Pharyngitis Flashcards
P
Etiology of Pharyngitis
- Most common cause is viral infections like Rhinovirus, Coronavirus, Adenovirus
- Some bacterial causes include Group A β-haemolytic Streptococcus (GABHS) or Streptococcus pyogenes
- other causes- allergy, trauma, toxins and neoplasm
Clinical presentation of Pharyngitis
- Sore throat
- Dysphagia
- Fever
- Headache, Nausea/Vomiting, Abdominal pain
- Erythema in tonsils and pharynx with or without exudate
- Enlarged lymph nodes
- Petechia especially in the soft palate
- Scarlatiniform rash on the body
- Exudate
- Petechia
- Inflammation of the pharyngeal mucosa
Types of Pharyngitis
Acute pharyngitis
Chronic pharyngitis
Other pathogens causing Pharyngitis
- H. influenza
- Staph aureus
- Corynebacterium diphtheria
- Neisseria spp (Gonococcal)
Other causes of Pharyngitis
- Allergy
- Trauma
- Toxins
- Neoplasm
Pharyngitis (Sore throat) is ——-
an acute inflammation or irritation of the pharyngeal mucosa following infection of the nasopharynx or oropharynx
Risk factors for Pharyngitis
- Exposure to cigarette smoking
- Frequent common cold and flu
- GERD
Pathophysiology of Pharyngitis
- Bacterial and viral infections lead to invasion of the mucosa
- local inflammatory response
- increased capillary permeability
- Leading to swelling, erythema, exudate, fever, and production of extracellular toxins and proteases in Streptococcal infections
Diagnosis of GABHS infection
Group A beta-hemolytic streptococcal rapid antigen detection test is the preferred method for diagnosing GABHS infection in the emergency department
Centor criteria for GABHS pharyngitis
Fever (1 point)
Anterior cervical lymphadenopathy (1 point)
Tonsillar exudate (1 point)
Absence of cough (1 point)
- > predictive for GABHS pharyngitis in children
Differential diagnosis
- Allergic rhinitis with postnasal drip
- Airway obstruction
- Neoplasms - head and neck
- Gastroesophageal reflux disease (GERD)
- Peritonsillar cellulitis
- Candidiasis
- Diphtheria
- Croup (Laryngotracheobronchitis)
- Gonorrhea
- Epiglottitis
- Herpes Simplex Virus (HSV)
- Infectious Mononucleosis (IM)
- Pneumonia, Mycoplasma
- Retropharyngeal abscess
- Scarlet Fever
——— is less expensive than the rapid antigen detection test but not the best test to use in the emergency department due to difficulty with follow-up
Throat culture
Physical examination
- Assessment of airway patency
- Temperature
- Hydration status
- HEENT
- Lymphadenopathy
- Cardiovascular evaluation
- Pulmonary assessment
- Abdominal examination
- Skin examination
———- is the preferred method for diagnosing GABHS infection in the emergency department
GABHS rapid antigen detection test
Factors to rule in or rule out diagnosis of GABHS pharyngitis
- Sore throat
- Fever
- Most common in children aged 4-7 years (but other ages may also be affected)
- Associated w/ sudden onset of symptoms
Complications of pharyngitis
- Acute rheumatic fever
- Acute glomerulonephritis
- Mastoiditis
- Peritonsillar abscess
- Otitis media
- Rhinosinusitis
- Necrotizing fasciitis
Treatment of Pharyngitis
- Antimicrobial treatment
2 . Analgesic and antipyretic
Analgesic and antipyretic treatment for Pharyngitis includes pain and fever management with ———-
Paracetamol or Ibuprofen
If allergic to penicillins, alternatives include ——–
cephalosporins, Macrolides, or Clindamycin
What is the first-choice treatment for Pharyngitis
Penicillin V
Follow and monitoring parameters
- Alleviation of signs and symptoms after 3 days and at the end of the course of antibiotics
- Culture if history or evidence of rheumatic fever or if symptoms are consistent with a relapse
- Patients advised to avoid contact sports
- Viral pharyngitis generally requires no specific follow-up unless immunosuppression is suspected or symptoms worsen
Antimicrobial treatment for Pharyngitis should be based on ?
laboratory confirmation of GABHS pharyngitis
Advantage of the GABHS rapid antigen test ?
The GABHS rapid antigen detection test decreases the use of unnecessary antibiotics in pediatric patients when used properly
The goal of treatment for Pharyngitis
- to improve clinical signs and symptoms
- minimize adverse drug reactions
- prevent transmission to close contacts
- prevent complications
complications – including rheumatic
fever, peritonsillar abscess, cervical
lymphadenitis or mastoiditis
Criteria for Steroids use
Steroids may improve clinical symptoms and shorten the clinical course in patients with;
* severe or exudative pharyngitis
* airway obstruction
* significant swelling
* odynophagia
Duration of antibiotic therapy?
Antibiotics may be given up to 7-10 days after onset of symptoms to prevent acute rheumatic fever
Pharmacological management of Pharyngitis
- Penicillin V = first choice treatment
– 250mg PO q8h (children) X 10 days
– 250mg PO q6h or 500mg PO q12h (adults) - Benzathine penicillin i.m. stat
- or amoxicillin (50 mg/kg/d in 2-3 doses orally) X 10
days
