RED PART 1 Flashcards
What is acute pharyngitis
characterised by the rapid onset of sore throat and pharyngeal inflammation. This and tonsilitis both sore throat
What is acute tonsilitis
inflammation of the parenchyma of the palatine tonsils. This and pharyngitis both sore throat
Epidemiology of tonsilitis/ pharyngitis
children aged 5 to 10 are most often affected, with another peak between ages 15 and 20
RFs for T/P
- Young age
- Infected contacts: school-age children are often in close contact with others and are frequently exposed to viruses or bacteria that can cause tonsillitis
Causes of pharyngitis
- Adenovirus
- Rhinovirus
- EBV
- Group A streptococcus
Infection of the pharynx or throat, which can develop if a virus/ bacteria move beyond the nose, and travel down into the pharynx.
Tonsilitis pathophysiology
- If the infection from pharynx spreads to involve the tonsils, it’s called tonsillitis.
- Pathogens penetrate the tonsillar epithelium, causing local inflammation that results in oropharyngeal swelling, erythema, oedema and pain.
Viral tonsiilitis causes
- Rhinovirus - most common
- coronavirus
- adenovirus
Bacteria tonsilitis
- group A beta-haemolytic streptococci (GAS;strep. pyogenes)
- Haemophilus influenzae
- Morazella catarrhalis
- Staphylococcus aureus
What is recurrent tonsilitis due to?
SA
Non- infectious tonsilitis
rare and causes include GORD, chronic cigarette smoke, and hayfever
Signs of tonsilitis
- Pyrexia: usually >38°C in tonsillitis
- Red, inflamed and enlarged tonsils, with or without exudates (pus)
- Anterior cervical lymphadenopathy
- Evidence of dehydration if reduced oral intake: e.g. reduced skin turgor, dry mucous membranes
Symptoms of tonsilitis
- Sore throat: usually sudden onset
- Pain on swallowing
- Loss of appetite
- Fever
- Malaise
Investigations for tonsilitis
Acute tonsillitis is primarily aclinical diagnosis
- Throat culture: gold-standard for definitively diagnosing bacterial tonsillitis; not routinely performed.
- Rapid group A streptococcal (GAS) antigen test: a less sensitive alternative to throat culture
Centor clinical predication score for bacterial tonsilitis
A score of3 or more gives a 40 – 60 % probability ofbacterial tonsillitis, and it is appropriate to offer antibiotics. A point is given if each of the following features are present:
- Fever over 38ºC
- Tonsillar exudates/ swelling of tonsils
- Absenceof cough
- Tenderanterior cervical lymph nodes (lymphadenopathy)
DDs for tonsilitis/ pharyngitis
- Infectious mononucleosis (glandular fever; due to EBV)
- Epiglottitis
Treatment for tonsilitis
- Most cases are self-limiting without antibiotics, even if bacterial, with symptoms lasting around 1 week.
- Paracetamol and ibuprofen: as required, for pain and fever
- Adequate intake of fluid: to avoid dehydration
Antibiotic treatment for tonsilitis if high feverPAIN or Centor score
- First line: phenoxymethylpenicillin
- If penicillin allergy: clarithromycinorerythromycin
Hospital admission for tonsilitis
- Rarely requiredbut a few indications include inability to swallow, breathing difficulty, clinical dehydration, peri-tonsillar abscess, retropharyngeal abscess or sepsis
- Corticosteroids: oral prednisolone or IV/IM dexamethasone may be appropriate if there are severe clinical features
Tonsillectomy if…
- Recurrent tonsillitis or complications (e.g. quinsy)
- Obstructive sleep-disordered breathing in children <16 years
Complications of tonsilitis
- Scarlet fever
- Chronic tonsillitis
- Acute otitis media
What is otitis media?
presence of inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection
Complication of viral resp illness
Epidemiology of otitis media
- Most commonly affects children
- Approximately 80% of all children will experience a case of otitis media during their lifetime
- It is more commonly seen in winter
- Associated with upper resp tract infection
RFs for otitis media
- FH
- Children
- Bottle feeding
- GORD
Why does otitis media affect children the most?
viral infections are more common in this age group, and due to their shorter and more horizontal Eustachian tubes
Pathophysiology of otitis media
- The bacteria enter from the back of the throat through the eustachian tube.
- Bacterial infection of the inner ear is often preceded by a viral upper respiratory tract infection.
Bacterial pathogens for otitis media
- Streptococcus pneumoniae (most common)
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
Viral pathogens otitis media
- Respiratory syncytial virus
- Rhinovirus
- Adenovirus
- Influenza
Signs of otitis media
- A red or cloudy tympanic membrane
- Bulging of the tympanic membrane
- Middle ear effusion: air-fluid level behind the tympanic membrane
Symptoms of otitis media
- Fever
- Ear pain
- reduced hearing
- vomiting
- sore throat
Otitis media investigations
Otitis media is a clinical diagnosis
- Imaging:
- CT to confirm diagnosis
Management for non severe otitis media
- Observation: many cases are self-resolving
- Analgesia: e.g. paracetamol or ibuprofen
Antibiotics for more severe otitis media
- First line:amoxicillin
- Second line:co-amoxiclav if no improvement on amoxicillin
- Penicillin allergy: macrolide, e.g. clarithromycin or erythromycin
Complications of otitis media
- Chronic or recurrent infection
- Hearing loss
- Glue ear:
- Tympanic membrane perforation
