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
How do you treat a chronic Strep carrier?
IM Bicillin LA - long-acting injectable penicillin (treatment of choice)
augmetnin is the preferred oral method (in longer lasting, more serious cases or for patients with a penicillin resistance)
Clindamycin or Cephalosporins for penicillin allergic (NOT AZITHROMYCIN)
change all toothbrushes and glassware
How are Deep Tissue/Neck Infections related to pharyngitis?
GABHS have the capacity to be highly invasive and can extend from the pharynx and oral cavity to the deep neck
Why are Deep Tissue/Neck Infections crucial to prevent?
It can be life threatening.
Once the infection reaches the neck, it can spread to the mediastinum, carotid sheath, skull base, and meninges. Mortality rates are 20-50%.
If there are issues beyond the tonsils or extension into the soft spaces, refer emergently!!
What is Glomerulonephritis?
inflammation of the glomeri that occurs in reaction to the presence of GABHS toxin
What symptoms occur as a result of Glomerulonephritis?
hypertension
hematuria (blood in the urine - first sign)
proteinuria
edema due to inflammation of the renal glomerulus
How is Glomerulonephritis treated?
Not treated immediately; the course is usually benign and will heal itself in weeks to months. Follow closely to make sure that a progressive course does not lead to renal failure or death.
Peritonsiallar Abscess
asymmetric (big clue) deviation of tonsils voice changes difficulty swallowing saliva neck pain five days of throat pain - think abscess hot potato voice treated with antibiotics ENT referral is needed may need to be drained
How are GABHS carriers identified?
RST and/or culture is positive when asymptomatic
ASO titer (heterogenous in acute infection; homogenous in carrier state)
not if one family member is always unaffected (have culture and titer drawn)
Tonsillar Hypertrophy
noninfection pharyngeal issue
chronic enlargement of tonsils and adenoids lead to snoring/apnea
tonsillectomy for recurrent infection (3 in 3 yrs, 5 in 2 years, 7 in one year)
Soft Palate Resection
most common surgical correction to relieve snoring
Viral Pharyngitis
itchy throat, on and off symptoms, little ulcers, very compact presentation
Bacterial Pharyngitis
wake up with horrible symptoms
