Sore Throat Research Articles

A single-center experience in home management of mild and moderate COVID-19 cases.

The use of telemedicine for treatment of coronavirus disease 2019 (COVID-19) infection has been effective in lowering the risk of infection and relieving strain on the healthcare system. This study aimed to describe the clinical characteristics of COVID-19 cases, their follow-up, risk factors of disease severity, and predictors of hospital admission while using telemedicine. The study included 611 Egyptian patients with mild and moderate COVID-19 disease. The patients were isolated at home and monitored daily. Based on the World Health Organization classification, 79% of studied patients had mild illness while 20.5% had moderate illness. The initial symptoms included cough (51.7%), fever (50.8%), fatigue (45.9%), sore throat (41.1%), dyspnea (35.2%), and headache (34%); 25.2% patients had prolonged symptoms (≥ 21 days). Dyspnea was the most frequent (15.5%) long-term symptom. Age, co-existing diabetes, and COVID-19 infection with moderate severity, were associated with the need for hospitalization. We compared patients with COVID-19 infection who required hospital admission (n = 37) versus patients who continued in home isolation (n = 574). High neutrophil/lymphocyte ratio, transaminases, and ferritin significantly correlated with the need for hospitalization. 18.9% of the patients who required hospital admission had diabetes. Multivariate analysis described age and diabetes as independent predictors of disease severity. Age and high neutrophil/lymphocyte ratio were independent predictors of hospital admission. Telemedicine is effective in-home management of mild/moderate COVID-19 patients, which may ease the pressure on the healthcare system, even beyond the pandemic.

Detection of Virulence Genes Hla (α-hemolysis), CrtN (staphyloxanthin) for Staphylococcus aureus Isolated from Patients with Otitis and Rhinitis

Staphylococcus aureus is a bacterium that is capable of causing several types of infections acquired in hospitals and other healthcare facilities. The presence of S. aureus in the nasal cavity is significant for both the spread and development of infection. The goal of this study is to detect some virulence genes hla and CrtN of S. aureus. Thirty samples were collected from patients with otitis, and nose and throat infection from Al-Ramadi Teaching Hospital and external Labs for the period December 2021 to February 2022. Oti¬tis and Rhinitis swabs were taken from the patients and cultured on Mannitol salt agar and blood agar then gram stain and biochemical test were done. DNA was extracted from these isolates, and PCR was used to detect 16s rRNA, hla, and CrtN genes. The results showed after the phenotypic, microscopic, and biochem¬ical test, 20 isolates were referred to as S. aureus, which is approximately 66.6% of the total samples. The infection rate among youth and children was higher than that of the elderly and children in particular. Most bacterial infections of the pharynx, nose, and throat are the cause of S. aureus about 90%. DNA extract from 20 positive samples for S. aureus, the diagnosis of the samples was confirmed by 16s rRNA gene. The PCR results showed 18 samples carrying the hla gene by 90% of the total samples, while only 14 samples were carrying the CrtN gene at 80%.

The health and economic dimensions of honey production in Imo state, Nigeria

A study was conducted on honey production in Imo state of Nigeria, with a focus on the health and economic dimensions of the industry. The research was carried out using a multi-stage sampling procedure, and a sample size of 80 honey-producer respondents was selected. Data was collected through a well-structured questionnaire and analyzed using descriptive and inferential statistics. The study found that honey producers in the area had a mean age of 51 years, 11 years of education, 21 years of farming/bee-keeping experience, and a household size of 6 persons. The average annual household income was €709.10, with a farm size/number of hives kept of 72 hives per farmer and a quantity of honey produced per annum of 145 litres. The cost and returns analysis showed that the cost of production of honey per litre and profit per litre were €0.40 and €2.40, respectively. The study also determined the nutritional uses and health benefits of honey (e.g. healing wounds, treating ulcers, controlling sore throats and colds, boosting immunity, and as an antibacterial agent). Several factors, including uncontrolled bush burning, bee forage shortage, deforestation, theft of beehives, colony absconding, and poor agricultural practices which strongly constrain honey production has been observed. It is concluded that honey production is a very profitable venture with numerous uses and health benefits and venturing youths into honey production as a source of livelihood should be encouraged, and extension education should be tailored to technologies in beekeeping and the identification of genuine honey to minimize the success of adulteration, among others.

