Suggest Treatment For Sore Throat And High Fever In An Elderly Person

Posted on Wed, 3 Aug 2016

Question: Hi, I am a 52 YOF who has had a sore throat, temperature of 99.3- about 99.8 during the day, and what feels like enlarged lymph nodes on the left. The sore throat feels mostly unilateral (Left), although the right pharynx looked red initially but is almost normal. I went in for a quick strep test and a culture last week, and both came back normal. At that time, my temp was normal. When I took it this passed Sunday (3 days ago) I temp was elevated to 99.something. I decided then to start taking the Amoxicillin that was prescribed and didn't know at the point the Step culture would be negative. I've continued to take the AB but I still have a fever (99.something) and the left side of my throat still feels irritated and looks red. (I don't have tonsils). I've had an EBV test 4 years ago when I had enlarged lymph cervical lymph nodes on the left for a couple of weeks--which didn't amount to anything. The result then was a normal IgM and an elevated IgG. This onset followed a few very stressful weeks with not enough sleep. Do you think this could be due to the EBV? and if not strep, then what? (The tech who took the throat swab on me felt like she was getting the back of my tongue rather than my throat...could the strep have been missed?). Thank you

Answered by Dr. Ralf Von Seckendorff (2 hours later)

Brief Answer:
Can be viral, will mostly cue itself

Detailed Answer:
Dear patient,

this may be a viral infection or still a strep test that might have been missed by the technique you described. However, Amoxicillin will deal with strep anyhow, but doesn't work on viruses.

In most cases this will cure itself in a week anyhow. Take a rest an treat it with otc throat and cold medicine, it will most likely improve within a week. If not the blood test for EBV may be repeated. But: EBV treatment would mean wait and rest also, but i think it is less likely as cause since you have IgG already and it normally does not reoccur once you had it in the past (that is a subject that science still puts in dispute though).

Best regards and best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ralf Von Seckendorff (2 hours later)

Thank you for your reply Dr. Von Seckendorff. You think it could still be viral even though it feels mostly unilateral with the left side of the pharynx appearing much redder than the right, (although the right was and is irritated but to a lesser degree--I don't really feel the soreness on the right but I do on the left) and with my feeling that the cervical nodes on the left are more prominent than the right? The other reason that made me think it was less likely to be viral (except for the EBV, possibly) is that I never developed much mucous production, runny nose, sneezing, etc. as I almost always do when symptoms start as a (viral) sore throat. Lastly, I don't think I usually run any fever with a viral sore throat, although I probably haven't checked it many times either. Given everything I've listed, here, if you think it could still be an uncomplicated viral infection that will most likely clear on its own within a week, I will worry less, but get it checked if it lingers. I am in healthcare and have become somewhat of a hypochondriac after going through school!

Answered by Dr. Ralf Von Seckendorff (8 hours later)

Brief Answer:
Even if not viral this will usually get better

Detailed Answer:
Dear Patient,

you are right that some of your symptoms might not be 100% conclusive with only viral infection. But even if it is bacteria: this will usually also get better with/ or without antibiotic. Best regards

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Nagamani Ng