Pharyngitis

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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


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