Analysis on Syndrome and Treatment of Shaoyin Cold Type Acute Tonsillitis

Acute tonsillitis belongs to the category of "milk moth" in traditional Chinese medicine. TCM clinical syndrome differentiation is often divided into two types: wind-heat pathogens affecting the lung meridian and dietary excess leading to heat accumulation in the lungs and stomach. The author's clinical practice found that some acute tonsillitis patients are often manifested as Shaoyin cold type, and the syndrome and treatment of general acute tonsillitis are totally different. "Throat Science Family Instructions" put forward the specific treatment of pharyngeal pain is Shaoyin typhoid type, and the prescription is Banxia Gangui Decoction, which is composed of eight kinds of drugs: Guizhi, Banxia, Fuling, Jiegeng, Yiyiren, Buguzhi, Ganjiang, and Zexie. It is traditionally used to treat symptoms such as sore throat, diarrhea, deep and thin pulse, and white tongue coating without thirst. Combining theory and clinical experience, the author reports successful clinical outcomes using this decoction to treat acute tonsillitis of the Shaoyin cold type. This paper aims to analyze the internal connection between Banxia Gangui Decoction and Shaoyin cold type acute tonsillitis. The paper outlines the symptom characteristics, etiology and pathogenesis, treatment based on syndrome differentiation, differential diagnosis of this condition, along with the therapeutic rationale for Banxia Gangui Decoction. A case study is included.

Mechanisms that potentially contribute to the development of post-streptococcal glomerulonephritis.

Post-streptococcal glomerulonephritis (PSGN) is primarily associated with preceding Group A streptococcal skin or throat infections, now mainly observed in economically disadvantaged communities. This condition significantly predisposes individuals to later-life chronic kidney disease and concurrent renal complications, with the elderly experiencing increased severity and less favourable outcomes. Streptococcal pyrogenic exotoxin B and nephritis associated plasmin receptor are identified nephritogenic antigens (nephritogens). Pathogenesis of PSGN is multifactorial. It can involve the formation of antigen-antibody immune complexes, causing inflammatory damage to renal glomeruli. Deposition of circulating immune complexes or in situ formation of immune complexes in glomeruli, or both, results in glomerulonephritis. Additionally, molecular mimicry is hypothesised as a mechanism, wherein cross-reactivity between anti-streptococcal antibodies and glomerular intrinsic matrix proteins leads to glomerulonephritis. Besides, as observed in clinical studies, streptococcal inhibitor of complement, a streptococcal-secreted protein, can also be associated with PSGN. However, the interplay between these streptococcal antigens in the pathogenesis of PSGN necessitates further investigation. Despite the clinical significance of PSGN, the lack of credible animal models poses challenges in understanding the association between streptococcal antigens and the disease process. This review outlines the postulated mechanisms implicated in the development of PSGN with possible therapeutic approaches.

Frequency of Group A Streptococcus Infection and Analysis of Antibiotic Use in Patients with Pharyngitis-A Retrospective, Multicenter Study.

Streptococcus pyogenes is responsible for 20-30% of pharyngitis in children and 5-15% in adults. The ineffective treatment of group A Streptococcus (GAS) infections can result in postinfectious sequelae. This study aims to evaluate the frequency of GAS pharyngitis and assess the management of patients with pharyngitis and antibiotic use. We conducted a multicenter, retrospective analysis of medical records from nine primary care centers in Poland. The study enrolled 1949 medical records of patients (children 67.4%, adults 32.6%). An infection of Streptococcus pyogenes, based on a rapid strep test, was diagnosed in 830 patients (42.6%). In the comprehensive study group of 1949 patients, 1054 (54.1%) were given antibiotics. Notably, 224 patients had a negative rapid strep test result but still received antibiotic treatment, underscoring the complexity of treatment decisions. The most commonly used antibiotics were oral penicillin V in 431 cases (41%) and amoxicillin in 219 cases (20.8%). We observed no significant difference between positive rapid strep test results and patients' sociodemographic data and comorbidities. The prevalence of GAS was 42.6% in the analyzed records of patients with pharyngitis, and 54.1% were prescribed antibiotics. Antibiotics were overprescribed for sore throats. Strategies are needed to promote rational antibiotic use.

The relationship between group A streptococcus test positivity and clinical findings in tonsillopharyngitis in children: systematic review and meta-analysis.

