Module 8.12 - Pharyngitis Flashcards
What is pharyngitis?
An inflammation of the pharynx that is usually associated with tonsillitis; can be acute or chronic.
What causes pharyngitis?
A. Viral- most common
- Influenza A and B
- Adenovirus
- Enterovirus
B. Bacterial- (less common)
- Group A beta-hemolytic streptococcus (GABHS) NOTE* Complications from GABHS pharyngitis, although rare, include rheumatic heart disease and glomerulonephritis.
- Haemophilus influenzea
- Neisseria gonorrhoeae
- Mycoplasma
C. Fungal – Candida albicans- commonly seen in immunocompromised patients
D. Pharyngitis may be associated with the following:
- Esophageal reflux (GERD)
- Allergic rhinitis (non-infectious)
- Sinusitis
- Carcinoma
What are the subjective/physical exam findings associated with pharyngitis?
A. Sore or painful throat
B. Dysphagia
C. Fever/chills
D. Malaise/myalgia
Viral:
- Edema of lymphoid tissue in the posterior oropharyngeal wall- elevated oval islands.
- Pale, boggy mucosae of the posterior pharynx, palatial petechiae
- Painful ulcers/blistering in oral cavity/pharynx
- Posterior cervical lymphadenopathy
Streptococcal (GABHS) – Centor criteria (fever, tonsillar exudate, tender anterior cervical LAD, but no cough)
- Bright red, edematous pharyngeal mucosa
- White or yellow exudate
3. Fever greater than 101 degrees F
- Anterior cervical lymphadenopathy
Candidal:
- Shiny, white and raised patches located on the following: posterior pharynx, tongue and buccal mucosa; patches may have erythematous rims (red base).
What lab/diagnostic tests are used to diagnosed pharyngitis?
A. Rapid strep antigen screen
B. Throat cultures, CBC with differential (if rapid strep is negative)
C. Mono spot for suspicion of mononucleosis
D. If indicated, culture for chlamydia and/or gonorrhea.
How do you manage a patient with bacterial pharyngitis?
A. Pain relief:
- Lozenges, OTC prn
- Throat sprays, OTC prn
- Warm salt water gargle
- Systemic analgesics: acetaminophen and NSAIDS
- Glucocorticoids are not recommended.
B. Antimicrobial therapy based on GABHS only
- Benzathine penicillin (Bicillin L-A) 1.2 million units IM single dose, or penicillin V (Pen-Vee K) 500mg po bid x 10 days.
- Cephalexin 500m po bid x 10 days
- Cefadroxil, 100mg po daily x 10 days
4. Clindamycin 300mg po tid x 10 days
5. Azithromycin 500mg po daily x 5 days
6. Clarithromycin 250mg po bid x 10 days
- Consider antiulcer agents for gastric reflux, such as Omeprazole (Prilosec) 20mg po daily or Lansoprazole (Prevacid) 15-30 mg po daily
How do you manage a patient with candidal pharyngitis?
A. Pain relief
- Lozenges, OTC prn
- Throat sprays, OTC prn
- Warm salt water gargle
- Systemic analgesics: acetaminophen and NSAIDS
- Glucocorticoids are not recommended.
B. For Candida
- Nystatin (Mycostatin) 100,000u/mL, take 4-6 mL swish and swallow qid (for mild disease only), or
- Fluconazole (Diflucan) 200mg po initially, and then 100mg daily x 14 days (at least)
How do you diagnose a patient with GABHS pharyngitis?
A clinical decision rule exists to guide the diagnosis of GABHS:
- Temperature above 100.9 degrees F = 1 point
- Recent exposure to a person with GABHS = 1 point
- Exudates on pharynx or tonsils = 1 point
- Enlarged or tender lymph nodes = 1 point
- Cough = -1 point
Patients with two or more points are presumed to have GABHS and should be treated without culture. Patients with one or zero points should have rapid strep test.
