Pharyngitis
Infectious Mononucleosis - s/s
Posterior cervical lymphadenopathy Triad of fever (38-40), pharyngitis and adenopathy Malaise/Fatigue Chills Sweats Pharyngeal erythema Thick, coating pharyngeal/tonsillar tightly adherent exudate Palatal petechiae Splenomegaly (more common in children) Rash (more common in children)
Kawasaki** - s/s
Prolonged fever (1-2 weeks) Bilateral non-purulent conjunctivitis Strawberry tongue Erythematous oral mucosa Cracked red lips Polymorphous erythematous rash with edema and erythema of hands and feet Periungual desquamation followed by peeling of the palms
GABHS - tests
Rapid antigen test (RADT) Throat Culture
C. diphteriae (bacterial)
Rare in developed countries "Bull's neck" Pseudomembranous exudate - dislodging causes bleeding Preventable by vaccine Highest incidence in adolescents and young adults
Infectious Mononucleosis - tests
Rash reaction to PCN Monospot Serum
GABHS - etiology
(Bacterial)
Infectious Mononucleosis - age/demo
15-30 y.o. Uncommon in adults
GABHS - Ages
5-15 y.o.
General viral - s/s
Abrupt onset +/- URI s/s Cough Rhinorrhea Coryza Diarrhea Conjunctivitis Fever (low grade) Hoarseness
Peritonsillar Abscess** -ages
All, but most common 20-40
Peritonsillar Abscess** - considerations
Associated with GABHS, Staph aureus, H.influenza, F. necro Watch closely, can impact airway
Kawasaki** - considerations
Associated with GABHS, Staph aureus, H.influenza, F. necro Watch closely, can impact airway Dermatological manifestations w/in 3 days of fever Important not to miss d/t serious vascular and cardiac sequelae
Epiglottitis** - Considerations
Can be caused by trauma, chemical exposure or microorganism Hib vaccine has reduced incidence
Peritonsillar Abscess**- s/s
Continuum: exudative tonsillitis to cellulitis to abscess Toxic/ill appearing "Hot potato voice" Asymmetric deviation of the uvula secondary to a mass in the throat. Fever Severe trismus (lockjaw), spitting, drooling
Peritonsillar Abscess** - tests
Drainage (may need to refer to ED or ENT) Abx - Augmentin, clindamycin, Pen VK Oral or IV steroids
Epiglottitis** - treatment
Emergency
Fusobacterium Necrophorum -age
Greater than GABHS in 15-25 y.o. Late adolescent 15-25 y.o.
Fusobacterium Necrophorum - Considerations
If untreated, can results in Lemierre's syndrome
N. gonorrhoeae
Infection with N. gonorrhoeae often asx Whitish-yellowish exudate
Infectious Mononucleosis - considerations
Long incubation - 4 to 7 weeks
Peritonsillar Abscess** - Prevenence
Most common deep infection of head and neck
HIV
Non-tender, generalized adenopathy Multisystem disorder Acute onset 5-29 days after infection with one or more of following complaints Fever Rash Pharyngitis Fatigue Weight loss Myalgia Arthralgia Headache Night sweats Nausea Vomiting
GABHS - Season/time
November to December & April to May
Non-group A Strep: Group C & G (bacterial) -
Often food borne outbreak pharyngitis No definitive treatment No fever, normally More localized symptom of local swelling Presents similar to GABHS
Fusobacterium Necrophorum -treatment
PCN, cephalosporins, clindamycin NOT responsive to macrolides
Infectious Mononucleosis - treatment
PCN, cephalosporins, clindamycin NOT responsive to macrolides Treat symptoms only Severe pain and swelling may use corticosteroids Self-limited - resolves within 3 weeks
Fusobacterium Necrophorum - s/s
Similar presentation to GABHS Fever, tonsillar exudate DOES NOT IMPROVE IN USUAL TIME FRAME Anterior cervical lymphadenopathy Peritonsillar abscess
GABHS - s/s
Sudden onset Tonsillar and/or pharyngeal erythema & edema Pain with swallowing Anterior cervical lymphadenopathy Palatal Petechiae Pharyngeal exudate (discrete) - gray/white Fever (>100.9; 39-40.5) Headache Myalgia Exposure in last 2 weeks Nausea, vomiting, abd pain "Hot potato voice" NO cough, coryza or rhinorrhea
General viral - considerations
These can be VERY painful
Epiglottitis** - s/s
Three D's - dysphagia (severe), drooling, distress Restlessness Anxious "Hot potato voice" Stridor, retractions, tachypnea & cyanosis if airway is compromised +/- fever +/- erythema
General viral - treatment
Treat symptoms only Analgesics Salt/warm water gargles Hydrate
Kawasaki** - prevalence/demo
Uncommon Higher in boys and Asians Children 2-5 y.o
GABHS - Considerations
Use centor score for diagnosis Acute rheumatic fever Acute post-streptococcal glomerulonephritis Scarlet fever
Infectious Mononucleosis - etyology
Viral
GABHS - Treatment
Will resolve without treatment in 8-10 days Treatment due to possible complications Penicillins preferred 1st line antibiotic Macrolides if PCN allergy Cephalosporins
Fusobacterium Necrophorum - cause
bacteria
Epiglottitis** - prevalence/demo
declined since introduction of hib vaccine
General viral - Prevelence
~80% of all acute pharyngitis