Pharyngitis definition
Inflammation of the pharynx or tonsils (tonsilitis)
Pharyngitis vs dysphagia
Pharyngitis is a sore throat, dysphagia is difficulty swallowing
Why are children predisposed to recurrent strep throats?
The most active phase for immune function of the tonsils and adenoids is between 3-10 years
Common pathogen etiologies of pharyngitis (5)
- Group A strep
- adenovirus
- gonococcus (sexually active)
- EBV/CMV (mono)
- coxsackie virus
Wegner’s granulomatosis and how does it relate to pharyngitis
Inflammatory dz of the blood vessels that if left untreated can be fatal, has subtle onset and is caused by autoantibodies against proteinase 3, often have sore eye, ear, and stuffy nose and SORE THROAT (keep it on differential for pharyngitis)** as well as microscopic hematuria
The most common cause of acute pharyngitis
Respiratory viruses
Respiratory syncytial virus
Common cause of pediatric URI that is self limiting but can cause apnea in infants or immunocompromised patients
Common signs and symptoms of mononucleosis (5)
- Fatigue and weakness***
- sore throat
- fever, night sweats
- swollen lymph nodes
- swollen spleen
Mononucleosis diagnosis (3)
- look for “kissing” tonsils (can compromise airway)
- monospot (rapid in clinic or draw blood in hospital)
- lymphocytosis on CBC
Mononucleosis/other viral pharyngitis treatment options (3)
- symptomatic treatment (alternating acetaminophen (tylenol) and ibuprofen (advil))
- avoid contact sports 4 weeks
- anti inflammatory NSAID or steroid if severe airway obstruction
Risk factors for fungal opportunistic infections (4)
- new born
- immunosuppressed (HIV or elderly or cancer treatment)
- after antibiotics
- oral or inhaled steroid
First line and second line agent for oropharyngeal candidiasis
- Topical antifungal (mycostatin - swish and swallow nystatin 400k-600k units 4x daily)
- fluconazole (200mg loading dose then 100-200 daily)
Why is azithromycin 1g preferred to doxy for chlamydia treatment?
It is 1g 1 time so it has better compliance, availability, and expense compared to doxy which is 100mg twice daily for 7 days
“bull neck” is a common finding of what condition?
Diptheria
Diptheria signs and symptoms (3)
- sore throat, malaise
- spots of gray and white exudate pseudomembrane
- bull neck
Diptheria treatment (2)
- diptheria antitoxin
- erythromycin 500mg 4x daily for 14 days
Most common bacterial cause of acute pharyngitis
Strep pharyngitis
Red pharynx with petechiae on soft palate is a common finding of….
….strep pharyngitis
Scarlet fever as a result of strep pharyngitis infection signs and symptoms (3)
- sandpapery red reash
- strawberry tongue
- pastia lines in the antecubital fossa
Rapid strep test
High specificity 95% so if positive almost guaranteed to be strep and can treat with antibiotics, however if negative require culture to determine need of antibiotics
Are carriers of GABHS in their throats contagious or at risk for acute rheumatic fever when not symptomatic?
No
Centor score
Addition of 4 variables to determine likelihood of follow up for culture to confirm suspected positive, with higher scores increasing probability of positive culture and 1-2 variables only requiring rapid strep initially
Treatment options of strep pharyngitis
- oral penV 500mg BID or TID for 10 days
- clindamycin 300mg TID for 10 days
- azithromycin (last line, most resistance exists)
When can a patient with GABHS return to school?
When a patient is no longer contagious 24 hours after starting therapy they may return to school
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