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Pharyngitis

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Pranav Patel
Pranav Patel

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PHARYNGITIS. -Pranav Patel.
TERMINOLOGY. Acute rheumatic fever-It is an illness following an autoimmune response to a group A streptococcus, it causes inflammation, especially of the heart, blood vessels and joints. Adenovirus-They are a group of common viruses that infect the lining of your eyes, airways and lungs, intestines, urinary tract, and nervous system. anaphylaxis -Serious,life-threatning allergic reaction. Cephalosporin-They are bactericidal (kill bacteria) and work in a similar way to penicillin. Coxsackieviruses-They RNA viruses that may cause hand, foot, and mouth disease (HFMD), as well as disease of muscles, lungs, and heart.
Epstein-Barr virus-The EpsteinBarr virus, formally called Human gamma herpes virus 4, is one of the nine known human herpes virus types in the herpes family, and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis. Etiology-Etiology is the study of causation or origination of disease. Group A streptococcus-GAS bacteria is a Gram positive, beta-hemolytic coccus in chains. It is responsible for a range of diseases in humans. These diseases include strep throat (acute pharyngitis) and skin and soft tissue infections. Herpes-A virus causing contagious sores, most often around the mouth or on the genitals. Influenza-It is a viral infection that attacks your respiratory system-your nose, throat and lungs, influenza is commonly known as flu.
Macrolide- they are a class of natural products that consist of a large macro cyclic lactone ring, it is often prescribed to treat rather common bacterial infections. Mastoiditis-It is usually caused by middle ear infection, it can result in damage of mastoid bone and formation of pus filled crystals. Otitis media-An ear infection is usually caused by bacteria or viruses. Peritonsillar abscesses- A peritonsillar abscess occurs when a collection of pus forms and infection spreads beyond the tonsils into the neck and chest. Post streptococcal glomerulonephritis-is a kidney disease that develops 10 to 14 days after a skin or throat infection. it is not caused by the bacteria itself, but by the body's infection fighting
Parainfluenza-They are a paraphyletic group of four distinct single-stranded RNA viruses belonging to the Paramyxoviridae family. These viruses are closely associated with both human and veterinary disease. Rhinorrhea- rhinorrhea is a condition where the nasal cavity is filled with a significant amount of mucus fluid. Rhinovirus-It is the most common viral infectious agent in humans and is the predominant cause of the common cold. Sinusitis-It is an inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection. Toxic shock syndrome-It is a rare but serious medical condition caused by a bacterial infection. t is caused when the bacterium streptococcus aureus gets into the bloodstream and produces toxins.
INTRODUCTION. Pharyngitis is a medical term for a sore throat. Causes of pharyngitis include viral infection, common cold and bacterial infection, such a group A streptococcus. Pharyngitis is defined as an infection or irritation of the pharynx, which is in the back of the throat. It is most often referred to simply as sore throat Pharyngitis can also cause scratchiness in the throat and difficulty in swallowing.
HISTORY Viral and bacterial causes of pharyngitis are similar and differentiation of etiology is based on examination of history and physical examination alone. Classic presentation are listed below: 1. Group A Streptococcus(GAS) infection is the most common in children. 2. Sudden onset is consistent with a GAS pharyngitis. Pharyngitis following several days of coughing or rhinorrhea is more consistent with a viral etiology. 3. Headache is consistent in GAS infection. 4. Cough is usually not associated with GAS infection.
ETIOLOGY. About 50-80% of pharyngitis or symptoms are viral in origin and include various viral pathogens. These pathogens are rhinovirus,influenza,adenovirus,coronavirus and parainfluenza. Less common viral pathogens include herpes,Epstein-barr virus,HIV and coxsackievirus. The most common bacterial infection in Group A streptococci, which causes 5-36% of cases of acute pharyngitis.
