Saturday, June 14, 2014

Pharyngitis and Tonsillitis

By Anonymous 1:39 AM
Definition
Pharyngitis or tonsillitis is inflammation of the pharynx or tonsils.
Physical finding and Clinical presentation
Adenoviral Pharyngitis
  • Pharynx
    1. May appear normal to severely erythematous
    2. Tonsillar hypertrophy and exudates commonly seen but do not indicate cause.
  • Viral infection
    1.  Rhinorrhea
    2. Conjunctivitis
    3. Cough
  • Bacterial infection, especially group A Streptococcus
    1. High fever
    2. Systemic signs of infection
  • Herpes simplex or enterovirus infection: vesicles
  • Streptococcal infection
    • Rare complications
      • Scarlet fever
      • Rheumatic fever
      • Acute glomerulonephritis
    • Extension of infection: tonsillar, parapharyngeal, or retropharyngeal abscess presenting with severe pain, high fever, trismus.
Cause
Viruses
  • Respiratory syncytial virus
  • Influenza types A and B
  • Epstein-Barr virus
  • Adenovirus
  • Herpes simplex
Bacteria
  • Streptococcus
  • Neisseria gonorrhoeae
  • Arcanobacterium haemolyticum
Other organisms
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
Differential Diagnosis
  • Sore throat associated with granulocytopenia, thyroiditis
  • Tonsillar hypertrophy associated with lymphoma.
Workup
  • Throat swab for culture to exclude S. pyogenes, N. gonorrhoeae (requires specifi c transport medium)
  • Rapid streptococcal antigen test (culture should be performed if rapid test negative and diagnosis suspected)
  • Monospot
Laboratory Tests
  • CBC with differential
    • May help support diagnosis of bacterial infection
    • Streptococcal infection suggested by leukocytosis of more
      than 15,000/mm3
  • Viral cultures, serologic studies rarely needed
Imaging Study
  • Seldom indicate
Treatment
  • If streptococcal infection proved or suspected:
    • Penicillin
    • Erythromycin if penicillin allergic
  • If gonococcal infection proved or suspected: ceftriaxone
  • Tonsillopharyngitis is generally managed in an outpatient setting with follow-up arranged in a week or two. Admission to the hospital is indicated for local suppurative complications (peritonsillar abscess, lateral pharyngeal or posterior pharyngeal abscess, impending airway closure, or inability to swallow food, medications, or water).
Pharyngitis associated with GAS (Group A strep) infection


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