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19 Cards in this Set
- Front
- Back
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pharyngotonsillitis defn |
an acute infection of the throat (oropharynx +/- tonsils) |
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etiology of pharyngitis |
viral 80% -epstein-barr virus, rhinoviruses, coronaviruses, adenoviruses, influenza
bacterial 15% -S pyogenes or Group A -beta hemolytic streptococcus (GAS = group A strep) -strep group C&G and NG- <1% |
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group A strep pharyngitis |
-primarily a disease of children 5-15yrs -occurs in temperate climates during winter and early spring -person to person transmission via droplet spread (crowding facilitates transmission) |
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signs & symptoms of viral infection |
-hoarseness -rhinitis (runny nose) -cough -gradual onset of throat symptoms -discrete mouth ulcers -conjunctivitis -coryza (nasal congestion) |
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signs & symptoms of group A strep infection |
-sudden onset of sore throat -absence of cough -fever >38 C -headache -N/V, abdominal pain -tonsillar exudates -swollen, tender anterior cervical lymph nodes -scarlatiniform rash -winter or early spring presentation -age 5-15yrs |
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diagnostic test - throat swab |
swabbing the throat and testing for GAS pharyngitis by RADT (rapid antigen detection test) and/or culture should be done as: -clinical features alone don't reliably discriminate between GAS and viral pharyngitis -in children and adolescents, (-) RADT test should be backed up by a throat culture -(+) RADTs do not need back-up culture |
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diagnostic - throat cultures |
routine use of back-up throat cultures for those w (-) RADT not usually necessary for adults -b/c of low incidence of GAS pharyngitis in adults and risk of subsequent acute rheumatic fever is very low in adults w acute pharyngitis |
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anti-streptococcal antibody titer tests |
not recommended in routine diagnosis of acute pharyngitis -reflect past but not current events |
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clinical course of group A strep |
-self-limiting -incubation period: 4-5d -within 3-4 days, fever resolves -within 7-10 days all Sxs resolve -within 6 wks, tonsils and lymph nodes decrease in size |
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complications |
secondary to bacterial infection
-peritonsillar cellulitis (Quinsy) -otitis media, sinusitis (bacteria living in throat travel to sinuses or ear) -cervical lymphadenitis -glomerulonephritis rare - immunological (strep antigens bind to glomeruli and induce an inflammatory response) - not preventable w antibiotic tx) -rheumatic fever |
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Rheumatic fever |
own body sees strep antigen but instead of attacking strep, attacks CV system (higher incidence in kids if not treated) -in 3% of untreated epidemic GAS and 0.4$ of untreated endemic GAS
inflammatory disease that can affect may CTs -heart - carditis, valvular damage -joints - arthritis -skin -subcutaneous nodules, erythema marginatum (circular rash -chorea (snake like/spastic movements)
risk increases w length of time strep reside in pharynx |
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goals of therapy of GAS |
-prevent rheumatic fever (have up to 9 days after onset of Sx to use antibiotics to prevent RF) -prevent other supperative complications -shorten duration of Sx -reduce transmission to close contacts -minimize potential ADRs of inappropriate antibiotic tharpy |
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treatmetnt |
-culture results needed to confirm strep -immediate antibiotic Tx if: very ill, delayed culture results >72h, or difficult to follow up pt -if culture is neg, stop antibiotic -antipyretics/analgesics and gargles (correlation of NSAIDs and gangrene - use tylenol) -pts w EBC infection who are treated w amoxicillin will develop rash |
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drugs for non penicillin allergy |
penicillin V Amoxicillin Benzathine penicillin G (IV - more painful, has more allergic rxns than oral) |
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drugs for penicllin allergy |
cephalexin clindamycin azithromycin clarithromycin |
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drugs to not use |
sulfonamides trimethoprim tetracyclines chloramphenicol ciprofloxacin levo/moxifloxacin |
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chronic carriers |
+ve throat culture, asymptomatic, no immune rxn -20% carrier rate -not at risk of spreading GAS or developing RF
ONLY treat for the following: -acute RF, acute poststreptococcal glomerulonephritis, or invasive GAS infection -outbreak of GAS pharyngitis in closed or partially closed community -presence of family or personal Hx of acute RF -family w excessive anxiety about GAS infections -when tonsillectomy considered |
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antibiotics for chronic carriers |
penicilin V + rifampin camoxicillin-clavulanate clindamycin benzathine pencillin G + rifampin |
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recurrences (secondary prevention) |
-pt w previous attack of RF in whom GAS pharyngitis devlops is at high risk for recurrent attack of RF -confirm w culture, then treat recurrence w different agent (antibiotic + beta-lactamse inhibitor may superior) -cts prophylaxis is NOT routinely recommended for pts. only use for well-documented histories of RFor definite evidence of rheumatic heart disease |
