tonsillitis

[MErc44]

Does anyone here have any experience with tonsillitis. Specifically have any of you had it. My throat is f&cking killing me right now and I have no symptoms of a systemic infection or a localized bacterial colonization. I was thinking that it was allergies because I have been hit pretty hard this month but this is the second day that I've had pretty bad pain. If it's like this tomorrow it might be time to make a trip to the friendly ENT downtown.

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[beriberi]

Or a trip to your friendly primary care doctor.I resist giving medical advice on these boards (most of the time). However, if you have a sore throat you are likely not in need of highly specialized care from a surgeon. If you are in need of surgery, your primary care doctor will probably be able to figure it out.

Or you could just go to the ER.

 

[MErc44]

so I just went to the doctor and found out that i have puss on my tonsils which most likely means that I have strep, but I don't have any symptoms except for 2 swollen lymph nodes on the left side of my neck. I can't wait to start med school so that I can learn about all the things that can happen to the body. The only thing that really worried me was that the doctor said that mono and strep A infections can happen concurrently in a low percentage of patients

 

[Stinger86]

The only thing that really worried me was that the doctor said that mono and strep A infections can happen concurrently in a low percentage of patients

Nothing like a doctor who gives his/her patient something extra to worry about. Mono usually has a fever and nausea component associated with the pharyngitis. Plus, swollen lymph nodes associated with mono often appear in the posterior neck (as opposed to the anterior neck, as ofter in strep), and then there's always the enlarged spleen...

Bottom line, probably just strep

 

[marchiafava]

Just to educate you people, only 25% of sore throats are Strep! Not all puss is strep. There are many other bacteria and even viruses that present this way. By the way, I hope he didn't start you on an aminopennicillin as a starter antibiotic. For those that are knowledgable, you'll know what I mean.

 

[aphistis]

Nothing like a doctor who gives his/her patient something extra to worry about. Mono usually has a fever and nausea component associated with the pharyngitis. Plus, swollen lymph nodes associated with mono often appear in the posterior neck (as opposed to the anterior neck, as ofter in strep), and then there's always the enlarged spleen...

Bottom line, probably just strep

Not to mention the oppressive tiredness that hallmarks the condition.

 

[MErc44]

we discussed mono because I had a bad case of the flu in feb and was tested for mono. It just somehow came up, it seems that doctors enjoy chatting with people who will one day be in the same profession. I enjoy it too. What the hell is wrong with aminopenicillin? Forgive my ignorance on the subject, especially since I am a microbiology major.

 

[exmike]

If you dont have fever or a swollen throat it is very likely a viral infection. Herpes (not the STD) is a possibility, especially if the sore throat is recurring.

If your symptoms persist for 5-7 days then subside you can almost be sure it was a viral infection. I'm along the lines of watchful waiting when it comes to sore throats. Antibiotics are way overprescribed for sore throats.

About two years ago I got a sore throat w/o systemic involvement. No fever or swollen glands, probably viral. However, about a week into it, when it usually resolves, my throat start swelling and the pain became unbearable. The doctor tried to do a throat culture and gave me PenVK. It turned out it was a anaerobic infection and I had to take clindamycin.

My point was my doc had no clue what kind of infection I had. In fact I remember him doing a culture for strep (which came up negative). Strep cultures wont find anaerobic infections. In fact the process of collecting a strep specimen probably kills the anaerobics.

Anyway, I basically suffered a much longer than I had to because 1) my doc probably initially thought it was viral so refrained from giving me t(x) and 2) my doc assumed it was strep even though the culture was negative and gave me a weak antibiotic which did absolutely nothing for me.

 

[beriberi]

Wow... a couple of points.

I have never heard of Herpes that causes sore throats. Gonorrhea can, however. (And really, any kind of herpes is a disease which is transmitted through close contact with an infected person, there is no STD herpes for bad people and non-STD herpes for good people. You got cold sores, you got them from somebody. You got genital herpes, you got them from somebody.)

Your doc did treat you. Pen V is not a "weak antibiotic." It works against most of the common bacterial pathogens that cause sore throats. Anaerobic infections that require antibiotics (in the throat) are fairly rare and there is no way that a primary care doctor can be testing patients for them. I am sorry for your suffering, but I am not sure it was so much longer than you had to (because the anaerobic infection had not yet shown itself.)

 

[slim shanie]

yeah I wouldn't worry about mono until you wake up one morning and have to roll yourself to the bathroom to take a crap. How's that for being scientific? haha

Beriberi, love the name. And right on on all of that stuff... Yeah Gonorrhea commonly causes your sore throats. Actually saw one yesterday at my first day on the job. Herpes does NOT cause sore throats so don't worry about that.

