Can anyone tell me about F Throat?
August 20, 2015 8:05 PM   Subscribe

My 17-year-old daughter started getting a sore throat Tuesday afternoon. Wednesday morning she was pretty miserable--couldn't swallow without extreme pain (like literally crying), sore neck/lymph nodes, lots of sinus congestion.

Of course I immediately assumed it was strep. I took her to the Little Clinic at Kroger. Negative for strep, no fever. Probably viral, on top of her seasonal allergies. She was given prescriptions for Sinahist and Flonase (already taking Allegra) and told to take 800 mg of ibuprofen every 8 hours (I had been giving her 400 mg but it was barely doing anything).

Today she was no better, probably worse. Same symptoms, plus more fatigue and body pain, and now a mild fever (100.7). I haven't seen her this sick since she had swine flu. Certainly no allergy/cold she has ever had has knocked her this low.

So I googled "sore throat not strep" and read about Fusobacterium necrophorum. Apparently, in the words of one article, it "causes a significant number of cases of pharyngitis in this young adult population." The good people at the Little Clinic told me to bring her back if she gets worse, and I plan to do this tomorrow assuming she doesn't wake up significantly improved. Does anyone know how to ask the Nurse Practitioner about this F Throat? Any tests to request? I know things take time to get over, but all my mothering instincts tell me this ain't no normal virus.

Oh yeah...she had mono last year, otherwise I would totally suspect that was the culprit.
posted by chaoticgood to Health & Fitness (25 answers total) 1 user marked this as a favorite
Just to clarify -- in addition to a rapid strep test, did the clinic do a throat culture? If so, have you gotten the culture results back?
posted by merejane at 8:18 PM on August 20, 2015

I used to get a ton of tonsil infections that tested negative for strep. Strep is definitely not the only bacteria that can make you miserable like that. I have a couple times had bacterial infections that hit my sinuses and my throat at the same time and it was gross and miserable. But this has literally only been a couple days, and acute bacterial sinus and tonsil infections tend to clear up on their own even without antibiotics. They don't always, but you're a long way off, from my past experiences, from the point where I would have concluded that it wasn't getting better and gone to the doctor even the first time. That's just me, and I'm not a doctor, but I've definitely felt like that gross more than a couple times and had it improving markedly within 3-4 days, with or without antibiotics. One time I'm pretty sure I had strep in both my throat and sinuses--I didn't have insurance at the time but I'd almost certainly caught it from someone who did and tested strep positive--it sounded a lot like that. So, it could definitely be bacterial, but that doesn't actually mean she will improve faster with antibiotics.

One thing I found that helped one of the worst times, awful as it was, was setting alarms to deliberately keep myself from sleeping a solid 8 hours during the worst couple days. Waking up to re-up ibuprofen and drink enough water to clear the crud out of my throat would keep away the hell that was a morning where everything had worn off and accumulated, respectively, overnight. Also, this is very YMMV, but I've found fizzy drinks more tolerable.
posted by Sequence at 8:21 PM on August 20, 2015 [2 favorites]

I get this kind of pain with symptoms, and it's not a virus at all - it's a raging throat infection from post-nasal drip/sinus infection, usually exacerbated by sleeping open-mouthed because of nasal congestion. Like, if I let the ibuprofen run out of my system it's Chloraseptic spray every 10 minutes until the new dose kicks in. (And yes, alarms set for every 4 hours, 400mg.)

I have to sleep sitting up. I actually have a bed frame that raises the head (manually) for this purpose, but a recliner will do or a stack of pillows on a couch. It's the only way to stop the drip long enough to get some healing, and this also keeps me from ending up with bronchitis. I had a round of this at Christmas and didn't lay down for 5 days, but I didn't get walking pneumonia this time so I'm counting it as a win.
posted by Lyn Never at 8:27 PM on August 20, 2015 [1 favorite]

I was once sick like this, and the diagnosis was mono after a blood test.
posted by mkb at 8:28 PM on August 20, 2015 [3 favorites]

I had this once. The campus clinic sent me away with a diagnosis of "not strep." I was back four days later, crying in pain when I tried to swallow anything. Turns out I had a peritonsillar abscess. I needed minor surgery to drain the abscess, and got better quickly after. You may want to take her to the er, or at least a real urgent care clinic.
posted by bluloo at 8:34 PM on August 20, 2015 [3 favorites]

Can you take her to the real doctor not the mini clinic?
posted by k8t at 8:57 PM on August 20, 2015 [20 favorites]

I'm not a doctor, but I think that just because she's already had mono, doesn't mean she can't get it again. My understanding is once you've had mono you can't catch it again, but the virus remains dormant in your body and it's possible to relapse. I had mono when I was younger, and I've relapsed before, though in my experiences the relapses were never anywhere near as bad as the original mono. That might be a possibility though.
posted by Itaxpica at 9:02 PM on August 20, 2015 [1 favorite]

I had a severe sore throat (it was like swallowing broken glass) with general ookiness and fatigue and it turned out to be hand, foot, and mouth disease. The rash on my hands and feet didn't show up for 3-5 days. It was MISERABLE. My doctor had originally diagnosed and treated me for strep until the slower (not the rapid one) strep culture came back negative and the rash broke out. He was just like, "...Huh. Well, I get one or two adults a year with hand, foot and mouth. Looks like you're it for this year."

