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2021 | OriginalPaper | Hoofdstuk

24. Keelpijn

Auteurs : Dr. S. Zwart, Dr. C. F. Dagnelie

Gepubliceerd in: Diagnostiek van alledaagse klachten

Uitgeverij: Bohn Stafleu van Loghum

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Samenvatting

Ongeveer 10 % van de mensen met keelpijn raadpleegt een arts. Acute keelpijn ( < 14 dagen) wordt meestal veroorzaakt door een virus – denk met name aan rino-, adeno- en coronavirussen en mononucleosis infectiosa – en gaat veelal gepaard met neusverkoudheid en hoesten. Een keelontsteking door een virus, maar ook één van bacteriële oorsprong, bijvoorbeeld door groep A-streptokokken, heeft meestal een mild natuurlijk beloop en duurt niet langer dan een week. Soms blijft de infectie niet beperkt tot tonsillen en slijmvliezen, maar breidt deze zich achter en rond de tonsil uit tot een peritonsillair infiltraat of peritonsillair abces. Langer bestaande keelpijn ( > 14 dagen) heeft vaak een niet-infectieuze oorzaak, zoals inademing van droge lucht of rook, verkeerd stemgebruik of keelschrapen en – zelden – een maligniteit. Bij risicopatiënten of een langer durend beloop kan nadere diagnostiek zinvol zijn. Bloedonderzoek is slechts geïndiceerd als aan een ernstige aandoening (maligniteit) wordt gedacht of als het vaststellen van een eventuele mononucleosis-infectie van belang wordt geacht.
Literatuur
1.
go back to reference DagnelieCF, Y van der Graaf Y, De Melker RA. Do Patients With Sore Throat Benefit From Penicillin? A Randomized Double-Blind Placebo-Controlled Clinical Trial With Penicillin V in General Practice.Br J. Gen. Pract. 1996 Oct;46(411):589-93 DagnelieCF, Y van der Graaf Y, De Melker RA. Do Patients With Sore Throat Benefit From Penicillin? A Randomized Double-Blind Placebo-Controlled Clinical Trial With Penicillin V in General Practice.Br J. Gen. Pract. 1996 Oct;46(411):589-93
2.
go back to reference Zwart S, Sachs APE, Ruijs GJHM, et al. Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. Br Med J. 2000;320:150–4.CrossRef Zwart S, Sachs APE, Ruijs GJHM, et al. Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. Br Med J. 2000;320:150–4.CrossRef
6.
go back to reference van Driel ML, de Sutter A, Deveugele M, et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med. 2006;4:494–9.CrossRef van Driel ML, de Sutter A, Deveugele M, et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med. 2006;4:494–9.CrossRef
7.
go back to reference van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij TJ. Illness behaviour and antibiotic prescription in patients with respiratory tract symptoms. Br J Gen Pract. 2007;57:561–8.PubMedPubMedCentral van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij TJ. Illness behaviour and antibiotic prescription in patients with respiratory tract symptoms. Br J Gen Pract. 2007;57:561–8.PubMedPubMedCentral
8.
go back to reference Hoogendoorn D. Acuut reuma en acute glomerulonefritis; huidige klinische incidentie en de sterfte in Nederland. Ned Tijdschr Geneeskd. 1989;133:2334–8.PubMed Hoogendoorn D. Acuut reuma en acute glomerulonefritis; huidige klinische incidentie en de sterfte in Nederland. Ned Tijdschr Geneeskd. 1989;133:2334–8.PubMed
9.
go back to reference Cals JW, Butler CC, Hopstaken RM, et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009;338:CrossRef Cals JW, Butler CC, Hopstaken RM, et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009;338:CrossRef
12.
go back to reference Lechien JR, Chiesa-Estomba CM, Place S, et al. Clinical and Epidemiological Characteristics of 1,420 European Patients with mild-to-moderate Coronavirus Disease 2019 [published online ahead of print, 2020 Apr 30]. J Intern Med. 2020;10.1111/joim.13089. https://doi.org/10.1111/joim.13089 Lechien JR, Chiesa-Estomba CM, Place S, et al. Clinical and Epidemiological Characteristics of 1,420 European Patients with mild-to-moderate Coronavirus Disease 2019 [published online ahead of print, 2020 Apr 30]. J Intern Med. 2020;10.1111/joim.13089. https://​doi.​org/​10.​1111/​joim.​13089
14.
go back to reference Zwart S, Ruijs GJHM, Sachs APE, et al. Betahaemolytic streptococci isolated from acute sorethroat patients: cause or coincidence? A case-control study in general practice. Scand J Infect Dis. 2000;32:377–84.CrossRef Zwart S, Ruijs GJHM, Sachs APE, et al. Betahaemolytic streptococci isolated from acute sorethroat patients: cause or coincidence? A case-control study in general practice. Scand J Infect Dis. 2000;32:377–84.CrossRef
15.
go back to reference Little P, Hobbs FDR, Mant D, et al. Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012;62:e787–94.CrossRef Little P, Hobbs FDR, Mant D, et al. Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012;62:e787–94.CrossRef
16.
go back to reference Lindbaek M, Høiby EA, Lermark G, et al. Clinical symptoms and signs in sore throat patients with large colony variant betahaemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55(517):615–9.PubMedPubMedCentral Lindbaek M, Høiby EA, Lermark G, et al. Clinical symptoms and signs in sore throat patients with large colony variant betahaemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55(517):615–9.PubMedPubMedCentral