This study aimed to present an evidence-based conclusion through a systematic meta-analysis to distinguish clinical signs and symptoms associated with the presence of group A beta-hemolytic streptococcus, as confirmed by throat culture or rapid test, from those in cases without culture confirmation. The study protocol has been published in PROSPERO (CRD42023450854). Studies published between January 1, 2013 and August 15, 2023 were scanned in seven databases. The methodological quality of the articles was assessed using The Joanna Briggs Institution (JBI) Cross-Sectional Studies and Cohort Studies checklist. Effect size calculations were made using fixed effects and random effects models. A total of 22 articles were included in the systematic review, with 14 included in the meta-analysis. The prevalence of streptococcal pharyngitis in these studies ranged from 7.3 to 44.1%. According to the meta-analysis results, a significant association was observed between GAS test positivity and the presence of tonsillar exudate, palatal petechiae, tonsillar hypertrophy, dysphagia, fever, and cervical lymphadenopathy (p < 0.05). No significant relationship was found between GAS test positivity and symptoms such as headache, sore throat, cough, absence of cough, hoarseness, scarlatiniform rash, tonsillar erythema, vomiting, rhinorrhea, and abdominal pain (p > 0.05). The findings of the meta-analysis suggest that, in addition to the Centor criteria, palatal petechiae, dysphagia, and tonsillar hypertrophy are noteworthy indicators of GAS infection. Contrary to previous studies, our meta-analysis indicates that symptoms such as headache, sore throat, cough, absence of cough, hoarseness, scarlatiniform rash, tonsillar erythema, vomiting, rhinorrhea, and abdominal pain may not be associated with streptococcal infection. Further research is needed to elucidate these findings.

Survival of hospitalised COVID-19 patients in Hawassa, Ethiopia: a cohort study

The COVID-19 pandemic, caused by SARS-CoV-2, led to 622,119,701 reported cases and 6,546,118 deaths. Most studies on COVID-19 patients in hospitals are from high-income countries, lacking data for developing countries such as Ethiopia.This study assesses clinical features, demographics, and risk factors for in-hospital mortality in Hawassa, Ethiopia. The research cohort comprises 804 cases exhibiting clinical diagnoses and/or radiological findings and indicative of symptoms consistent with COVID-19 at Hawassa University Comprehensive Specialized Hospital from September 24, 2020, to November 26, 2021. In-hospital mortality rate was predicted using Cox regression. The median age was 45 years, with males making up 64.1% of the population. 173 (21.5%) fatalities occurred, with 125 (72.3%) among males. Male patients had higher mortality rates than females. Severe and critical cases were 24% and 21%. 49.1% had at least one comorbidity, with 12.6% having multiple. Common comorbidities were diabetes (15.9%) and hypertension (15.2%). The Cox regression in Ethiopian COVID-19 patients found that factors like gender, advanced age group, disease severity, symptoms upon admission, shortness of breath, sore throat, body weakness, hypertension, diabetes, multiple comorbidities, and prior health facility visits increased the risk of COVID-19 death, similar to high-income nations. However, in Ethiopia, COVID-19 patients were young and economically active. Patients with at least one symptom had reduced death risk. As a conclusion, COVID-19 in Ethiopia mainly affected the younger demographic, particularly economically active individuals. Early detection can reduce the risk of mortality. Prompt medical attention is essential, especially for individuals with comorbidities. Further research needed on diabetes and hypertension management to reduce mortality risk. Risk factors identified at admission play a crucial role in guiding clinical decisions for intensive monitoring and treatment. Broader risk indicators help prioritize patients for allocation of hospital resources, especially in regions with limited medical facilities. Government’s focus on timely testing and strict adherence to regulations crucial for reducing economic impact.

Drug-induced hypersensitivity syndrome due to phenytoin: Case report and review of the literature.