Keep an eye out for an itchy rash on hands and feet and keep her hydrated! I hope she feels better soon!
posted by Aquifer at 9:05 PM on August 20, 2015 [2 favorites]

She could have strep and the test may have been flawed. She could also be having a reoccurrence of mono. The fever with the pain needs antibiotics. Call and demand some. If she doesn't begin to improve right away, then take her back in. If it looks like strep and it treats like strep, then it is strep.
posted by myselfasme at 9:16 PM on August 20, 2015 [1 favorite]

There's also this horrible thing going around discussed in this thread. I see you're in the US, it's not out of the question it's just this awful viral respiratory thing that lasts a couple of weeks. I had similar symptoms (sinus congestion, sore throat, headache, fatigue, sneezing) plus the ear stuffiness.

Still, the fever worries me. If she's got a fever tomorrow still, or it spikes higher, see a real doc.
posted by Miko at 9:40 PM on August 20, 2015

The number of wildly differing possibilities being tossed out here suggests to me that you should take her to a real doctor. Not to knock the people at the Kroger clinic, but they may not have the expertise for something like this and if the poor kid can't swallow without crying this seems like something that needs to be resolved ASAP.

Have her try gargling warm saltwater to see if that helps until you can get her to a doctor.
posted by Ursula Hitler at 12:33 AM on August 21, 2015 [5 favorites]

To throw out yet another wild possibility (and thus prove Ursula Hitler's point), I had enterovirus D68 last year, and it basically seemed like a particularly hellish flu, with more muscle weirdness. Not to suggest that your daughter has this at all-- I just mean that these are the same symptoms for a ton of common and less-common illnesses. Definitely take her to a real doctor.
posted by thetortoise at 1:02 AM on August 21, 2015

Just to counter all the "OMG I had symptoms like that and it was this awful disease" answers, I've had all those symptoms and it got better on its own. I know your daughter is in pain and you don't like to see her miserable, but its only been 2 days, try not to panic. If it is viral, there's nothing the doctor can do anyway. Taking antibiotics for someone that would get better on its own is one of the reasons we have antibiotic resistance so the clinic is right to be cautious without confirmation that what she has is bacterial. (I'm in my 30s and have only needed antibiotics once in my life - for tonsillitis)

Can you take her somewhere they can do real tests?
posted by missmagenta at 1:08 AM on August 21, 2015 [5 favorites]

N-thing that it's possibly mono. I've had it three times (one initial infection and two "relapses" or whatever you would call them) because I'm lucky, I guess. This was all confirmed by doctors and fits with the symptoms that I had.

The first time I had it, I felt a bit tired and crappy and had swollen lymph nodes. The second time was terrible and I had all the same symptoms that your daughter has - the worst sore throat I have ever had, huge lymph nodes, extremely blocked sinuses. I flew interstate and ended up not being able to hear out of one of my ears for a couple of days because the congestion was so bad that my ear wouldn't 'pop' back to normal. If it is mono, the only thing you can really do is treat the symptoms and let her rest as much as possible. The third time I had it, I slept for 18 hours a day. I thought I was turning into a cat.
posted by kinddieserzeit at 3:20 AM on August 21, 2015 [1 favorite]

Seconding suggestions for a real doctor and throat culture, but anecdotally: I had tonsillitis two weeks ago and was miserable. My doctor suggested a regimen of 3 Tylenol, alternating with 3 Advil in 3 hour intervals. It worked like a charm and helped me sleep off the worst of the pain. I was feeling better in a couple of days. Hope your kiddo feels better soon!
posted by Otter_Handler at 3:21 AM on August 21, 2015

I've got a 21 year old with pretty much the same thing.

Please, take her to a real doctor.


*There is a monster of a viral thing going around this year; seasonal allergies are the worst in years plus a virus and it's very, very bad, according to my kid's doctor at Mt. Sinai Hospital in NYC.

That does NOT mean your kid has this.

And you know you'll drive yourself crazy diagnosing over the internet.

