Pharyngitis Flashcards
Epidemiology of pharyngitis
Fall, winter, spring (peak late winter, early spring)
Acquired by direct contact with respiratory secretions
Infectious 2-5 days prior to symptoms and 1 week after (w/tx contagious for 24hours)
Incubation 24-72 hours
What is the etiology of pharyngitis?
Usually viral (80%)
Bacterial:
Streptococcus pyogenes (GAS) 30% peds, 15% adults, H influenza, Chlamydypholia pneumonia, Mycoplasma pneumonia, Neisseria Gonorrhea
1 in 4 children swab _ GAS
Carrier GAS
20% of adults
15 % meds
> 3 confirmed GAS /year: do a swab when asymptomatic
Not at increased risk of rheumatic fever
What are the signs and symptoms to look for in a sore throat
Viral: rhinorrhea, hoarseness, cough, conjunctivitis, diarrhea, fatigue, tonsillar hypertrophy, oropharyngeal erythema or edema, pharyngeal cobblestoning
Bacterial:
Fever more than 38, no cough, difficulty swallowing
Malaise, HA, mild neck stiffness, GI (anorexia, NV, abdo pain)
GROUP A STREP:
erythema
edema of the pharynx + uvula
tonsillar exudates
Petechia of the soft palate
Anterior cervical lymph nodes swelling
tenderness
mod-severe sore throat
Scarlet fever:
Erythematous papules beginning on the trunk spreading to the extremities and sparing the palms + soles, blanches to pressure, sandpaper, subsides in 6-9 days follows by desquamation of the palms + soles
Enlarged papillae on a coated tongue “strawberry tongue”
Fungal: loss of taste, mouth numbness, oropharyngeal white curd like plaques, oropharyngeal smooth red patches, angular cheilitis
What is the score of GAS?
Modified Centor Score
FeverPAin Criteria
Investigations in Pharyngitis
Throat culture
Rapid Antigen test (Spe 95%, Se 85%) consider confirming negative RADT with throat swab
Consider monospot if suspected mono (increase false negative in first 10 days)
Management Pharyngitis
Viral:
NSAIDs
Acetaminophen
Oral cortico for 1-2 days decrease odynophagia (NNT 4- Low evidence)
GAS:
generally resolves in 4-5 days without tx
Populations with higher incidence of GAS complications such as Indigenous population, are more likely to benefit from ABX
ATB shorten duration of symptoms by 16 hours
Protect against
- Sore throat at day 3 (NNT 4)
- Sore throat at day 7 (NNT 21)
- Acute rheumatic fever (NNT 90-4000)
- Subsequent acute otitis media (NNT 29)
- Subsequent acute sinusitis (NNT 50)
- Subsequent peritonsillar abscess (NNT 47)
They do NOT protect against meningitis or glomerulonephritis
Consider delaying treatment 2-3 days to await swab results (immediate treatment may increase reinfection rates & delaying treatment up to 9 days does NOT increase the risk of rheumatic fever)
FU for pharyngitis
24-48 hours if symptomatic
If swab + asses for peritonsillar abcess, concurrent viral infection, compliance
2-7 days post completion of abx if symptomatic
Repeat swab : tx with Amox-clav (resistance?)
