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104 Cards in this Set
- Front
- Back
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What % of amb care visits are for acute pharyngitis?
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2%
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What % of cases of acute pharyngitis is cx by GAS?
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5-10% in adults
15-30% in peds |
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what % of adults get rx for pharyngitis?
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73%
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what is one of the major contributors of abx resistance?
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inappropriate tx of pharyngitis
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Why do we tx strep throat (uncomplicated pharyngitis)?
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*Reduce severity of acute sx
*shorten duration of illness *reduce contagion |
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How much shorter is strep when tx?
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1 day
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When are treated and untreated patients with strep usually sx free?
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90% of people are by day 7
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what is the primary reason to treat strep?
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reduce incidence of major complications
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What are major complications of strep (uncomplicated streptococcal pharyngitis)
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Rheumatic fever
para-pharyngeal abcesses glomerulonephritis |
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Why worry about glomerulonephritis?
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because its the leading cx of kidney infections in kids, particularly boys
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What are some viral cx of pharyngitis?
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Influenza
parainfluenza rhinovirus coronaivirus enterovirus adenovirus HSV, EBV, HIV |
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When is group A strep the cx?
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5-10% in adults & 15-30% in kids
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What are other bacterial cx of pharyngitis?
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mycoplasma pneumoniae
chlamydophilia pneumoniae N. gonorrheoeae corynebacterium diphtheriae |
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What % of cases of acute pharyngitis is cx by Rhinovirus?
Peds? |
20%
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What % Group A strep?
Peds? |
15-30%
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what % coronavirus?
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5%
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What % adenovirus?
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5%
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what % is group C?
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5%
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What % is HSV?
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4%
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What % in parainfluenza?
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2%
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what % is influenza?
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2%
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What % is EBV & HIV?
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1%
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What is the only major pathogen that abx are directed?
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Group A strep
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What does suppurative GAS lead to?
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peritonsilllar & tonsillar abcesses
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What does nonsuppurative GAS lead to?
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rheumatic fever & PSGN (glomeular nephritis)
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What does GAS show upon exam?
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inflammation,& petechiae of soft palate
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What is another name for GAS?
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strep pyogenes or strep throat
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What is the major goal of diff diagnosis?
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Identify GAS & treat with abx, and NOT to tx those with other cx
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What is the only major pathogen that should be treated with abx & that can cx major sequelae?
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Group a strep
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When is there other major sequelae?
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10%
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What are some clinical features of acute sore throat?
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Tonsillar exudate
tender cervical adenopathy on the side low grade fever ***** absent cough and rhinorrhea Nausea/headache |
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What are sx of influenza as the cx?
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fever, myalgia, sudden onset....important to remember if it's spreading in community too!
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What do you see with viral cx of sore throat?
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rhinorrhea, cough, sometimes watery eyes
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What environmental factors have you thinking viral?
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exposure to it from kids, spouse, office??
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What do you see in mono?
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Posterior cervical lymphadenopathy
persistant fatigue splenomegaly systemic illness like wt loss, hepatitis |
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What are the major cx of mono & when do you see it??
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EBV, CMV
Usually in college/HS because they have their plate full, different sleep/wake cycles |
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What is usually the 1st sx in HIV?
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pharyngitis!
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What do you see with HIV/pharyngitis?
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wt loss, lymphadenopathy that is more than just the throat, risky behaviors that may indicate this dx
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what are some clinical algorithms for identifying GAS?
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signs, sx, and rapid antigen test
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What is the sensitivity and specificity of dx with clinical exam alone?
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55-74%
58-76% |
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Can experienced clinicians reliably predict Gas with H&P
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no, false positives always present
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What does the rapid antigen test look for?
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DNA of strep, if load is low, not enough DNA
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What is centor criteria?
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Most widely used and accepted for dx strep
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What are the criteria for GAS?
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tonsillar exudates
tender anterior cervical adenopathy (side) fever by hx absence of cough |
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What do you need according to criteria to dx GAS?
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3-4 criteria with +PPV = 40-60%
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What is the senstivity /specificity of this criteria?
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75% and leads to overtreatment with Abx by 50%
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What is the gold standard of diagnostic test?
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Culture
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how long does it take for a throat culture to come back?
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24-48 hours, can't be used when giving treatment that day, it is expensive
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Why is a throat c&s relatively insensitve?
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* collection methods
* lab processing *false positives |
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Why are there false positives with c&s?
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1-5% are carriers and not actually infected
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With proper technique what % is the sensitivity &specificity of the c & s?
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90%, 95-99%
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What is the rapid antigen test?
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antigen-antibody complex
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How is RAT done?
