Pharyngitis Flashcards
Pharyngitis define and classify
Inflammation of pharyngeal mucosa caused by infection of nasopharyngeal and oropharynx
Classify -acute and chronic
Etiology include common viral and bacterial causes pharyngitis
Viral-rhinovirus, adenovirus, coronavirus
Bacterial- group A beta hemolytic streptococcus (GABHS) or streptococcus pyogenes
Other pathogens -Neisseria spp ,S.aureus, H. Influenza
Other causes -allergy, trauma, toxin
Quick diagnostic measure
GABHS rapid antigen detection test
Preferred in emergency situation due to difficulty follow up of cultures
Pathophysiology of pharyngitis
Bacterial and viral infection
Invasion of microbes cause local inflammatory response due to migration of leukocytes leads to increased capillary permeability , increased swelling , erythema, exudate and fever . Streptococcal infections produce toxins and protease
Risk factors
Exposure to cigarette smoke
GERD
Frequent common cold /flu
Clinical presentation
Dysphagia
Sore throat
Fever
N/V
Erythema
Enlarged lymph nodes
Scarlatiniform rash
Petechia esp on soft palate
Which clinical presentation are suggestive of viral
Cough
Conjunctivitis
Coryza (runny nose)
Cause of gonococcal pharyngitis
Recent orogenital contact
Criteria for GABHS pharyngitis
Fever=1
Anterior cervical lymphadenopathy =1
Tonsillar exudate=1
Absence of cough=1
Predict GABHS pharyngitis in children
Complications pharyngitis
Otitis media
Mastoiditis
Acute rheumatic fever
Physical exam pharyngitis
Assessment of airway -ability to breath(oral/nasal)
Hydration status( dehydration due to odynophagia)
HEENT-conjunctivitis (adenovirus), rhinorrhea(viral) . Palatal petechiae tonsillopharyngeal exudate (M.pneumoniae ,adenovirus, GABHS)
Lymphadenopathy(streptococcal infection)
Cardiovascular: monitor potential rheumatic fever
Skin : scarlatiniform rash(GABHS )
Pulmonary: Non productive (M.pneumonia/C. Pneumoniae)
Differential diagnosis pharyngitis
Allergic rhinitis
Airway obstruction
Neoplasm-head and neck
GERD
Peritonsillar cellulitis
Scarlet fever
Pneumonia
Diagnosis pharyngitis
GABHS rapid antigen detection test
Throat culture (less expensive that rapid test)
Clinical presentation
Goal of treatment pharyngitis
Improve clinical symptoms
Prevent complications ie mastoiditis, rheumatic fever
Minimize adr
Prevent transmission to close contacts
Treatment pharyngitis
Antimicrobial to be used on lab confirmation of GABHS pharyngitis , blood test not required but may give w/in 7 days of onset of symptoms to prevent rheumatic fever
Analgesic and antipyretic ie paracetamol or ibuprofen
1. PenV 250mg q8h child-10days for adult 250mg PO q6h
2. PenG I.M stat
3. Amoxicillin 50mg/kg/d in 2-3 divided doses for 10 days