 x 10(8) copies/mL) from all specimens of 17 consecutive probable SARS case-patients, supporting the possibility of transmission through oral droplets. Immunofluorescence study showed replication of SARS-CoV in the cells derived from throat wash, demonstrating the possibility of developing a convenient antigen detection assay. This finding, with the high detection rate a median of 4 days after disease onset and before the development of lung lesions in four patients, suggests that throat wash and saliva should be included in sample collection guidelines for SARS diagnosis.

Adult↗

PubMed1999

[Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway].

We studied which device is most useful to reduce postoperative sore-throat. We investigated the relationship between intracuff pressure and postoperative sore-throat in using endotracheal intubation (ET), the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) in adult patients. We classified sore-throat into categories; pain at rest, hoarseness and dysphasia. We evaluated pain at rest by the score (0: no pain, 1: mild discomfort, 2: mild pain, 3: severe pain). Pain at rest (scores 1, 2, 3) was complained by 10 patients in ET group, 3 in LMA group, 5 in COPA group on the day of operation, showing significantly lower incidence of pain at rest in LMA group than in ET group. Hoarseness was complained by 15 patients in ET group, 2 in LMA group and 4 in COPA group, showing significantly lower incidence of hoarseness in LMA and COPA groups than in ET group. Dysphasia was complained by 3 in ET group, 1 in LMA group and 2 in COPA group, showing no significant difference. These results suggest that LMA is most appropriate to reduce postoperative sore-throat.

Adult↗

PubMed2000

[Guidelines for diagnosis and treatment of sore throat].

BACKGROUND: Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines. MATERIAL AND METHODS: We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants. RESULTS: Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt. INTERPRETATION: Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision-making if they want antibiotics.

Anti-Bacterial Agents↗

PubMed2000

[Guidelines for diagnosis and treatment of sore throat].

Anti-Bacterial Agents↗

PubMed2000

How effective are treatments other than antibiotics for acute sore throat?

To estimate the benefits of treatments other than antibiotics for acute sore throat, and the differences between non-antibiotic interventions and controls in patient-perceived pain of sore throat, a systematic review of controlled trials in Medline and the Cochrane Library was carried out. Sixty-six randomised controlled trials (with or without additional antibiotics) were identified and 17 met the selection criteria. Twenty-two non-antibiotic managements for sore throat were compared. Their efficacy relative to placebo ranged from no effect to 93%. Some non-antibiotic treatments may be more effective than antibiotics; however, publication bias may have exaggerated the benefits. These treatments should be investigated further with respect to efficacy, safety, and side-effects as potential firstline management options for acute sore throat.

Acetaminophen↗

PubMed2002

Understanding variation for clinical governance: an illustration using the diagnosis and treatment of sore throat.

BACKGROUND: The aim of clinical governance is to improve clinical care. An understanding of the information contained in variation is central to any improvement effort. We must distinguish between variation intrinsic to a process (common cause variation) and variation caused by extrinsic factors (special cause variation). The control chart is a method of distinguishing between these two kinds of variation: it is used in industry to effect improvement and may be useful in primary care. AIM: To illustrate the use of control charts to distinguish between common cause and special cause variation and to guide appropriate action. DESIGN OF STUDY: Analysis of diagnostic and treatment decisions for sore throat. SETTING: Single practice in the West Midlands. METHODS: We identified each general practitioner's (GP's) consultations for sore throat over a two-year period. We grouped these into two diagnostic categories (tonsillitis and non-tonsillar throat infection) and two treatment categories (antibiotics and no antibiotics). These data were illustrated graphically as XY control charts. RESULTS: In this practice, a special cause affects one GP's diagnosis--he is less likely to use the term 'tonsillitis'. A special cause also affects his treatment decisions--he is more likely to prescribe antibiotics. Diagnostic and treatment differences between the remaining GPs are consistent with common cause variation. CONCLUSION: In this practice, action to improve the quality of diagnosis and treatment of sore throat shouldfocus on investigating why one practitioner's diagnosis and treatment differs from that of his colleagues. Control chart analysis is valuable because it enables users to obtain practical guidance for action.

Decision Making↗

PubMed1975

Bacterial flora of the ear, nose and throat in aboriginal infants from brisbane and cherbourg.

A total of 1,044 nose and throat swabs and 54 ear swabs were collected from 219 Aboriginal babies in Brisbane and at Cherbourg over a two-and-a-half year period. The incidence of Staphylococcus aureus was found to be similar for both localities (approximately 20% in nasal swabs and 12% in throat swabs). Enterobacteria were found much more commonly at Cherbourg (43% in nasal swabs, 60% in throat swabs). Fifty-four ear swabs produced a wide variety of organisms with proteus species most common. Changes in the nose and throat flora over the period of examination are noted.

Australia↗

PubMed2003

[Two hospital staff with throat carriage of methicillin-resistant Staphylococcus aureus, which had to be treated with systemic antibiotics].

