Pharyngitis (CENTOR criteria) Flashcards
What is pharyngitis?
Acute inflammation of the oropharynx, commonly caused by viral or bacterial infections.
What is the most common overall cause of pharyngitis?
Viral infections, including rhinovirus, adenovirus, influenza, and EBV.
Viral pharyngitis is more common than bacterial pharyngitis in both adults (up to 90% of cases) and children (up to 40% of cases). In children, ∼ 30% of cases are caused by bacteria and ∼ 30% of cases have no isolable organism.
What is the most common bacterial cause of pharyngitis?
Group A Streptococcus (Streptococcus pyogenes). The accompanying symptoms of GAS are flushed cheeks with perioral pallor, strawberry tongue, and an erythematous rash with sandpaper-like texture.
What are the key symptoms of viral pharyngitis?
Sore throat, nasal congestion, rhinorrhea, low-grade fever, conjunctivitis, hoarseness and cough.
What are the key symptoms of bacterial pharyngitis?
Sore throat, fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough.
What is the CENTOR criteria used for?
Determining the likelihood of streptococcal pharyngitis and whether testing or empiric treatment is needed.
What does ‘CENTOR’ stand for in the CENTOR criteria?
Cough absent
Exudates on tonsils
Nodes (tender anterior cervical lymphadenopathy)
Temperature >100.4°F (38°C)
OR (age: 3-14 years)
How is the CENTOR score used for management?
0-1: No testing or antibiotics
2-3: Rapid antigen test
≥4: Empiric antibiotics
What is the preferred diagnostic test for suspected bacterial pharyngitis?
Rapid antigen detection test (RADT) for Group A Strep.
When should throat culture be performed?
For children with a negative RADT to confirm the result; not routinely done in adults.
When should STI testing be considered in pharyngitis?
If gonococcal or chlamydial pharyngitis is suspected (e.g., high-risk sexual exposure).
How is viral pharyngitis managed?
Supportive care with fluids, analgesics (acetaminophen, NSAIDs), and throat lozenges.
What is the first-line antibiotic for Group A Streptococcal pharyngitis?
Penicillin V or Amoxicillin.
What are alternative antibiotics for penicillin-allergic patients?
Macrolides (azithromycin), clindamycin, or first-generation cephalosporins.
Why is it important to treat Group A Strep pharyngitis with antibiotics?
To prevent rheumatic fever and reduce the severity and duration of symptoms.
What serious complications can arise from untreated streptococcal pharyngitis?
Rheumatic fever, poststreptococcal glomerulonephritis, peritonsillar abscess, and retropharyngeal abscess.
Which complication of Group A Strep pharyngitis is mitigated or preventable with early antibiotics?
Rheumatic fever and rheumatic heart disease.
Which complication of Group A Strep pharyngitis is NOT preventable with antibiotics?
Poststreptococcal glomerulonephritis.
What are the key symptoms of peritonsillar abscess?
Severe unilateral throat pain, ‘hot potato’ voice, trismus, and uvular deviation.
What is the most common viral cause of pharyngitis in children?
Adenovirus.
What viral cause of pharyngitis is associated with conjunctivitis and pharyngoconjunctival fever?
Adenovirus.
Which viral pharyngitis presents with exudative tonsillitis, posterior cervical lymphadenopathy, and hepatosplenomegaly?
Epstein-Barr virus (infectious mononucleosis).
What viral cause of pharyngitis presents with vesicular lesions in the posterior pharynx?
Coxsackievirus (herpangina).
What bacterial cause of pharyngitis presents with a grayish pseudomembrane in the throat?
Corynebacterium diphtheriae (diphtheria).
Which STI can cause pharyngitis and should be considered in sexually active patients?
Neisseria gonorrhoeae.
What lab test should be avoided in suspected mononucleosis and why?
Ampicillin or amoxicillin should be avoided as they can cause a rash in EBV patients.
How does gonococcal pharyngitis present?
Severe sore throat, pharyngeal exudates, and concurrent genital symptoms in sexually active patients.
