Keep the person as calm and comfortable as possible. Allow them to remain in the position that makes breathing easiest.
If they have a prescribed adrenaline auto-injector for anaphylaxis, use it according to their emergency instructions and call emergency services.
In Vietnam, call 115 for emergency medical assistance.
2. Trouble Swallowing or Excessive Drooling
A sore throat can naturally make swallowing uncomfortable.
During an ordinary viral infection, the throat may feel dry, scratchy, or painful when swallowing food and liquids.
However, there is an important difference between painful swallowing and being unable to swallow saliva.
When a person cannot swallow their own saliva and begins drooling, this may indicate significant swelling or obstruction around the throat.
This symptom deserves urgent attention.
Why Does Drooling Occur?
Normally, the body produces saliva continuously.
Most people swallow it automatically without noticing.
However, when swallowing becomes extremely painful or physically difficult, saliva may accumulate in the mouth and spill out.
This can occur with serious infections involving the tonsils, tissues surrounding the tonsils, or the epiglottis.
In children, sudden drooling accompanied by fever, difficulty swallowing, or unusual breathing sounds is particularly concerning.
Peritonsillar Abscess: A Possible Cause
One condition associated with severe throat pain and difficulty swallowing is a peritonsillar abscess.
A peritonsillar abscess develops when pus collects in the tissue surrounding a tonsil.
It may occur as a complication of tonsillitis or another infection in the throat.
Typical symptoms include:
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Severe throat pain, often worse on one side.
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Difficulty swallowing.
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Fever.
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Swelling near one tonsil.
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Ear pain on the same side as the throat infection.
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A muffled or unusual voice.
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Difficulty opening the mouth.
A person may also notice that the uvula, the small piece of tissue hanging at the back of the throat, appears pushed toward the opposite side.
This can be a useful clinical clue, although diagnosis requires professional examination.
The abscess may require drainage and antibiotic treatment.
Retropharyngeal Abscess
Another potentially serious condition is a retropharyngeal abscess.
This occurs when pus accumulates in the deep tissues behind the pharynx.
It is more common in young children but can also occur in adults.
Possible symptoms include:
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Fever.
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Severe throat pain.
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Difficulty swallowing.
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Drooling.
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Neck stiffness.
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Pain when moving the neck.
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Swelling.
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Changes in breathing.
Because the infection involves deep structures of the neck, it may spread and cause serious complications.
When Is Difficulty Swallowing an Emergency?
Seek emergency care if a person:
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Cannot swallow saliva.
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Is drooling because swallowing is impossible.
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Has difficulty breathing.
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Develops a muffled voice with rapidly worsening symptoms.
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Has severe throat pain with significant neck swelling.
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Cannot open the mouth normally and appears seriously ill.
Do not force food, water, or tablets into someone who cannot swallow safely.
The immediate priority is protecting the airway and obtaining medical assessment.
3. High Fever That Persists or Is Accompanied by Worsening Symptoms
Fever is one of the body's natural responses to infection.
When viruses or bacteria enter the body, the immune system releases chemical signals that influence the brain's temperature-regulating center.
This can cause body temperature to rise.
A mild fever may accompany an ordinary viral sore throat and often improves as the infection resolves.
However, a high or persistent fever accompanied by worsening throat pain, severe weakness, or other concerning symptoms may indicate a more significant infection.
A temperature above 39°C is a reason to take the illness seriously, particularly when the person looks or feels very unwell.
Nevertheless, temperature alone cannot determine whether an infection is dangerous.
Some serious infections occur without an extremely high fever, while ordinary viral infections can occasionally produce high temperatures.
The overall condition of the person matters.
Why Can Fever Become Concerning?
A persistent fever may indicate that the immune system is responding to an infection that has not yet been controlled.
Possible causes include:
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Bacterial tonsillitis.
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Streptococcal throat infection.
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Peritonsillar abscess.
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Deep neck infection.
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Influenza.
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COVID-19.
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Other systemic infections.
Not every bacterial infection produces a dangerous complication.
However, when fever continues alongside increasing pain, swelling, difficulty swallowing, or profound weakness, medical evaluation is important.
Strep Throat and Its Complications
Group A Streptococcus is a type of bacteria that can cause streptococcal pharyngitis, commonly called strep throat.
Symptoms may include:
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Sudden onset of throat pain.
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Pain when swallowing.
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Fever.
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Enlarged or tender lymph nodes in the front of the neck.
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Red and swollen tonsils.
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White patches or pus on the tonsils.
Some people may also experience headache, nausea, or abdominal discomfort.
Cough and runny nose are less typical of classic strep throat, although symptoms vary.
A clinician may use a rapid antigen test or throat culture to determine whether group A Streptococcus is responsible.
Antibiotics are appropriate for confirmed or sufficiently suspected bacterial infections according to clinical guidance, but they do not treat ordinary viral sore throats.
Untreated strep throat can sometimes lead to complications, including a peritonsillar abscess, scarlet fever, and, less commonly, acute rheumatic fever.
Fever With Chills and Confusion
A fever accompanied by shaking chills, confusion, faintness, or rapid deterioration may indicate a serious systemic infection.
One concern is sepsis.
Sepsis is a life-threatening condition in which the body's response to infection causes organ dysfunction.
It can develop from infections in different parts of the body, including the lungs, urinary tract, skin, and, occasionally, the throat or neck.
Possible warning signs include:
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Confusion or unusual behavior.
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Rapid breathing.
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A racing heartbeat.
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Severe weakness.
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Cold or clammy skin.
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Reduced urine output.
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Fainting or very low blood pressure.
A person with suspected sepsis needs immediate medical assessment.
What Should You Do?
If a sore throat is accompanied by persistent high fever and worsening symptoms, arrange prompt medical evaluation.
Seek emergency care if fever occurs with confusion, difficulty breathing, fainting, severe dehydration, or rapidly progressing illness.
Do not rely solely on fever-reducing medication to judge whether the infection is improving.
A lower temperature after taking medication does not necessarily mean the underlying cause has resolved.
4. Swelling Around the Neck or Jaw
Swollen glands in the neck are common during throat infections.
These glands are lymph nodes, which are part of the immune system.
They help filter substances from lymphatic fluid and contain immune cells that respond to infection.
When the body fights a throat infection, nearby lymph nodes may become enlarged and tender.
This is often a normal immune response.
However, rapidly increasing swelling, severe pain, redness, or swelling that spreads through the neck may indicate a more serious condition.
Why Do Lymph Nodes Swell?
Lymph nodes contain immune cells that become more active when the body encounters bacteria or viruses.
During an infection, these cells multiply and gather in the affected lymph nodes.
As a result, the nodes may become:
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Enlarged.
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Tender.
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Painful when touched.
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More noticeable under the jaw or along the sides of the neck.
This type of swelling is commonly seen with viral infections, tonsillitis, and strep throat.
It often improves as the infection resolves.