Acute Pharyngitis Flashcards
What is the most important bacterial cause of acute pharyngitis?
Group A streptococcus
What viral etiology causes severe pharyngitis?
Infectious mononucleosis
What pharyngeal lesions are usually seen in primary oral HSV infection?
Gingivostomatitis and ulcerating vesicles throughout the anterior pharynx
primary oral HSV infection can last up to how many days?
14 days
Discrete papulovesicular lesions or ulcerations in the posterior oropharynx, severe throat pain, and fever are characteristic of______________
Herpangina
What is pharyngoconjunctival fever?
pharyngitis with concurrent conjunctivitis.
pharyngitis tends to resolve within 7 days but conjunctivitis may persist for up to 14 days
can be epidemic or sporadic; outbreaks have been associated with exposure in swimming pools
Splenomegaly, lymphadenopathy, or hepatomegaly may be the clue to ________________________ in an adolescent with exudative tonsillitis
EBV infectious mononucleosis
Primary infection with HIV can manifest as the acute retroviral syndrome which manifest as?
non-exudative pharyngitis, fever, arthralgia, myalgia, adenopathy, and often a maculopapular rash
What are the features suggestive of Group A streptococcus pharyngitis?
sudden onset of sore throat
5-15 years old
patchy tonsillo pharyngeal exudates
anterior cervical adenitis (tender nodes)
scarlatiniform rash
What are the features suggestive of Viral pharyngitis?
conjunctivitis
coryza
cough
diarrhea
hoarseness
viral examthen
Scarlet Fever like rash with pharyngitis may be present with____________?
A. haemolyticum infections
What etiology agent is common cause of
pharyngitis in older adolescents and adults (15-30 yr old), had fever, tonsillar exudates, had anterior cervical adenopathy, and most did not have cough????
F. necrophorum
F. necrophorum pharyngitis is associated with
the development of _________________?
Lemierre syndrome
What is Lemierre syndrome?
internal jugular vein septic thrombophlebitis
patient appears toxic, Septic shock may ensue
May usually be asymptomatic but can
cause acute ulcerative or exudative pharyngitis with fever and cervical lymphadenitis
Gonococcal pharyngeal infections
Streptococcal pharyngitis is relatively uncommon before _______________,
is quite common among children ____________ , and declines in frequency in ________________
2-3 yr of age
5-15 yr old
late adolescence and adulthood
How long is the incubation period of GAS infection?
2-5 days
Describe the physical exam of the pharyngeal wall in GAS infection?
pharynx is red, the tonsils are enlarged and often covered with a white, grayish, or
yellow exudate that may be blood-tinged.
There may be petechiae or doughnut lesions on the soft palate and posterior pharynx, and the
uvula may be red and swollen
Describe the oral PE in GAS infection.
flamed and prominent (strawberry tongue). Initially, the tongue is often coated white, and
with the swollen papillae, it is called a white strawberry tongue. When the white coating is gone after a few days, the tongue
is often quite red, and is called a red strawberry tongue
What pyrogenic exotoxin may demonstrate the fine red, papular (sandpaper) rash of scarlet fever?
exotoxin A, B, or C
What is Pastia lines or sign?
rash blanches with pressure, and it may be more intense in skin creases, especially in the antecubital fossae, axillae, and inguinal
creases
What is Rumpel-Leeds phenomenon?
Capillary fragility can cause petechiae distal to a
tourniquet or constriction from clothing, a positive tourniquet test
What is the exotoxin most commonly associated with scarlet fever?
Streptococcal pyrogenic exotoxin A, encoded by the gene spe A
What is the important GAS virulence factor that facilitates resistance to phagocytosis?
M protein
Can a person experience multiple GAS infection?
yes because natural immunity is M type–specific and does not prevent infection with a new M type
What is the criteria of GAS infection?
temperature >38°C
absence of cough
tender anterior cervical adenopathy
tonsillar swelling or exudates
age 3-14 yr
Is throat culture needed if rapid antigen-detection tests is positive
no because it is assumed to be accurate and throat culture is unnecessary. but RADTs are generally much less sensitive than culture, confirming a negative rapid test with a throat culture is recommended
These can be used in children who have evidence of upper airway compromise due to mononucleosis
Systemic corticosteroids
This cannot be recommended for treatment
of most pediatric pharyngitis
Corticosteroids
What is recommended for patients with A. haemolyticum
oral erythromycin
What is suggested for patients with group C streptococcal isolates
oral penicillin
What is the primary benefit and intent of antibiotic treatment
prevention of acute rheumatic fever (ARF)
What is the golden time frame for antibiotics to be started?
within 9 days
Does Antibiotic therapyprevent acute poststreptococcal glomerulonephritis (APSGN)?
no
When can a Presumptive antibiotic treatment be started?
clinical diagnosis of scarlet fever
a symptomatic child has a household contact with documented streptococcal pharyngitis
there is a history of ARF in the patient or a family member
What is the duration of treatment of pharyngitis?
10 days
Is Follow-up testing for GAS necessary after completion of therapy and is recommended unless symptoms recur
NO
What can be given to patients allergic to penicillin?
10-day course of a narrow-spectrum, 1st-generation cephalosporin (Cephalexin)
10 days with erythromycin, clarithromycin, or clindamycin
5 days with azithromycin
What are the reasons of having recurrent pharyngitis?
reinfection with the same M type if type-specific antibody has not developed
poor compliance with oral antibiotic therapy
macrolide resistance if a macrolide was used for treatment infection with a new M type
What is the criteria for tonsillectomy?
≥7 episodes in the previous year
≥5 in each of the preceding 2 yr
≥3 in each of the previous 3 yr
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