Pharyngitis Flashcards
What causes Pharyngitis?
60-90% of cases are viral-related
bacteria account for 5-30% of cases
When and in what group is Pharyngitis most common?
winter
in children ages 4-7
What type of infection can result from Bacterial Pharyngitis?
14% of deep neck infection is caused by bacterial pharyngitis
What are tonsils?
small masses of lymphoid tissue around the pharynx that trap and remove bacteria and other foreign materials
adenoid, tubal, palatine, and lingual tonsils
What causes tonsillitis?
congestion with bactera
What are common causes of Pharyngitis?
Streptococci
viral infection (Herpes/Coxsackievirus, CMV, EBV)
oral candidiasis
STIs - more common in younger groups
other bacteria (non-group A streptococcus, fusobacterium, mycoplasma pneumoniae, Chlam. pneumoniae, adn A. haemolyticum, Diphteria)
differentiated by throat culture
What is important to know about patients that have Mononucleosis and secondary streptococcal tonsilitis?
1/3 of patients have secondary tonsilitis
ampicillin/amoxicillin should be avoided because it induces a rash in mononucleosis patients that could be misinterpreted as a penicillin allergy
How long does Pharyngitis last?
incubation lasts 1-3 days, but may last as long as 7 days
patients are contagious until 24 hours after they have begun antibiotics or for as long as symptoms persist if not treated
How is Pharyngitis treated?
antibiotics - penicillin
can decrease symptom duration and severity if given within 48 hours
no known penicillin resistance in the U.S.
What is GABHS and why is it important?
Group A Beta Hemolytic Strep; a type of bacteria that releases a toxin that could cause Scarlet Fever
Why do we worry about Strep Throat?
if not treated within 9 days, it could develop into
Rheumatic FEver
Glomerulonephritis with Acute Renal Failure
Peritonsillar Abscess
Pneumonia, otitis, sinusitis, osteromyelitis, mastoiditis, menigitis, or septic arthritis
What is Rheumatic Fever?
cardiac inflammation and scarring triggered by an autoimmune reaction to infection with group A streptococci
How is Rheumatic Fever prevented?
can be prevented if treated with antibiotics in the first 9 days of symptom onset
What are common symptoms of Strep Throat?
sore throat dysphagia fever malaise headache rash exudative tonsils palatal petechiae (tiny red spots that occur in response to infection; reaction of lymph system) tender anterior cervical lymphadecnopathy abdominal pain vomiting (especially in kids)
What is Scarlet Fever?
develops as a result of strep throat
red rash, strawberry tongue (early on can look like thrush), and desquamation (occurs after 1 week of infection; peeling of the palms and feet)
What are the center criteria for treating Strep Throat?
fever or history of fever exudate or tonsillar hypertrophy tender laterocervical adenopathies lack of cough age: under 15 = 1 point, over 45 (-1 point) 4 (37-57%) 3 (25-35%) 2 (10-17%) 1 (10%) none (2%)
Rapid Strep Test vs. Culture
PPV 90-99%
subject to quality of sample (eating and drinking effects results)
culture is 90% sensitive and 99% specific
culture may give you other causes for sore throat like Mycoplasma, Chlamydia, Candidia, and Gonococcus
culture may help establish carrier state
How is Strep Throat treated?
penicillin first!
Adults: Pen-V, bicillin LA (Pen-G), Azithromycin, Cefprozil
Children: Amoxacillin or PenV, bicillin LA (Pen G), Azithromycin, Cefprozil
What are complications that can occur if Pharyngitis is not treated?
inflammatory diseases that are not direct infections but where the immune response to streptococcal antigens causes injury to host tissues (Rheumatic Fever, GLomerulonephritis with Acute Renal Failure)
Extension to deeper tissue (deep neck infection, osteomyelitis, mastoiditis)
bacterial seeding/spread (pneumoniae, otitis, sinusitis, meningitis, septic arthritis)
What is Perianal Strep?
Strep can present as rectal pain and constipation in children 3-5 years old
establish strep by culturing throat and rectum; treat as chronic carrier
consider recurrent tonsilitis, family outbreaks
What is Rheumatic Fever (in more detail)?
prolonged febrile inflammation of connective tissues; body-wide, but particularly in the heart and joints
What are characteristics of Rheumatic Fever?
fever, carditis, subcutaneous nodules and migratory polyarthritis
cardiac enlargement, valvular murmurs, and effusions are seen clinically
When does Rheumatic Fever begin and how long does it last?
begins 3 weeks (1-5 weeks) after GABHS pharyngitis
Lasts 2-3 months
At what age does the first Rhumatic Fever attack usually arise?
ages 5-15 (carried for a lifetime)
repeated attacks lead to progressive damage to the endocardium and heart valves, with scarring and valvular stenosis or incompetence which can lead to heart failure