EPIDEMIOLOGY. In 2010,there were 1.814million emergency department visits for pharyngitis, of which 692,000 were for patients under the age of 15. Most of cases of pharyngitis occurs in children age under 5,adults can develop the disease but at lower rate. Globally, pharyngitis is observed in most of countries where antibiotics are overprescribed.
PATHOPHYSIOLOGY. With infectious pharyngitis, bacteria or viruses directly invade the pharyngeal mucosa, causing a local inflammatory response. Other viruses such as rhinovirus and coronavirus can cause irritation of pharyngeal mucosa secondary to nasal secretions. Streptococcal infections are characterized by local invasion and release of extracellular toxins and proteases. In addition protein M protein segment* of certain serotypes of GAS are similar to myocardial sarcolemma antigens are linked to rheumatic fever and subsequent heart valve damage.
EVALUATION. A variety of clinical decision rules have been developed to improve the diagnosis of group A beta-haemolytic streptococcal pharyngitis and to guide the treatment. Centor criteria* for group A beta-haemolytic streptococci: 1. Tonsilir exudate(Inflammation of tonsils) 2. Tender anterior cervical left mentoanterior. 3. History of fever. 4. Absence of cough.
POINT TOTALS AND RECOMMENDED ACTIONS. White blood cell counts have minimal value in the differentiation of viral versus bacterial etiologies of pharyngitis. A lymphocytosis (greater than 50%) or increased atypical lymphocytes (greater than 10%) may suggest infectious mononucleosis. Rapid antigen detection tests(RADT): oIt is very specific for group A beta-hemolytic streptococci, but their sensitivity widely ranges from 70-90%. If positive-Treatment should be initiated. If negative-Particular in children, throat culture should be obtained and should guide treatment.
A hetrophile antibody or monospot test: oTest is 70-92% sensitive and 96-100% specific. oThis test is specific for infectious mononucleosis is commonly available, but ideal standard is to use Epstein-Barr virus serology. oThe test sensitivity is lessened by testing early in the course of illness and by the age of the patient.
TREATMENT. Antibiotics for pharyngitis are usually used for group A beta- haemolytic streptococcal pharyngitis. Antibiotics may shorten the duration of symptoms by 16-24 hours and prevent rheumatic fever. Older data suggests 1 in 400(0.25%)remain untreated in case of pharyngitis. Antibiotics should be given only in cases of group A beta-haemolytic streptococcal-positive patients. Treatment option for group A beta-haemolytic streptococcal pharyngitis include oral treatment with penicillin V oral amoxicillin.
Cephalosporins,macrolides and clindamycin may also be used. Intramuscular penicillin is also a option. In patients with a mild penicillin allergy, cephalosporin can be used. In patients with a history of anaphylaxis to penicillin, azithromycin or clindamycin can be used. The disease is no longer infectious after 24 hours of antibiotics. Single-dose corticosteroids like dexamethasone may be given to reduce the severity of symptoms, although the evidence for this approach is limited. For patients with infectious mononucleosis, contact sports should be avoided for 6 to 8 weeks due to the risk of splenic rupture.
PROGNOSIS. In developing countries, over 20 million individuals are affected by group B streptococci and develop rheumatic fever. This disorder is leading to cause leading to death in younger people. Other complications as a result of streptococcal pharyngitis include peritonsillar abscesses, acute glomerulonephritis, and toxic shock syndrome. Mortality from pharyngitis is rare but does occur if the airway is compromised.
COMPLICATIONS. complications of bacterial pharyngitis include: Epiglottitis. Otitis media. Mastoiditis. Sinusitis. Acute rheumatic fever. Post streptococcal glomerulonephritis. Toxic shock syndrome.

