List I - Act Core Conditions Flashcards
What is tonsillitis?
- Inflammation due to infection of the tonsils
What are the characteristics of acute tonsilitis?
- Characterised by pharyngitis, fever, malaise and lymphadenopathy
- Over half of cases are bacterial with streptococcus pyogenes the most common organism
- Tonsils typically appear oedematous and yellow or white pustules may be present
- Infectious mononucleosis may mimic the condition
What is the treatment for suspected bacterial tonsillitis?
- Penicillin
Which complication can bacterial to tonsillitis lead to?
- Local abscess formation (quinsy)
What can be used to determine the likelihood of streptococcal infection and therefore the need for antibiotic treatment?
- FeverPAIN or
* Centor clinical prediction score
What are the criteria for the FeverPAIN score?
- Score of 1 point for each (maximum of 5)
- Fever over 38c
- Purulence (pharyngeal/tonsillar exudate)
- Attend rapidly (3 days or less)
- Inflamed tonsils (severely)
- No cough or coryza
Score of:
0 - 1 = 13 to 18%
2 - 3 = 34 to 40%
4 - 5 = 62 to 65% likelihood of isolating streptococcus
What are the Centor criteria?
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever over 38c
- Absence of cough
Each of the Centor criteteria score 1 point (maximum 4)
0, 1, or 2 = 3 to 17%
3 or 4 = 32 to 56%
likelihood of isolating streptococcus
Which antibiotic regime is indicated for patients with acute tonsillitis?
- Phenoxymethylpenicillin 1st choice
- Clarithromycin if there is a true penicillin allergy
- Erythromycin for a pregnant woman with penicillin allergy
What is the advice for the management of acute sore throat of any cause in primary care?
- Adequate fluid should be taken during the course of the illness
- Ibuprofen and paracetamol can be used as an antipyretic and/or analgesic
- Salt water gargling, medicated lozenges may provide relief from throat pain
- Avoid hot drinks
- Children can return to school or daycare after fever has resolved and they are no longer feeling unwell and/or after takin anti-biotics for at least 24 hours
When should patients with acute tonsillitis seek follow up?
- Symptoms not improving after 3 or 4 days of antibiotic therapy
- Pain does not improve after 3 days and there is fever over 38.3c so that antibiotic treatment can be initiated
- Difficulty swallowing
How are patients determined if they could be eligible for a tonsillectomy with recurrent tonsillitis?
- For people with severe recurrent tonsillitis (frequency of more than 7 episodes per year for one year , 5 per year for 2 years or 3 per year for 3 years, refer to ENT - the patient may benefit from a tonsillectomy
What is pharyngitis?
- Medical term for a sore throat
* Occurs when an acute upper respiratory tract infection affects the mucosa of the throat
What is acute pharyngitis?
- Inflammation of the part of the throat behind the soft palate (oropharynx)
What are the causes of acute sore throat?
- Common causes of acute sore throat include:
- Rhinovirus, coronavirus, parainfluenza virus
- Influenza types A and B
- Streptococcal infection
- Group A haemolytic streptococcus (aka streptococcus pyogenes) is the most common bacterial cause of sore throat and may cause pharyngitis, tonsillitis, or scarlet fever
- Adenovirus leading to pharyngoconjunctival fever
- Herpes simplex virus type 1 leading to acute herpetic pharyngitis
- Epstein Barr virus leading to infectious mononucleosis
- Fusobacterium necrophorum which may cause pharyngitis or tonsilitis (very rarely) can lead to Lemierre syndrome - septic phlebitis of the internal jugular vein
How common is sore throat?
- 31% reported in the last year
* 38% of these people visited a doctor
