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INTRODUCTION
Pharyngitis is defined as inflammation of
the pharynx.
The anatomic region of the pharynx
invariably affected in adults is the
oropharynx.
The predominant symptom is sore throat,
which overall is the third most common
chief complaint to physicians in an office-
based practice.
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Pharyngitis
Pharyngeal mucosa exhibits an inflammatory
response to many other agents
Opportunistic bacteria
Fungi
Environmental pollutants
Neoplasm
Granulomatous disease
Chemical and physical irritants
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Important disease mimic
Pharyngitis
Scc of the upper aerodigestive tract frequently presents
with a history of chronic sore throat.
Epiglottitis in adults commonly presents as a severe
acute sore throat and odynophagia with a relatively
normal oropharyngeal examination.
postnasal drip and laryngopharyngeal reflux can cause
an irritative pharyngitis.
Occupational and environmental exposures can also be
associated with an irritative pharyngitis and this has
been demonstrated in many different populations, such
as in the firefighters who have World Trade Center
cough
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Infectious causes of
pharyngitis
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Bacterial infection
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Bacterial infection
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BASIC KWNOLAGE ABOUT GABHS
GABHS is the pathogenic organism responsible for
most cases of bacterial pharyngitis in adults.
This organism is a gram positive cocci that
grows in chains. Its natural reservoir is the
skin and upper aerodigestive tract mucosa
of the nasopharynx and oropharynx.
The organism is a pathogen only in humans. Less
than 5% of adults are asymptomatic carriers
Spread occurs mostly through aerosolized
microdroplets, less commonly by direct contact,
and rarely through ingestion of contaminated non-
pasteurized milk or food.
Infections are more common in the autumn and
winter
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Symptoms & Signs
Symptoms are usually rapid in onset and include
severe sore throat, odynophagia, cervical
lymphadenopathy, fevers, chills, malaise,
headache, mild neck stiffness, and anorexia.
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Group A Streptococcus
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Group A Streptococcus
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Clinical course
Untreated; self-limited and consist of localized
inflammation that resolves after 3 to 7 days.
Patients are contagious during the acute illness and for
approximately 1 week afterward.
Prompt antibiotic treatment reduces the duration of
symptoms (if treatment begins within 24 to 48 hours of
symptom onset), reduces the period of contagiousness
to 24 hours after beginning treatment, and likely
decreases the incidence of suppurative complications.
Prevention of rheumatic fever is possible if antibiotic
therapy is started up to 10 days after the onset of
symptoms.
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Clinical diagnosis
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Diagnosis
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Scoring of clinical findings
centor scoring
Exsudative tonsilltis
Absence of cough
Fever(>38.8)
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Scoring of clinical findings
centor scoring
Present of 3or4 indicate positive value in
40-60%
Absence of 3or4 negative predictive value
in 80%
Antibiotics prescribed in 4 and 2or3 should
be take rapid test
Culture?
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These scoring systems should not
be used in
patients who are immunocompromised,
have complicated comorbidities, or have a
history of rheumatic fever.
during an epidemic of acute rheumatic
fever, in parents with school-aged
children, or for adults with occupations
that bring them into frequent contact with
children
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Throat culture
Strp carrier
18-24 hour wast of time
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Medical Management
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treatment
The oral course should be for 10 days.
Benzathine penicillin can be alternatively used as
a single intramuscular injection that provides
bactericidal levels for 21 to 28 days.
Erythromycin is an acceptable alternative for
patients allergic to penicillin, but isolated reports
of macrolide resistance (<5% of clinical isolates)
have been reported in the United States.
Clindamycin is an acceptable alternative for
patients with both a penicillin allergy and a
strain resistant to macrolides
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Medical Management
M HASEMI MD 27
NON–GROUP A β-HEMOLYTIC
STREPTOCOCCAL INFECTIONS
Pharyngeal infection with groups C and G
streptococci can cause acute
glomerulonephritis but has never been
shown to cause acute rheumatic fever
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Viruses
Rhinovirus
Adenoviruses
Coronaviruses
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symptoms of the common cold
The average adult gets 2 to 4 colds each year,
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EBV
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CLINICAL COURSE
The initial incubation period is from 3 to 7 weeks.
A prodrome of malaise, fever, and chills is
followed 1 to 2 weeks later by sore throat, fever,
anorexia, and lymphadenopathy (especially
cervical).
Sore throat is found in 82% of patients with IM
and is the most common omplaint.
Other symptoms may include abdominal
discomfort, headache, stiff neck, and skin rash
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EBV
Diagnosis
By Clinical presentation
CBC with differential (atypical lymphocytes –T
lymphocytes)
Detection of heterophil antibodies (Monospot test)
IgM titers
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Diagnosis
Infectious mononucleosis causes an absolute
lymphocytosis with more than 10% atypical
lymphocytes.
Finding atypical lymphocytes on a peripheral
blood smear may be consistent with a clinical
impression of IM but is not specific for this
illness.
Toxoplasmosis, cytomegalovirus, acute HIV-
infection, hepatitis A, tularemia, and rubella can
also be associated with this finding
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PHYSICAL EXAM
Examination of the oropharynx reveals an
exudative pharyngitis with erythema and
tonsillar hypertrophy , diffuse lymphoid
hyperplasia of Waldeyer's ring, petechiae at the
hard palate-soft palate junction, and ulcers on
the pharyngeal and epiglottic mucosa
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EBV petechiae
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EBV
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Treatment
Supportive management
Rest
Avoidance of contact sports (?->splenic rupture?)
Steroids are indicated for complications related to
impending upper airway obstruction, severe hemolytic
anemia, severe thrombocytopenia, or persistent severe
disease
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Human Immunodeficiency Virus
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A. haemolyticum
Pharyngitis caused by A. haemolyticum is
easily mistaken for GABHS or viral
pharyngitis with an exanthem because of
the overlap in symptoms. When
suspected, throat culture needs to be
performed using 5% human blood agar.26
Using this culture media, prominent
hemolytic zones are formed within 24
hours by A. haemolyticum.
Oral penicillin was recommended for
treatment in the past, but bactericidal tests demonstrated
increasing tolerance of this organism; thus first-line
antibiotic therapy for
A. haemolyticumpharyngitis is erythromycin.
Neisseria gonorrhoeae
Neisseria gonorrhoeae is a sexually transmitted
organism that affects the anogenital region but
can also cause gingivitis, stomatitis, glossitis,
and pharyngitis.
28.
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signs
Symptomatic patients usually come to medical attention
with findings suggestive of tonsillitis. The tonsils are
enlarged,and a white-yellow exudate arises from the
crypts.2
8 Oropharyngeal trauma may be evident, particularly on
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Treatment
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Initial therapy for uncomplicated OPC includes improving oral
hygiene and use of topical antifungals.91 Patients with a
refractory or recurrent infection and those at high risk for
systemic disease should be treated with systemic antifungals.
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Prophylaxis
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