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Pharyngitis

  • 2. TERMINOLOGY. Acute rheumatic fever-It is an illness following an autoimmune response to a group A streptococcus, it causes inflammation, especially of the heart, blood vessels and joints. Adenovirus-They are a group of common viruses that infect the lining of your eyes, airways and lungs, intestines, urinary tract, and nervous system. anaphylaxis -Serious,life-threatning allergic reaction. Cephalosporin-They are bactericidal (kill bacteria) and work in a similar way to penicillin. Coxsackieviruses-They RNA viruses that may cause hand, foot, and mouth disease (HFMD), as well as disease of muscles, lungs, and heart.
  • 3. Epstein-Barr virus-The EpsteinBarr virus, formally called Human gamma herpes virus 4, is one of the nine known human herpes virus types in the herpes family, and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis. Etiology-Etiology is the study of causation or origination of disease. Group A streptococcus-GAS bacteria is a Gram positive, beta-hemolytic coccus in chains. It is responsible for a range of diseases in humans. These diseases include strep throat (acute pharyngitis) and skin and soft tissue infections. Herpes-A virus causing contagious sores, most often around the mouth or on the genitals. Influenza-It is a viral infection that attacks your respiratory system-your nose, throat and lungs, influenza is commonly known as flu.
  • 4. Macrolide- they are a class of natural products that consist of a large macro cyclic lactone ring, it is often prescribed to treat rather common bacterial infections. Mastoiditis-It is usually caused by middle ear infection, it can result in damage of mastoid bone and formation of pus filled crystals. Otitis media-An ear infection is usually caused by bacteria or viruses. Peritonsillar abscesses- A peritonsillar abscess occurs when a collection of pus forms and infection spreads beyond the tonsils into the neck and chest. Post streptococcal glomerulonephritis-is a kidney disease that develops 10 to 14 days after a skin or throat infection. it is not caused by the bacteria itself, but by the body's infection fighting
  • 5. Parainfluenza-They are a paraphyletic group of four distinct single-stranded RNA viruses belonging to the Paramyxoviridae family. These viruses are closely associated with both human and veterinary disease. Rhinorrhea- rhinorrhea is a condition where the nasal cavity is filled with a significant amount of mucus fluid. Rhinovirus-It is the most common viral infectious agent in humans and is the predominant cause of the common cold. Sinusitis-It is an inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection. Toxic shock syndrome-It is a rare but serious medical condition caused by a bacterial infection. t is caused when the bacterium streptococcus aureus gets into the bloodstream and produces toxins.
  • 6. INTRODUCTION. Pharyngitis is a medical term for a sore throat. Causes of pharyngitis include viral infection, common cold and bacterial infection, such a group A streptococcus. Pharyngitis is defined as an infection or irritation of the pharynx, which is in the back of the throat. It is most often referred to simply as sore throat Pharyngitis can also cause scratchiness in the throat and difficulty in swallowing.
  • 7. HISTORY Viral and bacterial causes of pharyngitis are similar and differentiation of etiology is based on examination of history and physical examination alone. Classic presentation are listed below: 1. Group A Streptococcus(GAS) infection is the most common in children. 2. Sudden onset is consistent with a GAS pharyngitis. Pharyngitis following several days of coughing or rhinorrhea is more consistent with a viral etiology. 3. Headache is consistent in GAS infection. 4. Cough is usually not associated with GAS infection.
  • 8. ETIOLOGY. About 50-80% of pharyngitis or symptoms are viral in origin and include various viral pathogens. These pathogens are rhinovirus,influenza,adenovirus,coronavirus and parainfluenza. Less common viral pathogens include herpes,Epstein-barr virus,HIV and coxsackievirus. The most common bacterial infection in Group A streptococci, which causes 5-36% of cases of acute pharyngitis.
  • 9. EPIDEMIOLOGY. In 2010,there were 1.814million emergency department visits for pharyngitis, of which 692,000 were for patients under the age of 15. Most of cases of pharyngitis occurs in children age under 5,adults can develop the disease but at lower rate. Globally, pharyngitis is observed in most of countries where antibiotics are overprescribed.