As far as the strep culture being negative on yours exmike... those things are not very sensitive or specific tests. I followed a doc who did one on a kid who obviously had scarlet fever and it came back negative. They're just little screening tests that help bump up the probability that you have a strep infection but they're not perfect.

Penicillins will cover gram-positives which include the most probable bacteria that could have been causing your sore throat. And if it didn't work, you'd get better anyway. I don't think the reason penicillin didn't work was because it was an anaerobic infection but moreso that it was a gram-negative bacterium and the drug doesn't work very well with those. And I again agree with everything beriberi said there.

 

[Cowboy DO]

I have never heard of Herpes that causes sore throats.

mononucleosis is caused by the Epstein-Barr virus, a member of the herpes family

 

[Jaded Soul]

mononucleosis is caused by the Epstein-Barr virus, a member of the herpes family

That's just semantics. Of course we all know that EBV is in the herpesvirus family, but no one is going to think you mean EBV if you say "herpes."

 

[Cowboy DO]

Herpes (not the STD) is a possibility, especially if the sore throat is recurring.

I was just backing up exmike. Im assuming this is what he meant, but everyone was still talking like he said HSV-1/2. Not every one knows EBV is a herpesviridae, as i recall the person who started this post is a pre-med.

 

[exmike]

Wow... a couple of points.

I have never heard of Herpes that causes sore throats. Gonorrhea can, however. (And really, any kind of herpes is a disease which is transmitted through close contact with an infected person, there is no STD herpes for bad people and non-STD herpes for good people. You got cold sores, you got them from somebody. You got genital herpes, you got them from somebody.)

Your doc did treat you. Pen V is not a "weak antibiotic." It works against most of the common bacterial pathogens that cause sore throats. Anaerobic infections that require antibiotics (in the throat) are fairly rare and there is no way that a primary care doctor can be testing patients for them. I am sorry for your suffering, but I am not sure it was so much longer than you had to (because the anaerobic infection had not yet shown itself.)

I did my MPH in infectious disease, so believe me, I am well aware of all of your points. There are probably more types of virii that cause sore throats than we know, including hsv1/2 which both can cause sore throats. Recurrent herpes is more likely to occur in regions innervated by the trimeginal ganglia since that is where the virus moves after infection. The trigeminal innervates most of the face, mouth and throat so yes you can have recurrent herpes in the throat. You see most infections manifesting in the outer mouth area because that is most common point of contact.

My point about the weak treatment was that it was very apparent my infection was NOT an aerobic once given the negative culture. I failed to mention I was cultured twice. I didn't mean that PenVK wasn't useful for bacterial throat infections. I believe the doc assumed it was viral but felt like he needed to give me something. His clinic wasnt equipped to do anaerobic cultures and I didnt get clindamycin until went to a ENT to get a presumptive diagnosis of an anaerobic infection.

Anyway, everyone right, EBV is a herpes virus. I said non-genital Herpes because genital herpes preferentially infects the genital area vs oral herpes although both can infect both areas. I wasnt insinuating that there was a "Good and bad" herpes.

 

[beriberi]

Okay, I will concede a partial point. Stolen from www.utmb.edu (someone's grand round presentation)

The clinical manifestations and course of HSV depend on the anatomic site of the infection, the age and immune status of the host. First episodes of HSV disease, especially primary infections (i.e. first infections in which the host lacks HSV antibodies in acute-phase serum), are frequently accompanied by systemic signs and symptoms, involve both mucosal and extramucosal sites, and have a longer duration of symptoms, a longer time during which virus is isolated from lesions, and higher rate of complications than recurrent episodes of disease. Gingivostomatitis and pharyngitis are the most frequent clinical manifestations of first-episode HSV-1 infection. These infections are usually seen in children and young adults. Clinical symptoms and signs include fever, malaise, myalgias, anorexia, irritability, and cervical adenopathy, which may last from 3-14 days. Physical exam usually reveals grouped or single vesicular lesions on an erythematous base involving the buccal mucosa and hard and soft palate that become pustular and coalesce to form single or multiple ulcers. HSV of the pharynx usually results in exudative or ulcerative lesions of the posterior pharynx and/or tonsillar pillars. The acute illness evolves over 7-10 days, followed by rapid regression of symptoms and resolution of the lesions. On mucosal surfaces the lesions reepithelialize directly. No substantial evidence suggests that reactivation of oral-labial HSV infection is associated with symptomatic recurrent pharyngitis.

