Pharyngitis Flashcards
inflammation of the pharynx and surrounding tissues, can be from infections or noninfectious causes
pharyngitis
What can cause non infectious pharyngitis?
reflux disease post nasal drip irritation exposure to allergens or irritants no fever chronic symptoms
List 5 risk factors for pharyngitis.
smoking allergic rhinitis seasonality behavioural risk factors exposure to infected person within the last 2 weeks (transmission through airborne droplets)
Recall 6 common causative viral organisms of pharyngitis.
coronavirus adenovirus parainfluenza influenza respiratory syncytial virus epstein barr virus
(streptococcus pyogenes)
Recall 6 common causative bacterial organisms of pharyngitis.
- Groups C, G streptococci
- Arcanobacterium hemolyticum (scarlet rash)
- n. gonorrhoeae
- c. diphtheria
- Fusobacterium necrophorum
- acute primary HIV infection
Signs and symptoms
abrupt onset sore throat, exudate odynophagia tonsillar or pharyngeal swelling palatal petechiae fever, chills malaise headache
Describe signs of strep C. diphtheriae Epstein barr virus adenovirus
Strep = scarlet fever + rash
C. diphtheriae = thick grey exudate
epstein barr virus = splenomegaly, generalized lymphadenopathy
adenovirus: conjunctivitis, preauricular adenopathy
Signs that a child under 3 years old has pharyngitis?
runny nose, excoriated nares, generalized adenopathy
Symptoms for urgent referral
severe unilateral pain dysphagia stridor drooling neck swelling respiratory distress pharyngitis, + persistent fever, + neck pain pharyngeal pseudomembrane
Autoimmune inflammatory disorder of connective tissues in heart, joints, brain, skin
rheumatic fever
Clinical presentation: Viral vs bacterial
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
What is the incubation period?
2-5 days
When do symptoms usually resolve in pharyngitis?
8-10 days
How long for symptoms to resolve when taking antibiotics
< 4 days
How to diagnose pharyngitis
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
List parts of the centor score
- temperature > 38 degrees = 1
- absence of cough = 1
- swollen, tender anterior cervical nodes = 1
- tonsillar swelling or exudate = 1
age
3-14 = 1
15-44 = 0
>45 = -1
Pros of antimicrobial therapy for pharyngitis
reduces the duration of symptoms
reduces the risk of transmission
reduces the risk of rheumatic fever
Cons of antimicrobial treatment
does not prevent glomerulonephritis
choosing therapy based on symptoms alone = over prescribing = more sie effects
Adult first-line treatment
Child first-line treatment
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
Adult alternative treatment
child alternative treatment
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
What is considered a failure of first-line therapy? and what should adults and children take if that happens
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
Tips on patient education points
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
