Habal: Pharyngitis, Parotitis, Epiglottitis, Croup Flashcards
85% (or 70%?) of pharyngitis cases are caused by ______________.
viruses:
A CCPR HEI
Adenovirus (most common)
Coxsackievirus
Coronavirus
Parainfluenza viruses
Rhinoviruses
HSV-1
EBV
Influenza (VIRUS! not bacteria)
What bacteria are associated with pharyngitis?
SHriNC
Streptococcus PYOGENES (P for pharyngitis) - most common.
H. influenza
Neisseria gonorrhoeae
Corynebacterium diptheriae
What makes up the dx for strep throat?
GAS Infection (transmitted by respiratory droplets)
Most common ages: 5-15
Sx: HA, fever, throat pain, light color EXUDATE covering pharynx and tonsils
Tender ANTERIOR cerviclal lymph nodes
Palatal and uvular petechiae
Possibly accompanied by a RASH
What will you NOT see in strep throat?
Viral sx i.e. rhinorrhea, cough, and hoarsness
What are some key diferences between pharyngitis of GAS etiology versus viral etiology?
Seen in GAS but not viral: fever, HA, palatal petechiae, tender anterior cervial lymph nodes
Seen in viral but not GAS: conjunctivitis
What are the 4 life-threatening conditions of acute pharyngitis?
- *DERP:**
- *D**iptheria (membrane)
Epiglottitis (toxic appearance, fever, stridor, drooling)
Retropharyngeal abscess (neck pain, fever)
Peritonsilar abscess (uvular deviation, fluctuance)
How do you diagnose pharyngitis?
Rapid Strep Test - Rapid Antigen Detection Test (RADT). (thraot swab, fast. 80-90% senstitive)
Also: DNA-based testing: detected from throat swab. expensive, takes about an hour; 97% sepcificity.
Describe how you would go about diagnosing and treating a patient that you suspect to have strep throat. (Chart.)
Features of strep pyogenes?
G+, catalase negative
BACITRACIN sensitive (S. agalactiae is bacitratin resistant)
Swab test detects Antibody to Streptolysin-O (ASO)
Key virulence feature of Strep pyogenes?
M-Protein: outer membrane protein that interferes with opsonization.
(It interacts with Serum Factor H and interferes with stabilization of C3 conertase; therefore it decreases opsoniation power. Antiphagocytic.)
Three manifestations of Strep pyogenes?
- Pharyngitis (strep throat with tonsilar exudates, anterior swollen lymph nodes, fever)
- Scarlett fever (oropharyngeal infection with rash, sandpaper rash on palms, soles; strawberry tongue)
- Impetigo (honey-crusted cutaneous lesions)
4 main complicaitons of strep pyogenes?
-Bacteremia and septicemia –> arthritis, osteomyelitis, endocarditis, emningitis
-Toxic Shock-like Syndrome flu-like sx, necrotizing soft tissue infection, ARDS< renal failure
-Rheumatic Fever follows sore throat and low grade fever. MITRAL VALVE murmur. mitral stenosis. Tx with Penicillin.
-GN follows skin rash and sore throat. Associated with DNAase B.
What bacteria grows on Loffler’s agar in black colonies?
Corneybacterium diptherieae
How is corynebacterium diphtheriae transmitted?
airborne droplets
What is the main virulence factor for corynebacterium diphtheriae?
AB exotoxin
What is the mechanism of action of the AB exotoxin in corynebacterium diphtheriae?
ADP ribosylation of EF2 –> inhiits protein synthesis
Upon examination, your patient presents with a grayish membrane covering the tonsils and pharynx and “bull neck” due to cervical lymphadenopathy. What is your dx?
corynebacterium diphtheriae
Two main complications of corynebacterium diphtheriae?
Myocarditis and polyneuropathy
Is there a vaccination for corynebacterium diphtheriae?
DTaP: 2,4, and 6 months adn boosters at 1, 6, and every 10 years
(tetanus, diptheriae, and pertusis)
What are the two main modes of transmission of adenoviruses?
Fecal-oral and transplacental
Your patient has pink eye (conjunctivitis) and sore throat. What is part of your Ddx?
Adenovirus.
What subtypes of adenoviruses manifest as pharyngoconjunctivitis and fever in young children?
3-7
What subtypes of adenoviruses manifest as acute respiratory infection?
4-7