Drug hypersensitivity syndrome (DIHS) is a rare but potentially fatal adverse drug reaction characterized by fever, rash, and visceral organ damage, particularly affecting the liver. Early recognition and appropriate management are crucial to prevent serious complications. However, there is limited information on the clinical presentation and management of DIHS, especially in the context of antiepileptic drugs. This case report aims to highlight the importance of recognizing subtle clinical signs and symptoms of DIHS, which can be easily overlooked, particularly in the context of antiepileptic drug use. We report a case of a 15-year-old male patient who developed DIHS after being prescribed phenytoin sodium for epilepsy. The patient presented with symptoms of fever, sore throat, rash, jaundice, and liver dysfunction. Initially, the patient did not receive glucocorticoids and experienced additional reactions to cefoxitin and phosphatidylcholine, likely due to cross-reactivity. The diagnosis of DIHS was made based on the patient's clinical presentation, including fever, extensive rash, organ involvement, and hematological abnormalities. The temporal association with the use of phenytoin sodium, along with the exclusion of other causes of fever and rash, supported the diagnosis. Upon initiation of glucocorticoid therapy with dexamethasone, the patient's symptoms significantly improved. The rash and pruritus decreased, and laboratory values showed improvement, with a decrease in liver enzymes and normalization of white blood cell counts. The patient's fever resolved within 48 hours of starting corticosteroids, and there was no evidence of ongoing inflammation as indicated by a decrease in C-reactive protein levels. Furthermore, the patient's 30-month follow-up revealed no recurrence of rash, liver dysfunction, or organic damage, indicating the long-term effectiveness of the treatment administered. This case highlights the importance of recognizing the subtle clinical signs and symptoms of DIHS, especially in the context of antiepileptic drug use. It underscores the potential benefits of early initiation of glucocorticoid therapy in managing DIHS. The case also serves as a reminder of the potential for drug cross-reactivity in DIHS and the need for cautious drug selection during the acute phase of the syndrome.

Dermatological manifestations, and drug-induced reactions in COVID-19 patients: an observational study from İstanbul, Turkiye

Aims: The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, cough, sneezing, sore throat, rhinitis, dyspnoea, chest pain, malaise, fatigue, anorexia, and headache. Moreover, cutaneous manifestations have been observed in 0.2% to 20.4% of cases. This investigation further explores the dermatological manifestations associated with COVID-19 and reactions induced by its pharmacological treatments. Conducted at a university hospital, the study examined 841 patients and identified skin manifestations in 1.5% of cases. It differentiates between symptoms directly attributed to the viral infection and those arising from treatment, highlighting the need for clinical vigilance and adaptability in managing these manifestations. COVID-19 has been linked to a wide range of clinical symptoms, extending beyond the well-known respiratory effects to include various dermatological manifestations. These manifestations, which range from mild rashes to severe conditions like vasculitis, may complicate diagnosis and management, particularly when similar symptoms are induced by therapeutic drugs used in COVID-19 treatment. Methods: This cross-sectional study included 841 patients treated in the COVID-19 outpatient and inpatient units of the university hospital between March and May 2020. The assessment involved clinical examinations and telemedicine consultations, focusing on differentiating between viral and drug-induced dermatological reactions. Results: Dermatological manifestations were observed in 1.5% of the 841 patients. Direct virus-related skin changes were noted in 1% (n=8) of patients, including maculopapular eruptions (50%, n=4) on the face and trunk, trunk-localized urticaria (25%, n=2), and purpuric lesions (12.5%, n=1) on the lower extremities. Drug-induced dermatological reactions were identified in 0.5% (n=5) of patients, featuring conditions such as bullous drug reactions, psoriasiform drug eruptions, hypertrichosis, and urticaria. Conclusion: These findings highlight the complex interplay between COVID-19 and its treatment, where both the virus and pharmacological agents can trigger significant dermatological reactions. The need for healthcare providers to consider both viral and drug-induced factors in the diagnosis and management of skin manifestations in COVID-19 patients is underscored. Further studies are essential to refine treatment protocols and reduce adverse dermatological outcomes.

Potensi Rempah-Rempah sebagai Bahan Pembuatan Minyak Balur

As the villagers of Bandar Kuala become more knowledgeable about healthy lifestyles, the need for locally available herbal medicines with health benefits is bound to increase. Some of the sources of ingredients from spices and plants that are easily accessible to Bandar Kuala villagers and have various health benefits are turmeric, cardamom, bay leaves, soursop leaves, candlenut, sambiloto, frangipani flowers, kenanga flowers, anise, areca flowers, kencur, coconut oil, coriander, nutmeg, cloves, lempuyang wangi, temu mango, temu kunci. Phytochemicals from these plants are known to prevent or cure various diseases such as high blood pressure, cancer, diabetes, flu, cough, sore throat, pain and others. Cultivation of traditional medicinal plants in the garden on a large scale can be of economic value to the community, thus potentially improving the welfare of the villagers, and it is important to provide health education on the use of spices that already exist in an environment that is easily accessible to the residents of Bandar Kuala village.