Two hospital staff, women aged 20 and 22 years, were inadvertently found to be positive for methicillin-resistant Staphylococcus aureus (MRSA). Both had been in a hospital outside of the Netherlands, but due to the long period of time that had elapsed since then, they did not fall under the standard protocol for MRSA screening. After the usual wash procedure with chlorhexidine and mupirocin nasal ointment treatment, they remained positive for MRSA in the throat culture. Both patients still had their pharyngeal tonsils and were suffering from throat complaints. After systemic treatment with two antibiotics, they both became MRSA-free. Throat carriership of MRSA might be a reason why MRSA eradication fails in the case of apparently healthy healthcare workers. The addition of a throat culture to the screening of healthcare workers would therefore be useful.

Administration, Intranasal↗

PubMed2003

[Isolation and identification of SARS-coronavirus in nasal and throat swabs collected from clinically diagnosed SARS patients].

OBJECTIVE: To isolate and identify SARS-coronavirus in nasal and throat swabs collected from clinically diagnosed severe acute respiratory syndrome (SARS) patients. METHODS: Nasal and throat swab specimens were inoculated onto well of 24-well plate containing confluent monolayers of Vero and MRC-5 cells. Isolates were identified with serology, electron microscopy and genome sequence. RESULTS: One hundred and fifty-eight nasal and throat swabs specimens from 79 SARS patients in Peking Union Medical College Hospital between April and May, 2003 were cultured for SARS-coronavirus. Cytopathic effect (CPE) was found in three nasal swab specimens inoculated in Vero cells. Acute and convalescent phase serum specimens collected from SARS patients were found with seroconversions and/or a fourfold or greater rises in indirect fluorescence antibodies (IgG and IgM) titers when the 3 isolates (infected Vero cells) were used as antigen. Coronavirus was observed in the culture supernatant by negative-stain electron microscopy. Genome sequence confirmed the isolates were SARS-coronavirus. CONCLUSIONS: The 3 isolates from nasal and throat swabs samples collected from 79 clinically diagnosed SARS patients were SARS coronavirus.

Adolescent↗

PubMed2004

Risk factors associated with postoperative sore throat after tracheal intubation: an evaluation in the postanesthetic recovery room.

BACKGROUND: Postoperative sore throat after tracheal intubation is an unpleasant and distressing experience to patients. The aim of the study was to carry out a large-scale search for the risk factors of postoperative sore throat in patients undergoing endotracheal general anesthesia. METHODS: During a 6-month study period, patients (> or = 10 years old) who consecutively underwent endotracheal general anesthesia for all kinds of surgical procedures were included. A total of 7541 patients were recruited in our study. RESULTS: Five risk factors associated with postoperative sore throat were identified. They were female gender, age between 30-39, surgical sites within the oral or nasal cavity, or around the neck, use of nitrous oxide during anesthesia, and duration of anesthesia longer than 2 hours. CONCLUSIONS: Five risk factors related to postoperative sore throat were identified in our study.

Adolescent↗

PubMed1992

Managing sore throat: a literature review. I. Making the diagnosis.

OBJECTIVE: To assess the justification for the routine use of investigations in the diagnosis of bacterial causes of sore throat. DATA SOURCES: The literature from 1945 to 1990 was systematically screened to identify studies that addressed diagnosis of bacterial infection and the efficacy of antibiotics in sore throat, using the key-words "pharyngitis" and "tonsillitis". RESULTS: Difficulties were identified with clinical methods and investigations that identify streptococcal infections. The practice of throat-swab culture--the "gold standard"--appears to have developed as a strategy to protect patients from acute rheumatic fever. However, this method may be limited in its usefulness for protection against acute rheumatic fever because: (i) in many cases in which the streptococcus is isolated from symptomatic patients there is no serological evidence of infection; (ii) there are very high asymptomatic carrier rates of the streptococcus; (iii) even after adequate treatment with penicillin there are high bacteriological failure rates; and (iv) those organisms that can be isolated from the mucosal surface are a poor representation of organisms lying deep in the tissues. Evaluation of other diagnostic techniques such as Gram's stain and rapid antigen testing, as well as decision analysis, has also been hampered by the difficulties encountered with use of this inadequate gold standard. CONCLUSION: There is little indication from the literature that any routine system of identifying bacterial causes of sore throat is helpful to the clinician.

Bacteriological Techniques↗

PubMed2004

Epizootiology of arenaviral infections in the white-throated woodrat (Muridae: Sigmodontinae) and other woodrats in Arizona.

The purpose of this study was to extend and refine our knowledge of the geographical distribution and natural host relationships of the arenaviruses associated with woodrats indigenous to Arizona. Antibody to a Tacaribe serocomplex virus was found in 112 of 1,250 white-throated woodrats, five of 208 Mexican woodrats, one of 114 Stephen's woodrats, and none of 862 other rodents captured at 51 sites in 10 counties in Arizona. Of the 112 antibody-positive white-throated woodrats, 109 (97.3%) were captured within extensive, dense patches of prickly pear cactus and cane cholla in three counties in mid-central Arizona. Analysis of the serological and zoographical data suggested that white-throated woodrats usually become infected early in life and that the distribution of antibody-positive white-throated woodrats in Arizona is not linked to a specific biome.

Animals↗

PubMed2004

Acute thoracic aortic dissection presenting as sore throat: report of a case.

