Pharyngitis

Question 1

inflammation of the pharynx and surrounding tissues, can be from infections or noninfectious causes

Answer 1

pharyngitis

Question 2

What can cause non infectious pharyngitis?

Answer 2

reflux disease 
post nasal drip irritation 
exposure to allergens or irritants 
no fever
chronic symptoms

Question 3

List 5 risk factors for pharyngitis.

Answer 3

smoking
allergic rhinitis 
seasonality 
behavioural risk factors 
exposure to infected person within the last 2 weeks (transmission through airborne droplets)

Question 4

Recall 6 common causative viral organisms of pharyngitis.

Answer 4

coronavirus 
adenovirus 
parainfluenza
influenza
respiratory syncytial virus
epstein barr virus  

(streptococcus pyogenes)

Question 5

Recall 6 common causative bacterial organisms of pharyngitis.

Answer 5

1. Groups C, G streptococci
2. Arcanobacterium hemolyticum (scarlet rash)
3. n. gonorrhoeae
4. c. diphtheria
5. Fusobacterium necrophorum
6. acute primary HIV infection

Question 6

Signs and symptoms

Answer 6

abrupt onset 
sore throat, exudate 
odynophagia 
tonsillar or pharyngeal swelling 
palatal petechiae 
fever, chills
malaise 
headache

Question 7

Describe signs of 
strep
C. diphtheriae 
Epstein barr virus 
adenovirus

Answer 7

Strep = scarlet fever + rash
C. diphtheriae = thick grey exudate
epstein barr virus = splenomegaly, generalized lymphadenopathy
adenovirus: conjunctivitis, preauricular adenopathy

Question 8

Signs that a child under 3 years old has pharyngitis?

Answer 8

runny nose, excoriated nares, generalized adenopathy

Question 9

Symptoms for urgent referral

Answer 9

severe unilateral pain 
dysphagia 
stridor 
drooling 
neck swelling 
respiratory distress 
pharyngitis, + persistent fever, + neck pain 
pharyngeal pseudomembrane

Question 10

Autoimmune inflammatory disorder of connective tissues in heart, joints, brain, skin

Answer 10

rheumatic fever

Question 11

Clinical presentation: Viral vs bacterial

Answer 11

Viral:
–Odynophagia, cough, rhinorrhea, conjunctivitis, hoarseness, diarrhea, rash

Group A Strep pharyngitis:
–Odynophagia
–Pharyngeal/tonsillar erythema +/- exudate
–Fever
–Palatal petechiae
–Tender cervical adenopathy
–Absence of cough
–Scarlet fever
–History of exposure, winter to early spring presentation

Question 12

What is the incubation period?

Answer 12

2-5 days

Question 13

When do symptoms usually resolve in pharyngitis?

Answer 13

8-10 days

Question 14

How long for symptoms to resolve when taking antibiotics

Answer 14

< 4 days

Question 15

How to diagnose pharyngitis

Answer 15

Symptoms are non-specific; not reliable for determining bacterial vs viral cause

A throat culture or rapid antigen detection swab is required for diagnosis
•A positive culture or rapid antigen test in absence of clinical symptoms likely represents a Strep carrier

•Test of cure not recommended

Question 16

List parts of the centor score

Answer 16

1. temperature > 38 degrees = 1
2. absence of cough = 1
3. swollen, tender anterior cervical nodes = 1
4. tonsillar swelling or exudate = 1

age
3-14 = 1
15-44 = 0
>45 = -1

Question 17

Pros of antimicrobial therapy for pharyngitis

Answer 17

reduces the duration of symptoms
reduces the risk of transmission
reduces the risk of rheumatic fever

Question 18

Cons of antimicrobial treatment

Answer 18

does not prevent glomerulonephritis

choosing therapy based on symptoms alone = over prescribing = more sie effects

Question 19

Adult first-line treatment

Child first-line treatment

Answer 19

Adults
Penicillin 600 mg po bid (or 300 mg tid) x 10 days

Children
Penicillin 40 mg/kg/day po bid x 10 days
Amoxicillin 50 mg/kg/day po bid x 10 days

Question 20

Adult alternative treatment

child alternative treatment

Answer 20

Adults
Cephalexin 500 mg po bid x 10 days
–Clindamycin 300 mg po tid x 10 days

Children
Cephalexin 40 mg/kg/day divided bid x 10 days
–Clindamycin 20 mg/kg/day divided tid x 10 days

Question 21

What is considered a failure of first-line therapy? and what should adults and children take if that happens

Answer 21

Worsening symptoms after 72 hours of antimicrobial therapy
Early relapse 2-7 days post therapy

Adults
Amoxicillin/clavulanate 875 mg po bid x 10 days

Children
Clindamycin, azithromycin or clarithromycin

Question 22

Tips on patient education points

Answer 22

Supportive care
–Rest, fluids, maybe adjunctive treatments
•Handwashing is the best way to reduce the spread of viral infections
•Symptoms typically improve in 8-10 days without treatment
•Antimicrobials effective at reducing risk of rheumatic fever even if delayed up to 9 days
–Rheumatic fever is a rare complication