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with latex agglutination, coagglutination, ELISA, optical immunoassay/ chemiluminescent DNA probes
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What is teh sensitivity/specificity of RAT?
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80-90%
90-100% |
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What are the advantages of RAT?
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done in office,
fast results |
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Why do we treat strep pharyngitis?
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1. prevent rheumatic fever (rare over 15)
2. prevent peritonsillar abcess 3. reduce sx duration by 1-2 days 4. prevent transmission |
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what do you do if positive with 2, 3, or 4 of criteria?
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RAT, rx abx only with + RAT
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What is modified centor?
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give points to see those who may possibly have GAS
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What are 4 modified centor positives?
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fever
tonsillar exudate anterior cervical adenopathy Absence of cough |
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When can you skip RAT?
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when pt has 0 or 1 modified centor positive
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What do you do if RAT is neg?
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perform a back up C& S
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what is 1st line tx for GAS?
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PCN V times 10 days
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What if allergic to PCN?
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give Erythromycin times 10 days?
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What is problem with Emycin & Benzathine PCN IM?
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E mycin cx nausea
PCN IM means you have to keep in office to check for reaction |
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What are other rx's for GAS?
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cephalosporin x 4-6 days
Azithromycin x 5 days |
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What % of macrolides are resistant?
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14%
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When do cases of pharyngitis resolve in adults?
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7 days
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If pt does not get better what 5 things do we think of ?
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Antibiotic compliant?
Antibiotic resistant Complications Re-infection What other dx to consider |
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What are some other dx to consider?
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HIV, G/C, lesser known bacteria
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What are characteristics of peritonsillar abcess?
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Severe pain
Hot potato voice uvula deveation palatal/retropharygeal bulge Trismus Hard to swallow |
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What should you do with peritonsillar abcess?
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throat c&s
cbc with diff blood c&s Monospot Admit to hospital |
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What if GAS is neg?
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diff dx of acute pharingitis and tonsillitis
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What should you keep in mind with the dx of acute pharyngitis and tonsillitis?
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pt. age
exposure hx of infections mono clinical characteristics |
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What is cx of Mono?
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Herpes virus/ EBV
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What percent of cases of mono are cx by EBV?
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80%
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What are sx of mono?
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fever
lymphadenpathy (posterior cervical) exudative pharygitis, headache n/v |
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What type of rash is with Mono?
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maculopapular eruption
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How long does maculopapular eruption last?
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1-5 days
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What is acute phase of mono?
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2-3 weeks
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How long does fatigue persist?
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2-3months
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What labs are ordered?
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monospot
heterophile antibody screen EBV antibody IgG IgM lymphocytosis atypical monocytes Liver enzymes |
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do you see hepatomegaly/splenomegaly with mono?
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yes
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What are sx of EBV mono?
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pharyngitis
Tonsillar exudate posterior cervical adenopathy fatigue rash fever |
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What are the different cx of mono vs. GAS?
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Mono = viral
GAS = bacterial |
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What is the difference in onset?
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Mono = gradual
GAS = sudden |
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Where is the adenopathy?
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M - posterior
G- anterior |
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Which one has splenomegaly?
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M- splenomegaly with diffuse LAD
G- neither |
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What do mono labs reveal?
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lymphocytosis, atypical lymphocytes > 10%, positive heterophile antibody or monospot
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what do GAS labs reveal?
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leukocytosis
left shift with bands pos strep screen |
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How is mono tx?
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supportive care
poss steriods |
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What abx must be avoided with mono?
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Amoxicillin because it gives idiosycratic rash that last 3-5 days
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What does mono put you at risk for?
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hepatitis
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What are supportive tx for sore throats (7)?
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antipyretics
analgesics fluids gargle lozenges Tea time off work/school infection transmission handwashing! |
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With acute sore throat and rash what is another diff dx?
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Scarlet fever
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how does scarlet fever present?
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Strawberry tongue/ sandpapery rash
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How long is it's incubation period?
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3-5 days
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What is scarlet fever?
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vascular response to bacterial endotoxin of strep
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What are it's clinical characteristic?
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fever, pharyngitis, headache, rash, pastias sign, strawberry tongue
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how long does rash last?
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24-48 hours
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how is scarlet fever tx?
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PenVK
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What is Rheumatic fever?
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inflammatory multisystem disease
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When does rheumatic fever occur?
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weeks to months after GAS infection
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What is the clinical presentation?
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gradual onset fever
malaise wt loss carditis new murmur/rub/effusion cardiomegaly polyarthritis migratory |
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How do you diagnose rheumatic fever?
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antibody assays
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