A high-riding brachiocephalic artery: a unique diagnostic dilemma

We present a case of the A high-riding brachiocephalic artery, a rare variant of neck vessels. It is clinically and surgically important, as unknowingly may lead to severe life-threatening complications. A 67-year-old male, presented with throat pain, dysphagia, heartburn with belching for 4-5 months. He was diagnosed with High riding brachiocephalic on further evaluation with USG neck which was reported as, superiorly placed right brachiocephalic artery noted in the suprasternal notch with maximum diameter 1.6 cm. Asymptomatic nature conservative line of management was followed and on follow up, patient had improvement in the symptoms.

A rare presentation of nasopharyngeal mass: a case report

A Thornwaldt's cyst develops in the nasopharynx, which is the region where the throat and nasal passageways converge, extending from the back of the nasal tube to above the soft palate. A painful throat, obstruction of the eustachian tube, and pus with an unpleasant taste and odour might result from an infection of the cyst. Here in our study, we report a case of a 27-year-old male presented with symptoms of nasal obstruction and voice change for the past 1 year. On zero-degree endoscopic examination, a nasopharyngeal mass was seen arising from the roof of the nasopharynx without bony erosion of skull base. Further based on his radiological investigations, heterogeneous hyperintense lesion in T1/T2 weighted images of size 5×5 mm noted in nasopharynx most likely to be the Thornwaldt’s cyst. Thus, the surgical removal of the nasopharyngeal mass has been performed through a transoral and trans nasal endoscopic technique with no remnants at the surgical site. The histopathological findings revealed respiratory-type epithelium with underlying lymphoid tissue confirming Thornwald’s cyst as diagnosis. The patient was discharged with no complications and have been periodically advised for a follow-up. The differential diagnosis should include a meningocele or meningo-encephalocele. Various therapeutic approaches, including endoscopic, transoral, or trans palatal surgical interventions, can be used for treatment of symptomatic cysts.

Sore throat with septic complications

Ayoung man presented with exertional dyspnea and thoracic pain following pharyngitis. The findings included pulmonary melting, left-sided pleural empyema and spondylitis. Cultures for detection of the pathogen were negative and sequencing for bacterial DNA was additionally carried out resulting in detection of Fusobacterium necrophorum that is typical for oropharyngeal infections. Furthermore, environmental diagnostics revealed two infected molars as apossible source of the infection and ajugular vein thrombosis. The results were compatible with Lemierre syndrome. This case highlights the potential of molecular diagnostics of pathogens.

The Effect of Controlled Hypotensive Anesthesia on Postoperative Sore Throat

Aim: Postoperative sore throat (POST) is a commonly encountered and significant complication following anesthesia, which can adversely affect the quality of a patient's recovery. Many factors contribute to the development of POST. Controlled hypotension (CH) is a surgical technique used to reduce blood flow, improve visibility, and shorten procedure time by safely lowering blood pressure. In this study, we aimed to investigate the effects of CH on POST, coughing, hoarseness, and vomiting in patients undergoing surgery in a supine position with a fixed endotracheal cuff pressure. Material and Method: A total of 124 patients, aged between 18 and 65 years, classified as American Society of Anesthesiologists (ASA) class I-II and scheduled for elective surgical procedures, were included in the study. The patients were divided into two groups: Group N (n=65), consisting of normotensive individuals, and Group H (n=59), which included patients subjected to CH. In both groups, the endotracheal cuff pressure was manually set to 25 cmH2O using a cuff pressure manometer. CH was achieved in Group H by administering glyceryl trinitrate (nitroglycerin) infusion, maintaining the mean arterial pressure (MAP) within the range of 55-65 mmHg. Patients were assessed for POST, coughing, hoarseness, and vomiting at postoperative 15 minutes, 2, 6, 12, and 24 hours. Results: Demographic data, smoking status, ASA scores, surgical and anesthesia durations were similar between the groups. Statistically significant differences were observed between the groups in the numeric rate scores (NRS) for throat pain at 15 minutes and 2 hours, as well as hoarseness scores at 2 and 6 hours. The groups were similar regarding vomiting rates and cough scores. Conclusion: In this study investigating the impact of CH on sore throat, we observed an increased incidence of POST and hoarseness in patients subjected to CH.