So, primary infection can cause pharyngitis; Recurrent pharyngitis is not caused by HSV. So, you were kind of right. I guess we don't talk about HSV pharyngitis because it doesn't matter; it doesn't change how you treat the patient. ( A child with a sore throat and negative culture won't get swabbed for HSV--and probably shouldn't)

You were not cultured in the doctors office--or if you were, the results were not what treatment was based on. Cultures take days; you probably had a rapid strep test that came back negative twice. However, a patient may have a group A strep with a negative rapid strep; some drs choose to start abx if they suspect bacterial infection (which, in this case was right--you did have a bacterial infection). I will maintain that there was no reason to suspect anaerobic infxn and that the PMD acted correctly.

 

[MErc44]

so my strep A culture, which I guess was a rapid culture was negative. I don't know what the hell is going on with me as I have a low grade fever maybe around 100. Throat is still no better and it's been about 4 days. I wish the student health service was a little more helpful. I keep thinking that I picked something up in costa rica when i was there on spring break, but that was about seven weeks ago and I think I would have had some symptoms before now. Are most of you guys second year students? I have taken some a class in bacterial pathogenesis and am taking virology right now but ever since I got my first acceptance I haven't really learned anything. Just gliding by.

 

[exmike]

Okay, I will concede a partial point. Stolen from www.utmb.edu (someone's grand round presentation)

The clinical manifestations and course of HSV depend on the anatomic site of the infection, the age and immune status of the host. First episodes of HSV disease, especially primary infections (i.e. first infections in which the host lacks HSV antibodies in acute-phase serum), are frequently accompanied by systemic signs and symptoms, involve both mucosal and extramucosal sites, and have a longer duration of symptoms, a longer time during which virus is isolated from lesions, and higher rate of complications than recurrent episodes of disease. Gingivostomatitis and pharyngitis are the most frequent clinical manifestations of first-episode HSV-1 infection. These infections are usually seen in children and young adults. Clinical symptoms and signs include fever, malaise, myalgias, anorexia, irritability, and cervical adenopathy, which may last from 3-14 days. Physical exam usually reveals grouped or single vesicular lesions on an erythematous base involving the buccal mucosa and hard and soft palate that become pustular and coalesce to form single or multiple ulcers. HSV of the pharynx usually results in exudative or ulcerative lesions of the posterior pharynx and/or tonsillar pillars. The acute illness evolves over 7-10 days, followed by rapid regression of symptoms and resolution of the lesions. On mucosal surfaces the lesions reepithelialize directly. No substantial evidence suggests that reactivation of oral-labial HSV infection is associated with symptomatic recurrent pharyngitis.

So, primary infection can cause pharyngitis; Recurrent pharyngitis is not caused by HSV. So, you were kind of right. I guess we don't talk about HSV pharyngitis because it doesn't matter; it doesn't change how you treat the patient. ( A child with a sore throat and negative culture won't get swabbed for HSV--and probably shouldn't)

You were not cultured in the doctors office--or if you were, the results were not what treatment was based on. Cultures take days; you probably had a rapid strep test that came back negative twice. However, a patient may have a group A strep with a negative rapid strep; some drs choose to start abx if they suspect bacterial infection (which, in this case was right--you did have a bacterial infection). I will maintain that there was no reason to suspect anaerobic infxn and that the PMD acted correctly.

You wouldn't culture a child for HSV b/c they aren't at risk and there is no added value to a positive diagnosis except in cases where abuse is suspected. I believe somethink like half the population is HSV antibody positive (correct me if im wrong) so HSV culture is rarely used in any case.

I stand corrected on the recurrent pharygeal HSV, although isnt it odd that it wouldnt be recurrent? I wonder what's the biological basis for that.

I was swabbed so it wasnt a rapid test. I had already suspected a anaerobic infection when he swabbed the second time. He thought maybe he had messed up the initial culture. One unscientific hint of an anaerobic infection is the smell associated with it since aerobic infections usually arent so noticeably putrid. The doc noted that the culture swab smelled really bad. I dont know why it didnt occur to him then it might be anaerobic.

Anyway, I'm not faulting the doc. I think what he did was along generally accepted practice guidelines. I probably shouldve asked him to consider an anaerobic infection and do an anaerobic culture but I felt out of my place to press him for it.

 

[MErc44]

apparently i have epstein barr. Son of a B%tch. Does anyone know how the test for mono actually works. I don't know about this three month hiatus from drinking, I have graduation in about three weeks, drinking will occur there for sure.