Acute viral and bacterial pharyngitis Flashcards
Grading of tonsils….0 to +4
If tonsils are absent?
0
If tonsils are touching each other “kissing tonsils”
+4
If tonsils are visible
+1
If tonsils are halfway between tonsillar pillars and uvula
+2
If the Tonsils are touching the uvula
+3
Acute viral pharyngitis is usually accompanied with?
Upper respiratory infection
Causative agents of viral pharyngitis are?
rhinoviruses RSV adenovirus influenza virus parainfluenza virus
What is the typical course of viral pharyngitis illness?
self limiting and usually resolves within 4-10 days without complications.
What antibiotics do you give to treat this condition?
NO ANTIBIOTICS ARE INDICATED
what are appropriate supportive care measures for viral pharyngitis?
antipyretics for mild fever and discomfort
rest is recommended until child is free of fever for 1 day
increase PO fluids
decongestants and cough suppressants may be given
Which medication is ineffective in relieving symptoms of viral pharyngitis?
Antihistamines are ineffective
Is cough, rhinorrhea, coryza, hoarseness, conjunctivitis, diarrhea symptoms seen with viral or bacterial pharyngitis?
VIRAL
What are the symptoms seen with Group A beta hemolytic strep pharyngitis?
history of strept A exposure or being around kids
occurs in winter or early spring
sudden onset of sore throat, severe pain with swallowing
headache, nausea, vomiting, abdominal pain more common in kids
tonsillopharyngeal erythema with or without exudate
tender, enlarged anterior cervical lymph nodes
red, beefy swollen uvula
petichiae on palate, scarlatiniform rash
What is the modified Centor Criteria?
Used for decision making of pharyngitis fever +1 absence of cough +1 tender anterior cervical adenopathy +1 tonsillar swelling or exudates +1 age younger than 15 years +1 15-45 years 0 older than 45 years -1
If patient scores 2-3 points with Modified Centor criteria what interventions are done?
order rapid test and throat culture
treat with antibiotics if positive
If patient scores 0-1 points on centor criteria what interventions are done?
no testing or antibiotics are warranted
If patient scores 4+ points with Modified Centor Criteria what interventions are done?
No testing warranted
treat empirically with antibiotics
T/F Children with Group A Beta hemolytic strept do not present with similar symptoms as adults
True
sometimes they only present with fever
What are clinical manifestations of bacterial pharyngitis (strept throat)?
abrupt onset pharyngitis headache fever abdominal pain tender anterior cervical lymphadenopathy tonsillar and pharyngeal inflammation and exudate (day 2 of illness) difficulty swallowing due to pain scarlatina rash (sand paper rash)
What are two serious conditions that can occur after Group A Beta Hemolytic strep (GABHS) infection?
Rheumatic fever (scarlet fever) about 18 days after Acute glomerulonephritis about 10 days after
T/F if patient has cough it is unlikely that the patient has GABHS?
TRUE
When does Scarlet fever show up?
usually get rash 24 hours after onset of GABHS
What ages do you typically see scarlet fever?
less than 3 years old and in adults
What are signs and symptoms of scarlet fever
scarlatina rash (sand paper rash) on trunk that blanches
Pastias line
circumolar palor
desquamation 7-10 days after start of rash on hands and feet and trunk and abdomen
strawberry tongue
Is ASO testing helpful for diagnosis of strept?
NO
only used for retrospective diagnosis related to acute glomerulonephritis.
What is treatment for GABHS?
if 60 pounds (27 kg) give Penicillin V 250 mg two or three times a day for 10 days
if >60 lbs. then given Penicillin V 500 mg PO BID x 10 days
If patient is allergic to beta lactams what antibiotics are used to treat strept throat?
Clindamycin
Clarithromycin
Azithromycin
What antibiotic has recently been associated with cardiac pathology (causing arrhythmias)
Clarithromycin
When can kids return to school and no longer contagious?
After being on antibiotics for 24 hours
What is the treatment for patients that have carrier state of GABHS (have the bacteria show up on culture swab but patient exhibits no immunologic response)?
Clindamycin or Rifampin plus Benzathine penicillin
Penicillin V plus Rifampin
