26 American Family Physician
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Volume 83, Number 1 ◆ January 1, 2011
Avoiding Sore Throat Morbidity
and Mortality: When Is It Not
“Just a Sore Throat?”
University of Alabama at Birmingham,
Huntsville Regional Medical Campus,
reasons? for? ambulatory? care? visits.? We? see?
Although? we? know? that? other? organisms?
believe? those? organisms? cause? self-limited?
ments? using? programmed? evaluation? and?
history? and? physical? examination.? This?
We? encourage? physicians,? residents,? and?
of? worsening? pharyngitis,? including? non-
with? false-negative? rapid? testing),? infec-
tious? mononucleosis,? acute? human? immu-
nodeficiency? virus? infection,? peritonsillar?
patient’s? symptoms? persist? or? worsen,? the?
diagnosis? no? longer? fits? this? category,? and?
a? more? careful? diagnostic? and? therapeutic?
which? usually? begins? with? a? sore? throat?
that? improves? over? the? first? four? to? five?
symptoms,? with? the? addition? of? bactere-
Lemierre? syndrome? occurs? most? often?
in? adolescents? and? young? adults? (ages? 15?
tis? occurs? predominantly? in? the? same? age?
group.6? A? Lemierre? syndrome? variant? can?
also? occur? before? adolescence;? however,? it?
bacterium? pharyngitis? is? readily? available.?
media? from? throat? swabs.? Blood? cultures?
Many? Lemierre? syndrome? diagnoses? occur?
syndrome.? We? believe? that? following? the?
American? College? of? Physicians/Centers?
lines? endorsed? by? the? American? Academy?
of? Family? Physicians? would? decrease? the?
risk? of? Lemierre? syndrome? in? adolescents?
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Physicians? do? not? need? to? change? their? approach? to?
who? have? persistent? or? worsening? symptoms,? and? to?
tion? to? the? following? red? flags:? rigors,? shaking? chills,?
Address correspondence to Robert M. Centor, MD, FACP, at rcentor@
uab.edu. Reprints are not available from the authors.
Author disclosure: Nothing to disclose.
Medicine,? Centers? for? Disease? Control? and? Prevention.? Principles? of?
Ann Intern Med.?2001;134(6):509-517.
and?management?of?group?A?streptococcal?pharyngitis.?Clin Infect Dis.?
group?C?streptococcus.?J Gen Intern Med.?2007;22(2):272-274.
? 6.?Centor? RM.? Expand? the? pharyngitis? paradigm? for? adolescents? and?
young?adults.?Ann Intern Med.?2009;151(11):812-815.
spective?epidemiological?and?clinical?survey.?Eur J Clin Microbiol Infect