pharyngitis (quiz 1, exam 1) Flashcards
viral pharyngitis: __% of adults develop pharyngitis annually
10-20%
viral pharyngitis: clincial features include
- sore throat
- fever may be present
- cough
- hoarseness
- rhinorrhea
- conjunctivitis
- rash
- diarrhea
- stomatitis or ulcerative lesions in the oropharynx
common casuses of viral pharyngitis
- rhinovirus
- coronavirus
- adenovirus
uncommon causes of viral pharyngitis
- EBV
- Coxsackievirus
- HSV
- HIV
the most common bacterial cause of pharyngitis is
Group A beta-hemolytic Streptococcus (GAS or GABHS) (aka Streptococcus pyognes)
bacterial pharyngitis GABHS, epidemiology: incidence of GAS as a casue of pharyngitis in adults ranges from only __% and __% of sore throat cases in children
- 5-10%
- 20-30%
epidemiolgoy: GAS has highest incidence in children ages __
5-15 yo
epidemiology: GAS infections in __ with bimodal peaks in __ and __
- late fall - early spring
- Nov/Dec
- Apr/May
epidemioogy: GAS incubation period is
1-2 days
GAS clincial features: the sore throat of GAS is typically of __ onset, associated with __, and is usually accompanied by __
in severe cases, these 4 symptoms may develop
some pts may appear __, but symptoms can also be mild
- sudden
- odynophagia
- fever
- headache
- nausea
- vomiting
- abdominal pain
- toxic
GAS glassical physical findings
- tonsillopharyngeal erythema (usually with exudates, but they may be absent)
- tender, enlarged anterior cervical lymph nodes
GAS scarlet fever: pts develop this type of rash, __, whcih is the result of __; this rash often spreads to the __, sparing the __, before __; besides the rash, scarlet fever is also often accompanied by these symptoms __(2)
- scarlatiniform rash = sandpaper like papular erythematous rash
- streptococcal endotoxins
- extremities
- palms and soles
- desquamating
- fever and tachycardia
acute streptococcal pharyngitis; pus is present in the tonsillar crypts, and some palatal petechiae are seen
typical group A streptoccoal pharyngitis showing erythematous soft palate, uvula, and tonsils, with tonsillar exudate
GAS scarlatiniform rash - confluent blanching erythema
GAS scarlatiniform rash - confluent blanching erythema
bacterial pharyngitis: common causes
- Group A beta-hemolytic Streptococcus
- Group C and G streptococci
bacterial pharyngitis: uncommon causes
- Neisseria gonorrhea
- Arcanobacterium haemolyticum
- Cornynebacterium diptheriae
- Mycoplasma pneumoniae
- Chlamydia trachomatis
GAS complications: although __% of pharyngitis is viral in etiology, antibiotics are prescribed or __% of cases seen in primary care visits; the most scommon reason sited for over prescribing is the concern about the 2 most serious complications, which are __ and __
- 90%
- 50-90%
- acute rheumatic fever
- post streptococcal glomerulonephritis
GAS complications: therapy for streptoccoal pharyngitis can be delayed for up to __ days after the onset of symptoms and still prevent the onset of acute rheumatic fever
9 days
other complications of streptoccal pharyngitis include these 5 things
- peritonsillar abscess
- cervical lymphadenitis
- mastoiditis
- sinusitis
- otitis media
a rare complication of either viral or bacterial pharyngitis is __; pharyngeal inflammation may lead to invasive infection by __, followed by __ and __
- Lemierre syndrome
- Fusobacterium necrophorum
- sepsis
- internal jugular vein thrombosis
classic symtpoms of Lemierre syndrome are
high fevers are rigors occuring as early as 2 days after the onset of sore throat
Lemierre syndrome: on examination, __ is often detected over the __
- tenderness
- sternocleidomastoid msucle
Lemierre syndorme: septic jugular vein thrombosis can lead to __ lodging in the lungs and the classic __ finding on CT of the chest
- spetic emboli
- cannonball
Lemierre syndrome: treatment is with antibiotics with good __ activity, suck as __ or __
- anaerobic
- ampicillin-sulbactam (inhibitor of bacterial beta-lactamase)
- clindamycin
Lemierre syndrome: sore throat, painful swelling of neck, fever, rigor, hemoptysis, dyspnea, pustular exudates