Acute dissection of the aorta can be one of the most dramatic of cardiovascular emergencies. Its symptoms can occur abruptly and progress rapidly. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. Aortic dissection presenting as a sore throat is quite unusual. A 53-year-old man presented with sore throat as the early symptom of an acute thoracic aortic dissection. Unfortunately, the diagnosis was delayed, and the patient died. Given the high morbidity and mortality after delayed recognition or misdiagnosis, aortic dissection should be considered in the differential diagnosis of a patient presenting with sore throat and normal findings of neck and throat, even when there is no classic symptoms.

Aortic Dissection↗

PubMed1992

Sore throat after endotracheal intubation.

Nitrous oxide can diffuse into the cuff of an endotracheal tube during tracheal intubation, and the cuff pressure against the tracheal wall may cause mucosal damage. An endotracheal tube has been developed (Brandt Anesthesia Tube) that effectively limits nitrous oxide-related intracuff pressure increases. We determined whether the incidence of postoperative sore throat could be reduced by using this tube. Forty-eight female patients, 18-50 yr of age, were included in the study. Endotracheal intubation was performed with either a Brandt Anesthesia Tube or a Mallinckrodt endotracheal tube. All patients were interviewed postoperatively after 20-30 h by individuals who did not know which tube was used. In the Mallinckrodt group, 12 of 20 patients had a sore throat and 10 patients had intracuff pressures greater than 25 mm Hg. Only 3 of 20 patients in the Brandt group had a sore throat. We found that the incidence of sore throats after intubation could be significantly reduced by using the Brandt Anesthesia Tube (P less than 0.005).

Adolescent↗

PubMedDate not supplied

[The impact of a sore throat score on clinical management of streptococcal angina].

OBJECTIVE: To establish the validity and the role of a clinical sore throat score in clinical management of streptococcal angina on a first visit to a primary care provider. METHODS: This study included 168 patients. The sore throat score had 5 criteria: age, fever, absence of cough, tender anterior cervical nodes, tonsillar swelling or exudate. The score range is -1 to 5. RESULTS: Of the 168 patients, 53 (31.5%) had a positive culture result for beta hemolytic streptococci. Compared with throat culture a score = 3 has a sensitivity of 62.,26% (95%CI: 47.9%-75.2%), a specificity of 78.26% (95%CI: 69.6%-85.4%). Efficiency of this score is 73.21%. CONCLUSIONS: The clinical sore throat score may assist the primary care providers in estimating that a patient has streptococcal angina without replacing rapid antigenic testing or culture.

Adolescent↗

PubMed1991

Diagnostic considerations in the evaluation and treatment of sore throat.

Adults with sore throats make 40 million visits to medical facilities each year, and sore throat is the third most common reason for visits to primary care practitioners. While often associated with pharyngitis, a complaint of sore throat may also herald a variety of other underlying disorders, both common and uncommon. These disorders range from local to systemic diseases, and include infectious as well as non-infectious etiologies. This article focuses on the differential diagnosis of sore throat and reviews useful approaches to the evaluation of this prevalent symptom. Specific strategies for history taking, key findings to look for on physical exam and recommendations for the selection of appropriate laboratory studies are included. A summary of management options for the more common problems is also provided.

Diagnosis, Differential↗

PubMed1978

Evaluation of pharmacist management of streptococcal throat infections in a health maintenance organization.

A program within a health maintenance organization in which pharmacists were delegated the responsibility of treating and managing adult patients whose throat culture results were positive for group A, beta-hemolytic Streptococcus was evaluated. Results of 50 patients who received diagnostic throat cultures and treatment from internists, physician's assistants and nurse practitioners were compared with results of 58 patients treated and managed by pharmacists who followed procedures defined by physicians. Six hypotheses were tested with respect to the pharmacy program: (1) provider time is saved; (2) the time between throat culture and therapy initiation is shortened; (3) there are fewer return sick visits; (4) there are more reculture follow-up visits; (5) the medication regimen which exhibits a higher rate of cure (oral vs injection) is used more often; and (6) cost savings are realized. Hypotheses 1, 2 and 6 were supported by the results, 3 and 4 were possibly supported, and 5 was not testable. Pharmacists appeared to be as effective as the other practitioners in the management and treatment of streptococcal sore throat.

Adult↗

PubMed1986

Comparison of throat culture and latex agglutination test for streptococcal pharyngitis.

Numerous reports have recently appeared in the clinical microbiology literature that describe agglutination tests for identifying patients with group A streptococcal pharyngitis. These studies have indicated a close correlation between the results of the agglutination tests and traditional throat culturing. This paper describes a comparison study of 100 consecutive throat swab specimens using a commercially available agglutination test and routine throat culturing. The cultures were interpreted by an individual who was blinded to the agglutination test results. All agglutination testing was done by two laboratory members of a family practice office staff. The agglutination procedure was easy to perform and clear to interpret. The test sensitivity and specificity compared well with that reported in the literature from microbiology laboratories. The new agglutination tests are useful in the office laboratory for the identification of group A streptococci. Their primary advantage compared with throat culturing is the rapid availability of test results.

False Negative Reactions↗