17.
18.
go back to reference Dunn N, Lane D, Everitt H, Little P. Use of antibiotics for sore throat and incidence of quinsy. Br J Gen Pract. 2007;57(534):45–9.PubMedPubMedCentral Dunn N, Lane D, Everitt H, Little P. Use of antibiotics for sore throat and incidence of quinsy. Br J Gen Pract. 2007;57(534):45–9.PubMedPubMedCentral
19.
go back to reference Little P, Stuart B, Hobbs FD, et al. Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study. BMJ. 2013;347:CrossRef Little P, Stuart B, Hobbs FD, et al. Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study. BMJ. 2013;347:CrossRef
20.
go back to reference Coenraad S. Baatenburg de Jong RJ. Hoofd-halscarcinoom. Huisarts Wet. 2012;55(12):572–6.CrossRef Coenraad S. Baatenburg de Jong RJ. Hoofd-halscarcinoom. Huisarts Wet. 2012;55(12):572–6.CrossRef
21.
go back to reference Huovinen P, Lahtonen R, Ziegler T, et al. Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms. Ann Int Med. 1989;110:612–6.CrossRef Huovinen P, Lahtonen R, Ziegler T, et al. Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms. Ann Int Med. 1989;110:612–6.CrossRef
23.
go back to reference Dagnelie CF, Touw-Otten FWMM, Kuyvenhoven MM, et al. Bacterial flora in patients presenting with sore throat in Dutch general practice. Fam Pract. 1993;10:371–7.CrossRef Dagnelie CF, Touw-Otten FWMM, Kuyvenhoven MM, et al. Bacterial flora in patients presenting with sore throat in Dutch general practice. Fam Pract. 1993;10:371–7.CrossRef
24.
go back to reference Gunnarsson RK, Holm SE, Söderstrom M. The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures. Scand J Prim Health Care. 1997;15:149–55. Gunnarsson RK, Holm SE, Söderstrom M. The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures. Scand J Prim Health Care. 1997;15:149–55.
27.
go back to reference Pichichero ME. Sore throat after sore throat after sore throat. Are you asking the critical questions? Postgrad Med. 1997;101:205–25. Pichichero ME. Sore throat after sore throat after sore throat. Are you asking the critical questions? Postgrad Med. 1997;101:205–25.
28.
go back to reference Centor RM, Whitherspoon JM, Dalton HP, et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1:239–46.CrossRef Centor RM, Whitherspoon JM, Dalton HP, et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1:239–46.CrossRef
29.
go back to reference Aalbers J, O’Brien KK, Chan WS, et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med. 2011;9:67.CrossRef Aalbers J, O’Brien KK, Chan WS, et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med. 2011;9:67.CrossRef
31.
go back to reference Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 20;11:CD000023 (updated 2020). Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 20;11:CD000023 (updated 2020).
32.
go back to reference Zwart S. Sneltests bij luchtweginfecties: ook bij acute keelpijn? Commentaar. Huisarts Wet. 2013;56(11):574–5.CrossRef Zwart S. Sneltests bij luchtweginfecties: ook bij acute keelpijn? Commentaar. Huisarts Wet. 2013;56(11):574–5.CrossRef
33.
go back to reference Dagnelie CF, Bartelink ML, van der Graaf Y, et al. Towards a better diagnosis of throat infections (with group A beta-hemolytic streptococcus) in general practice. Br J Gen Pract. 1998;48:959–62.PubMedPubMedCentral Dagnelie CF, Bartelink ML, van der Graaf Y, et al. Towards a better diagnosis of throat infections (with group A beta-hemolytic streptococcus) in general practice. Br J Gen Pract. 1998;48:959–62.PubMedPubMedCentral
35.
go back to reference Gulich MS, Matschiner A, Gluck R, Zeitler HP. Improving diagnostic accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein (CRP). Br J Gen Pract. 1999;49:119–21.PubMedPubMedCentral Gulich MS, Matschiner A, Gluck R, Zeitler HP. Improving diagnostic accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein (CRP). Br J Gen Pract. 1999;49:119–21.PubMedPubMedCentral
36.
go back to reference Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults:reliability of rapid streptococcal tests and clinical findings. Arch Intern Med. 2006;166(6):640–4.CrossRef Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults:reliability of rapid streptococcal tests and clinical findings. Arch Intern Med. 2006;166(6):640–4.CrossRef
37.
go back to reference Linder JA, Chan JC, Bates DW. Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. Arch Intern Med. 2006;166(13):1374–9.CrossRef Linder JA, Chan JC, Bates DW. Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. Arch Intern Med. 2006;166(13):1374–9.CrossRef
38.
go back to reference Gröndal H, Hedin K, Strandberg EL, André M, Brorsson A. Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study. BMC Fam Pract. 2015;16:81. Published 2015 Jul 4. https://doi.org/10.1186/s12875-015-0285-y Gröndal H, Hedin K, Strandberg EL, André M, Brorsson A. Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study. BMC Fam Pract. 2015;16:81. Published 2015 Jul 4. https://​doi.​org/​10.​1186/​s12875-015-0285-y
Metagegevens
Titel
Keelpijn
Auteurs
Dr. S. Zwart
Dr. C. F. Dagnelie
Copyright
2021
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2620-4_24