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Pharyngitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Pharyngitis is defined as inflammation of the pharynx. It can be generalised or localised to a specific area (tonsillitis). The presenting symptom is usually a sore throat, and this is the most common presentation for primary care consultation. Most cases of pharyngitis are due to infection: viral in 40–60% and bacterial in 5–30% of cases. Non-infectious causes include dry air, allergy/post-nasal drip, chemical injury, gastro-oesophageal reflux disease (GERD), smoking, neoplasia and endotracheal intubation.
Respiratory Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Pharyngitis is mostly caused by viruses (adenovirus and rhinovirus) but also by bacteria (Group A streptococcus). Differential diagnosis includes epiglottitis and retropharyngeal abscess (fever, chills, voice change, dysphagia, neck stiffness and feeling of lump in throat). Untreated Group A streptococcus can cause rheumatic fever, post-streptococcal glomerulonephritis, toxic shock and abscess. Consider gonococcal infection if risk factors are present. Symptoms include fever, malaise, hoarse voice, sore throat and myalgia. Treatment is supportive for viral infections, which should resolve in up to 10 days; if a bacterial infection is suspected, for example, streptococcal, give 250–500 mg penicillin V four times a day orally for 10 days in those without penicillin allergy. Avoid amoxicillin in suspected EBV, as it leads to rash.
Acute Streptococcal Pharyngitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
GAS is the main cause of bacterial pharyngitis and causes up to 30% of all cases of acute pharyngitis in children and up to 10% in adults. Patients with pharyngitis spread GAS via the respiratory route. GAS pharyngitis has an incubation period of 2–5 days and symptoms can last up to 5 days. Antimicrobial therapy reduces duration and severity of symptoms by 1–2 days (when begun within 48 hours of illness). Its main goal is to prevent transmission to others and reduce risk of rheumatic fever. Some guidelines recommend routine treatment of GAS pharyngitis. GAS bacteraemia is rarely associated with uncomplicated pharyngitis or nonsuppurative complications of pharyngitis.
Forget-me-not: Lemierre’s syndrome, a case report
Published in Journal of American College Health, 2023
Benjamin Silverberg, Melinda J Sharon, Devan Makati, Mariah Mott, William D Rose
Sore throat is one of the most common presenting concerns in a college health clinic. Without considering the pretest probability, many practitioners reflexively test for Streptococcal pharyngitis and mononucleosis, sometimes offering antibiotics even when a bacterial infection has not been proven. Table 1 offers an extensive, albeit not exhaustive, differential diagnosis for the adolescent patient with a sore throat. Viruses are canonically thought to be the most common etiology of pharyngitis overall (reportedly up to 90% of cases in adults). Symptomatic infections due to group A beta-hemolytic streptococci (GAS) are more common in children age 5-12 years, with a lower incidence in adults (except perhaps for those who directly care for children).7 Some clinician-researchers have argued that Fusobacterium necrophorum (FN) is a major – and less recognized – cause in adolescents.1,7 Confusing the matter further, bacterial infections may follow an initial viral infection. Missed diagnoses (and thereby incorrect treatment) and rare complications can prove fatal, as is the case with rheumatic fever and Lemierre’s syndrome. Unlike GAS, no bedside confirmatory test currently exists for FN and, further, the bacterium requires an anaerobic culture medium to grow.7
Treatment outcomes of acute streptococcal tonsillitis according to antibiotic treatment. A retrospective analysis of 242,366 cases treated in the community
Published in European Journal of General Practice, 2022
Mattan Bar-Yishay, Ilan Yehoshua, Avital Bilitzky, Yan Press
Cases of GABHS tonsillitis treated in the community between the years 2010 and 2019 were identified using MD Clone system, which allows for case identification around a reference event. Initially, 420,954 patients given a clinical diagnosis of tonsillitis or pharyngitis in the community by a primary physician (family physician or paediatrician) were identified. Diagnoses included in our initial search are detailed in the Supplementary Materials (Appendix 1). Only the first case of clinically diagnosed pharyngitis for each patient identified within the 10-year study period was included. Cases in which the first diagnosis was recurrent tonsillitis/pharyngitis were excluded. Of the 420,954 clinically diagnosed cases identified, 283,092 (67%) patients had a positive throat culture result for GABHS within four days of clinical diagnosis. Out of those culture-confirmed GABHS tonsillitis cases, 242,366 (86%) patients purchased a suitable course of systemic antibiotic treatment within seven days of clinical diagnosis. Antibiotic treatments included are detailed in the Supplementary Materials (Appendix 2).
Unilateral Acute Idiopathic Maculopathy Associated with Streptococcal Pharyngitis, A Case Report
Published in Ocular Immunology and Inflammation, 2022
Clare L. Shute, Usha Chakravarthy, Clara E. McAvoy
Given the temporal relationship between developing a sore throat and experiencing unilateral visual loss, biochemical, hematological, and serological investigations were carried out 2 weeks following initial presentation with acute pharyngitis. Biochemistry showed a CRP of 19.2 (normal range <5 mg/L) and a mild uremia of 9.9 mmol/L (normal range 2.4–7.8 mmol/L). Hematological investigations showed an ESR of 20 mm/hr (normal range 1–12 mm/hr) and a WCC of 4.7 x109/L (normal range 4–10 x109/L). Serological investigations revealed a raised anti-streptolysin titer (ASOT) at 800 IU/ml and Streptococcus Anti-DNAse-B (ADB) antibody at 400 U/ml (ASOT > 200 IU/ml and ADB > 200 U/ml are suggestive of current/recent infection according to local laboratory protocol). The anti-streptolysin titer remained raised at 800 IU/ml 2 months later.