A Systematic Review on Medicinal Plant Species to treat Pharyngitis

Pharyngitis, commonly known as a sore throat, is a prevalent condition characterized by inflammation and discomfort in the throat. This ailment can be caused by various factors, including viral or bacterial infections, allergies, or environmental irritants. While conventional treatments like antibiotics and over-the-counter medications are widely used, interest in herbal remedies for pharyngitis has been steadily increasing. Herbal remedies have been used for centuries to treat sore throats, and there is some scientific evidence support their use. Some of the most commonly used herbs for sore throat include Glycyrrhiza glabra, Althaea officinalis, Ulmus glabra, and Salvia officinalis. These herbs can be used to make tea, lozenges, or gargles. It is important to note that herbs can interact with other medications, so it is always best to consult your doctor before using them. This abstract provides an overview of the herbal remedies that have been traditionally used and explored in recent review for alleviating pharyngitis. The paper summarizes the potential benefits of these herbs in managing sore throat infections, highlighting their anti-inflammatory, antimicrobial, and soothing properties as promising candidates for pharyngitis relief.

Capture of Group A Streptococcus by Open-Microfluidic CandyCollect Device in Pediatric Patients.

Obtaining high-quality samples to diagnose streptococcal pharyngitis in pediatric patients is challenging due to discomfort associated with traditional pharyngeal swabs. This may cause reluctance to go to the clinic, inaccurate diagnosis, or inappropriate treatment for children with sore throat. Here, we determined the efficacy of CandyCollect, a lollipop-inspired open-microfluidic pathogen collection device, to capture Group A Streptococcus (GAS) and compare user preference for CandyCollect, conventional pharyngeal swabs, or mouth swabs in children with pharyngitis and their caregivers. All child participants (30/30) were positive for GAS by qPCR on both the mouth swab and CandyCollect. Caregivers ranked CandyCollect as a good sampling method overall (27/30), and all caregivers (30/30) would recommend CandyCollect for children 5 years and older. Twenty-three of 30 children "really like" the taste and 24/30 would prefer to use CandyCollect if a future test were needed. All caregivers (30/30) and most children (28/30) would be willing to use CandyCollect at home. All participants tested positive for GAS on all three collection methods (pharyngeal swab, mouth swab, and CandyCollect). While both caregivers and children like CandyCollect, some caregivers would prefer a shorter collection time. Future work includes additional studies with larger cohorts presenting with pharyngitis of unknown etiology and shortening collection time while maintaining the attractive form of the device. Obtaining oral samples for the diagnosis of streptococcal pharyngitis is of great importance for children. To address the challenges associated with traditional pharyngeal swab sampling, we developed the CandyCollect device, a lollipop-inspired open mesofluidic saliva sampling system. In this study, saliva samples were collected from children, aged 5-14 years, with CandyCollect and mouth swabs and analyzed via qPCR. The results show CandyCollect is the child preferred collection tool and had 100% concordance with the results from traditional diagnosis methods as part of their clinical care.

Group A Streptococcus infections in children and adolescents in the post-COVID-19 era: a regional Italian survey

BackgroundDespite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated.MethodsIn June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023.ResultsAmong 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis.Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. ConclusionsWe reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool.In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis.

Isolated external jugular thrombophlebitis secondary to acute pharyngitis: a case report and a review of the literature

BackgroundExternal Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side.Case presentationA 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued.ConclusionsEJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

Telephone Counseling for Children Recovering from Tonsil Surgery-A Randomized Controlled Feasibility Study.

Even though children after tonsil surgery experience pain and other limitations in their daily lives, nursing care is transferred to parents after tonsil surgery, and they might need some kind of support. The aim of the study was to test the design of a randomized controlled trial intended to evaluate a nurse-led telephone follow-up after tonsil surgery on postoperative symptoms and quality of life. Of the seventeen children aged 3-17 years scheduled to tonsil surgery, nine were randomized to the intervention group and eight to the control group using a randomization list. The parents in the intervention group were contacted by telephone on days 1, 3, 5, and 10 postoperatively for counseling by a nurse. The instruments Postoperative Recovery in Children (PRiC) and the health-related quality of life instrument (EQ-5 D-Y) were used to evaluate postoperative symptoms and quality of life, respectively. Eight participants in the intervention group reported throat pain compared to five participants in the control group on the operation day and four days after, possibly due to an uneven distribution of the type of surgery between the study groups. The parents appreciated the telephone counseling, and there were no unplanned revisits in the intervention group. However, it was difficult to recruit participants and the assessment tools were not always fully completed. No explicit conclusions can be drawn from this feasibility study due to the low number of participants and the study design needs adjustments.