Case 1

Question 1

Case 1: Case history #1
A 7-year-old girl 
fever, nausea, vomiting,
and sore throat. 
NO cough, rhinorrhoea, or nasal congestion. 
oral temperature is 38.5°C
exudative pharyngitis with enlarged, tender anterior
cervical lymph nodes.
Whats the diagnosis?

Answer 1

Acute pharyngitis

Question 2

Significance of Absence of cough, nasal congestion, and nasal discharge

Answer 2

distinguishes bacterial from viral aetiologies.
Present: viral
Absent: bacterial

Question 3

Define acute pharyngitis

Answer 3

rapid onset of sore throat and pharyngeal inflammation (with or without exudate).

Question 4

What is the most common organism that causes this condition?

Answer 4

viral organisms or

group A Streptococcus (GAS).

Question 5

List the common viruses

Answer 5

• Epstein-Barr virus (mononucleosis),
• adenoviruses
• enteroviruses
• influenza A and B, and
• parainfluenza
• corona virus

Question 6

differentiate between viral and bacterial pharyngitis

Answer 6

Viral: 
Conjunctivitis 
cough, nasal congestion, and nasal discharge
Mouth ulcer 
Hoarse voice

Bacterial: FOUR CRITERIA (3/4 indicates GAS)
fever >38
Tonsilar/pharyngeal exudate
Cervical lymphadenopathy 
No cough

Question 7

List common bacterial causes:

Answer 7

• Streptococcus Group A ( S. pyogenes); is most common
bacterial causes of pharyngitis (5-15 years)
• Group C and G Streptococci
• Corynebacterium diphtheriae ( rare cause) why?
• Neisseria gonorrhoea (in patients with STD)
• Mycoplasma species and Arcanobacterium haemolyticum
(found rarely in adolescents with pharyngitis) .

Question 8

What investigations would you perform?

Answer 8

It is microbiologically confirmed by a rapid antigen test, and if negative, a throat culture for GAS

Question 9

The “gold standard” for diagnosis of S. pyogenes pharyngitis

Answer 9

Culture of throat swab

Question 10

Culture of throat swab for group A Streptococcus

Answer 10

• Culture of a throat swab on a sheep-blood agar plate • β-hemolytic colonies
• Bacitracin susceptibility
• Gram-positive cocci in chains
• catalase-negative
• Groupidentification:LancefieldantigenAtest

Question 11

GAS histology

Answer 11

Gram + cocci in chains

Beta hemolytic colonies

Question 12

GAS is Bacitracin sensitive or not?

Answer 12

Yes

Question 13

GAS: catalase + or -

Answer 13

-

Question 14

Group identification

Answer 14

LancefieldantigenAtest

Question 15

Treatment

Answer 15

1. Antibiotic treatment:
   • Penicillin or amoxicillin for 10 days
   • For penicillin –allergic patients:
   ❖ Erythromycin
   ❖ first-generation cephalosporin 2. Adjunctive therapy:
   • an analgesic/antipyretic agent (acetaminophen, ibuprofen)

Question 16

Throat swab medium

Answer 16

Sheep blood agar

Question 17

Complications of GAS

Answer 17

Glomerulonephritis

Acute rheumatic fever

Question 18

Goal of treatment

Answer 18

Short symptoms
Prevent transmission
Prevent complications