So go to a doctor.
posted by kinetic at 6:23 AM on August 21, 2015 [3 favorites]

Best answer: Having had something along these lines for the past week and a half (lucky the sore throat pain has lessened somewhat), I talked over the possibilities of fuso and mono with my doctor. I haven't had mono before and am going for the blood test tomorrow morning, at my doctor's suggestion. If that comes back negative, she's open to the possibility that it's fuso. It's tough because, unlike strep, there's no easy test. And as someone mentioned upthread, prescribing antibiotics for everyone with this combination of symptoms who's strep-negative would involve putting a lot of people on antibiotics who likely have a viral infection, contributing to antibiotic resistance. There's an article in the Annals of Internal Medicine on fusobacterium, and in the article (or maybe a response to it) there's discussion of 4 criteria for deciding whether antibiotics would be appropriate. Perhaps this could be worth bringing to your daughter's NP or physician; giving them the information to evaluate is, in my experience, less crazy-making than reading through multiple articles on your own.

Writing from my phone now, but will post the link shortly.
posted by brackish.line at 6:51 AM on August 21, 2015 [2 favorites]

brackish.line, are you talking about the study linked at the very top of this looks-thoughful-to-a-layman discussion?
posted by wenestvedt at 7:56 AM on August 21, 2015

Best answer: New England Journal of Medicine's Journal Watch blog has a readable summary of the Annals article on fusobacterium I mentioned in my previous comment.

These were the criteria I mentioned seeing in the article:
"Using these guidelines, physicians can choose to prescribe antibiotics for patients with a pharyngitis score of 3 or 4 (three or four of the following: fever, absence of cough, tender anterior cervical lymph nodes, tonsillar exudate)."

All of this said - solid clinical judgement is key for interpreting this information, and I hope you can get your daughter to a good NP or physician and talk over your concerns with them.

I hope your daughter is feeling better soon!
posted by brackish.line at 8:02 AM on August 21, 2015 [1 favorite] wenestvedt, yes that's what I was talking about! (This is what happens when I have to leave my computer mid-comment!)
posted by brackish.line at 8:03 AM on August 21, 2015

Another possibility--when I was in college a couple of decades ago, twice I came down something I characterized as the worst sore throat I's ever had in my life, and the doc diagnosed it as a mycoplasma bacterial infection (PDF), and said it tended to go around colleges and other groups of young people.

So yes: doctor.
posted by telophase at 8:21 AM on August 21, 2015

Go to a real doctor, and go today. Serious Fusobacterium infections aren't common, but the potential consequences are rapidly life threatening, and your daughter's age and the preceding mono are reasons to take this seriously. Real doctor. Today. Hopefully it will be nicely and quickly ruled out by a competent professional (ie, not us).
posted by amelioration at 8:59 AM on August 21, 2015

In my case I noticed that if lymph nodes are involved, its a bacterial infection. Sore throat, no lymph node swelling, viral. Also rapid strep tests are not reliable. My docs usually do both and give out antibiotics just in case, then give me a call when the longer test results come in. Hope she feels better soon.
posted by PJMoore at 10:46 AM on August 21, 2015 [1 favorite]

Seconding suggestions for a real doctor and throat culture, but anecdotally: I had tonsillitis two weeks ago and was miserable. My doctor suggested a regimen of 3 Tylenol, alternating with 3 Advil in 3 hour intervals. It worked like a charm and helped me sleep off the worst of the pain. I was feeling better in a couple of days. Hope your kiddo feels better soon!

PLEASE do not take acetaminophen (Tylenol) this frequently unless you want to do very quick and permanent damage to your liver. The maximum daily dosage for Tylenol is 4000mg. This would equate to 12 tablets total a day if consuming 325mg tablets/caplets. At most, the drug shouldn't be taken less than 4-6hrs apart.

It absolutely can be alternated with ibuprofen (Advil). The maximum daily dosage for this drug is 3200mg, or 16 tablets total a day (assuming 200mg tablets); generally timed every 6-8hrs apart.

Otter_Handler, I'm surprised your doctor recommended such high dosages. If I tried to give my patients (I'm an RN) this much Tylenol this frequently, the pharmacy computer wouldn't even open to let me gain access to the med; a huge red warning comes across the screen indicating an exceeded dosage for the day.

OP, please do take your daughter to be evaluated at a regular doctor if she's not better today. Pharmacy Clinics are great for flu shots, etc. but if she's running a temp and has a previous history of mono, she needs to be looked over again.
posted by dancinglamb at 10:50 AM on August 21, 2015

I've had symptoms like this twice. Once it was a horrible throat infection(of the bacterial variety, but not strep), once it was hand foot and mouth.

For the latter there's nothing they can really do, but for the former i had to take SERIOUS antibiotics.

Just go to an actual doctor. I'm always a foot dragger on that and am encouraged by my partner and friends who are always like "you're gonna go to the doctor for that" but it would have gotten really bad the first time if i hadn't, and was still miserable.

They might give you the high sign and tell you to just ride it out, but isn't it worth knowing?
posted by emptythought at 12:48 PM on August 21, 2015

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