A. thrombophlemitis of the right external jugular v.
B. CT imaging of the chest revelaed bilateral pleural effusion and multiple areas of consolidation with cavitation
the best tested algorithm for determining likelihood of GABHS pharyngitis is based on the __, followed by __ for individuals with moderate to high likelihood based on the the __ (the first blank)
- Centor Criteria
- rapid streptococcal antigen testing (RSAT): sensitivity is 80-90%, speficicity is >95%
GAB diagnosis: specimens should be obtained by vigorous swabbing of both __ and __
- tonsills (or tonsillar fossae in pts without tonsils)
- posterior pharynx
GAS diagnosis: the high accuracy of these tests eliminates the need for confirmatory bacteiral culture among __
adults
GAS diagnosis: in children and adolescents, must backup negative __ with __
- RADT
- throat culture
Centor criteria for streptoccoal pharyngitis
- temperature > 38C or 100.4F
- tonsillar exudates
- tender cervical adenopathy
- no cough or rhinitis
Centor criteria and management (adults): number of centor criteria, % adults with streptoccus on throat culture, management
- 0 or 1: not tested/miimal risk; symptomatic treatment
- 2: 23%; RSAT, Abx only if positive
- 3: 41%; RSAT, Abx only if positive
- 4: 60%; empiric Abx or RSAT w/ Abx if positive
GAS diagnosis: what group of pts should you get a throat culture for, even if the RSAT comes back negative?
- children and adolescents
- adults at higher risk for severe infections (poorly controlled diabetes mellitus, immunocompromised, on chronic corticosteroids)
GAS management: symptomatic therapy
- rest
- fluids
- non-steroidal anti-inflammatory drugs
- salt water gargles
- over the counter menthol lozenges
GAS management: antibiotics reduce the duration of illness by __ days; they reduce the risk of __ even when initiated within __ days of the onset of symptoms; they reduce disease __
- 1-2 days
- acute rheumatic fever
- 9 days
- transmission
GAS management: __ is the recommended antibiotic, and __ is endorsed as an alternative; both antibiotics require a __ day course to eradicate GAS
- penicillin (PCN)
- Amoxicillin
- 10 day
GAS management: __ are an option for individuals with PCN allergy, but decreased utility due to increasing prevalence of __; __ is another alternative
- macrolides (i.e., erythromycin, azithromycin)
- macrolide resistant S. pyogenes
- Clindamycin
GAS management: in the US, macrolide resistance was found in __% of isolates
3-9%
GAS antibiotic treatment: for individuals without penicillin allergy, these 4 meds
- Penicillin V
- Amoxicillin
- Benzathine penicillin G
- Penicillin G benzathine and penicillin G procain (Bicillin C-R 900/300)
penicillin V: dosage and duration
- children: 250 mg po bid or tid - 10d
- adolescents and adults: 500 mg po bid or tid - 10 d
(pts without penicillin allergy)
amoxicillin: dosage and duration
- 50 mg/kg po qd (max = 1000mg) - 10d
- 25 mg/kg po bid (max = 500 mg)
(pts without penicillin allergy)
benzathine penicillin G: dosage and duration
> 27 kig; 1.2 million units IM - 1 dose
(pts without penicillin allergy)
penicillin G benzathine and penicillin G procain (Bicillin C-R 900/300): dosage and duration
< 27 kg: 1.2 million units IM - 1 dose
(pts without penicillin allergy)
cephalexin: dosage and duration
20 mg/kg/dose po bid (max = 500 mg/dose) - 10 days
(pts with penicillin allergy)
(do not use cephalosporins in pts with immediate type hypersensitivity rxns to PCN)
cefadroxil: dosage and duration
30 mg/kg po qd (max = 1g) - 10 days
(pts with penicillin allergy)
(do not use cephalosporins in pts with immediate type hypersensitivity reactions to PCN)
clindamycin: dosage and duration
7 mg/kg/dose po tid (max = 300 mg/dose)
(pts iwth penicillin allergy)
azithromycin: dosage and duration
12 mg/kg po qd (max = 500 mg) - 5 days
(pts with penicillin allergy)
(resistance well documented)
clarithromycin: dosage and duration
7.5 mg/kg/dose po bid (max = 250 mg/dose) - 10 days
(pt with penicillin allergy)
(resistance will documented)
test for GAS in the following for children and adolescents: evidence of acute pharygitis (erythema, edema, and/or exudates) on PE and absence of signs and symtpoms of viral infections like __
- concurrent conjuctivitis
- coryza
- cough
- hoarseness
- anterior stomatitis
- discrete ulcerative lesions
- viral exanthems
- diarrhea
__% of chldren between 3-15 yo are pharyngeal carries of GAS. neither RADT nor thorat culture can differentiate pts with acute GAS pharyngitis from GAS carriers with intercurrent __ illness
- 5-21%
- viral