  • 10. PATHOPHYSIOLOGY. With infectious pharyngitis, bacteria or viruses directly invade the pharyngeal mucosa, causing a local inflammatory response. Other viruses such as rhinovirus and coronavirus can cause irritation of pharyngeal mucosa secondary to nasal secretions. Streptococcal infections are characterized by local invasion and release of extracellular toxins and proteases. In addition protein M protein segment* of certain serotypes of GAS are similar to myocardial sarcolemma antigens are linked to rheumatic fever and subsequent heart valve damage.
  • 11. EVALUATION. A variety of clinical decision rules have been developed to improve the diagnosis of group A beta-haemolytic streptococcal pharyngitis and to guide the treatment. Centor criteria* for group A beta-haemolytic streptococci: 1. Tonsilir exudate(Inflammation of tonsils) 2. Tender anterior cervical left mentoanterior. 3. History of fever. 4. Absence of cough.
  • 12. POINT TOTALS AND RECOMMENDED ACTIONS. White blood cell counts have minimal value in the differentiation of viral versus bacterial etiologies of pharyngitis. A lymphocytosis (greater than 50%) or increased atypical lymphocytes (greater than 10%) may suggest infectious mononucleosis. Rapid antigen detection tests(RADT): oIt is very specific for group A beta-hemolytic streptococci, but their sensitivity widely ranges from 70-90%. If positive-Treatment should be initiated. If negative-Particular in children, throat culture should be obtained and should guide treatment.
  • 13. A hetrophile antibody or monospot test: oTest is 70-92% sensitive and 96-100% specific. oThis test is specific for infectious mononucleosis is commonly available, but ideal standard is to use Epstein-Barr virus serology. oThe test sensitivity is lessened by testing early in the course of illness and by the age of the patient.
  • 14. TREATMENT. Antibiotics for pharyngitis are usually used for group A beta- haemolytic streptococcal pharyngitis. Antibiotics may shorten the duration of symptoms by 16-24 hours and prevent rheumatic fever. Older data suggests 1 in 400(0.25%)remain untreated in case of pharyngitis. Antibiotics should be given only in cases of group A beta-haemolytic streptococcal-positive patients. Treatment option for group A beta-haemolytic streptococcal pharyngitis include oral treatment with penicillin V oral amoxicillin.
  • 15. Cephalosporins,macrolides and clindamycin may also be used. Intramuscular penicillin is also a option. In patients with a mild penicillin allergy, cephalosporin can be used. In patients with a history of anaphylaxis to penicillin, azithromycin or clindamycin can be used. The disease is no longer infectious after 24 hours of antibiotics. Single-dose corticosteroids like dexamethasone may be given to reduce the severity of symptoms, although the evidence for this approach is limited. For patients with infectious mononucleosis, contact sports should be avoided for 6 to 8 weeks due to the risk of splenic rupture.
  • 16. PROGNOSIS. In developing countries, over 20 million individuals are affected by group B streptococci and develop rheumatic fever. This disorder is leading to cause leading to death in younger people. Other complications as a result of streptococcal pharyngitis include peritonsillar abscesses, acute glomerulonephritis, and toxic shock syndrome. Mortality from pharyngitis is rare but does occur if the airway is compromised.
  • 17. COMPLICATIONS. complications of bacterial pharyngitis include: Epiglottitis. Otitis media. Mastoiditis. Sinusitis. Acute rheumatic fever. Post streptococcal glomerulonephritis. Toxic shock syndrome.

Editor's Notes

  • #11: *M protein segment-It is a virulence factor that can be produced by certain species of streptococcus,parasites,viruses and bacteria are covered in sugar and protein molecules that help them gain entry in to host by counteracting hosts defences. One such molecule is M protein produced by Streptococcal bacteria.
  • #12: *centor criteria-centor criteria is a clinical findings that taken together maybe used as an aid in making diagnosis of group A beta-haemolytic streptococcus as a cause of pharyngitis or tonsillitis.