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Pharyngitis - MUST READ_PART I
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10.25.06 (1 year ago)
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Pharyngitis
PART 1
Description
•Inflammation of the pharynx that causes a sore throat
•May be caused by a variety of micro-organisms; pharyngitis of viral etiology is the most common
•Group A beta-hemolytic streptococcal infections are considered a potentially serious cause because of the risk of rheumatic fever and glomerulonephritis
•Sore throat, tonsillar exudate, cervical adenopathy, and a temperature >100°F (38°C) may indicate streptococcal infections in the absence of throat culture results
•Antibiotic treatment may usually be initiated when the causative micro-organism streptococcus is suspected
Urgent action
Antibiotics are typically initiated when streptococcal or other bacterial infections are suspected before verifying culture results.
Cardinal features
•Sore throat
•Enlarged tonsils; tonsillar exudates
•Pharyngeal erythema
•Soft palate petechiae
•Anterior cervical adenopathy
•Painful swallowing
•Fever greater than 100°F (38°C), erythematous rash, or abdominal pain suggests streptococcal infection
•Absence of cough, rhinorrhea, or itchy eyes suggests streptococcal infection rather than viral infection
Causes
Common causes
•Viral causes are the most common (90% in adults, 60-75% in children) and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, respiratory syncytial virus
•Bacteria: group A beta-hemolytic streptococci, especially Streptococcus pyogenes, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Haemophilus influenzae, Moraxella catarrhalis, nontypable Haemophilus
•Fungi - Candida - may be found in immunocompromised individuals
Rare causes
•Chemical irritation
•Gastroesophageal reflux disease
•Postnasal drainage from chronic allergies
•Neoplasms
•Mycoplasma pneumoniae
•Chlamydia pneumoniae
Serious causes
•Group A beta-hemolytic streptococci - risk of rheumatic heart disease or glomerulonephritis
•Corynebacterium diphtheriae - myocarditis, peripheral neuritis
Contributory or predisposing factors
•Group A beta-hemolytic streptococci epidemics
•Recent family history - may be passed between family members
•Close quarters (military barracks, dormitories)
•Immunosuppression
•Oral sex - at risk for gonococcal pharyngitis and Chlamydial trachomatis pharyngitis
•Recent illness
Demographics
Age
Streptococcal infection occurs predominantly between the ages of 5-18 years. Pharyngitis under 3 years of age is uncommon but possible, especially in the carrier state in the household; it is nearly always due to viral etiologies.
Clinical presentation
Symptoms
•Sore throat
•Odynophagia
•Chills
•Malaise
•Headache
•Anorexia
•Abdominal pain
Signs
•Pharyngeal erythema
•Pharyngeal exudate
•Enlarged edematous tonsils
•Fever
•Anterior cervical adenopathy
•Rash - may or may not be present
Differential diagnosis
Thrush
Thrush is caused by candidal infection, and can be oral or vaginal. Otherwise known as candidiasis or moniliasis.
Features
•Sore throat
•Cheesy, white plaques that reveal an erythematous base when scraped
Mononucleosis
Mononucleosis is caused by infection with Epstein-Barr virus, transmitted primarily in saliva through oral contact.
Features
•Fatigue
•Sore throat
•Diffuse lymphadenopathy
•Splenomegaly
•Pharyngeal petechiae
•IgM antibodies
Epiglottitis
Inflammation of the epiglottis, with rapid onset and progression of symptoms.
Features
•Sore throat
•Fever, toxic
•Dyspnea, respiratory distress
•Dysphagia
•Drooling
•Dysphonia
•Inspiratory stridor
Workup
Diagnostic decision
The diagnosis of group A streptococcal pharyngitis may be suspected on the basis of clinical signs and symptoms but may be confirmed with laboratory testing. Either a positive rapid antigen test or a positive throat culture provide evidence of group A beta-hemolytic streptococci in the pharynx. A negative rapid antigen test does not rule out streptococcal pharyngitis and should be confirmed with a throat culture.
Don't miss!
Do not examine the throat if epiglottitis is suspected because examination may precipitate respiratory obstruction.
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