Pharyngitis Overview and Causes

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Questions and Answers

What is the peak incidence period for pharyngitis?

Winter through early spring

Summer through early fall

Late fall through early spring (correct)

Spring through early summer

Which virus is commonly associated with herpangina?

Epstein-Barr virus

Adenovirus

Coxsackie virus (correct)

Influenza virus

What symptom is most characteristic of bacterial (GABHS) pharyngitis compared to viral pharyngitis?

Petechiae on the soft palate (correct)

Gradual onset

Rhinorrhea

Cough

Which of the following conditions is NOT a differential diagnosis for pharyngitis?

Asthma Signup and view all the answers

Which of these is a common treatment for bacterial pharyngitis?

Antibiotics Signup and view all the answers

What should be monitored closely for signs of active infection in a child before a tonsillectomy and adenoidectomy (T&A)?

Presence of a sore throat and cough Signup and view all the answers

Which foods should be avoided after a tonsillectomy due to the risk of complications?

Foods with red dye Signup and view all the answers

What is the primary reason to avoid suctioning in children after a tonsillectomy?

It can dislodge eschar protecting the incision site Signup and view all the answers

What is the greatest risk period for postoperative bleeding after a tonsillectomy?

7-10 days post-op Signup and view all the answers

Which medication should be avoided for pain management in children after T&A due to metabolic variability?

Codeine Signup and view all the answers

What should be assessed to monitor for signs of bleeding after a tonsillectomy?

All secretions and emesis for fresh blood Signup and view all the answers

What is the most common source of pertussis infection?

Unrecognized infection in adult family members Signup and view all the answers

Which stage of pertussis is characterized by severe coughing fits and possible cyanosis?

Paroxysmal stage Signup and view all the answers

What is a critical point to educate families about following surgery for T&A?

The risk of bleeding is highest immediately after surgery Signup and view all the answers

Which protective measure is crucial in maintaining a patent airway post T&A?

Keeping suction equipment nearby Signup and view all the answers

What are indications for a tonsillectomy?

At least 7 episodes of tonsil infection in the past year Signup and view all the answers

What is the expected recovery measure to prevent complications after a tonsillectomy?

Frequent change of toothbrush after surgery Signup and view all the answers

Which symptom is indicative of a worsening condition following GAS pharyngitis?

Drooling Signup and view all the answers

Which class of medication is recommended for treating severe throat pain in pharyngitis?

Systemic analgesics Signup and view all the answers

What is a major cause of Scarlet Fever?

Transmission through contaminated food Signup and view all the answers

What should not be used for the treatment of GAS pharyngitis due to high resistance rates?

Tetracyclines Signup and view all the answers

Which statement is true regarding self-care post-antibiotic treatment for pharyngitis?

Toothbrushes should be changed after therapy begins Signup and view all the answers

What complication is most concerning for children with untreated streptococcal throat infections?

Post Strep glomerulonephritis Signup and view all the answers

During the tonsillectomy procedure, what is the purpose of the time-out taken by the surgical team?

To verify the correct patient, procedure, and site Signup and view all the answers

What is the incubation period for Scarlet Fever typically?

1 to 7 days Signup and view all the answers

What is a common consequence of adenoid hypertrophy?

Sleep disturbances due to nasal obstruction Signup and view all the answers

Which of the following procedures is NOT typically performed for the treatment of tonsil-related issues?

Endoscopic sinus surgery Signup and view all the answers

Which post-operative complication may occur after a tonsillectomy?

Nausea and vomiting Signup and view all the answers

What is a primary method of transmission for streptococcus bacteria?

Person to person via respiratory secretions Signup and view all the answers

Study Notes

Pharyngitis

Inflammation of the pharynx and tonsil tissues, most often caused by infection.
Peak incidence occurs in late fall and early spring.
Younger children are more prone to viral pharyngitis during winter.
Bacterial pharyngitis (GABHS) predominantly affects children aged 5-15, with winter peaks.

Pathogenesis of Pharyngitis

Viral Causes

Adenovirus
Influenza A & B
Parainfluenza
Epstein-Barr virus
Coxsackie virus (causing herpangina, hand, foot, and mouth disease)
Enterovirus
Coxsackie virus (hand, foot, and mouth disease) characteristically presents with oral ulcers, hand/foot rash (vesicles/papules) in spring, summer, and fall, often with associated coryza, conjunctivitis, cough, and diarrhea.
Enterovirus and coxsackievirus often cause herpangina, marked by oral blisters and ulcers on the anterior pillars.

Bacterial Causes

Group A β-hemolytic streptococcus (GABHS)
Group B, C, and G streptococci (non-GABHS)
Corynebacterium diphtheriae
Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma pneumonia
Other: Mucosal irritation, foreign bodies, chemical exposure, referred pain

Pharyngitis Differentials

Allergic rhinitis
Postnasal drip
Fungal infections
Tonsillar abscess
Retropharyngeal abscess
Epiglottitis

Diagnosis of Pharyngitis

Viral Pharyngitis

Gradual onset
Cough
Sore throat
Fever
Rhinorrhea
Diarrhea
Erythematous pharynx (redness)
Follicular, ulcerative, or exudative lesions in the pharynx

Bacterial Pharyngitis (GABHS)

Rapid onset (incubation 2-4 days)
Sore throat
Fever
Difficulty swallowing
Beefy-red, swollen pharynx, uvula, and tonsils
Tonsillar exudate (pus) and enlarged tonsils
Swollen and tender cervical and tonsillar lymph nodes
Petechiae on soft palate, "strawberry" tongue (coated)
Possible multiple GI symptoms (e.g., vomiting)
Scarlet fever-like rash

Treatment of Pharyngitis

Rapid strep test/throat culture needed for diagnosis.
Antibiotics (e.g., amoxicillin) for bacterial infection, crucial to prevent complications like rheumatic fever and glomerulonephritis.
Increase fluid intake.
Analgesics for pain.
Return to school/daycare 24 hours after antibiotic initiation.
Inform parents/guardians to watch for signs of worsening symptoms (e.g. peritonsillar abscess).

Antibiotics for Pharyngitis

Penicillin (and related agents like ampicillin and amoxicillin), cephalosporins, macrolides, and clindamycin are suitable treatments for GAS pharyngitis.
Sulfonamides and tetracyclines are generally avoided due to resistance risks.

Analgesic and Corticosteroid Treatment

Systemic analgesics (e.g., acetaminophen, ibuprofen) can reduce throat pain and fever in cases of pharyngitis and tonsillitis.

Follow-up Care for Pharyngitis

Routine follow-up cultures are not usually needed but a test of cure can be recommended in some instances.
Assessment of carrier state may be considered, especially given a low risk of transmission and complications.

Complications of Pharyngitis

Acute rheumatic fever
Post-streptococcal glomerulonephritis (especially children <7 years old)
Pediatric autoimmune neuropsychiatric disorder associated with strep (PANDAS), possibly presenting as OCD, ADHD, tics, or worsening of existing behaviors, following or coinciding with a strep infection

Education Regarding Pharyngitis

Transmission occurs via respiratory secretions.
Adherence to prescribed medications is essential.
Children can return to school 24 hours after antibiotic initiation, but sharing of personal items should be avoided.

Scarlet Fever

Hypersensitivity reaction caused by toxin from GABHS.
Often follows streptococcal pharyngitis, but other strep infections can cause it too.
Characterized by a scarlet-colored rash and inflammatory process in the tonsils and pharynx.
Incubation period: 1-7 days, rash usually appears on day 2.

Tonsillectomy & Adenoidectomy (T&A)

Surgical removal of tonsils and/or adenoids.
A common pediatric surgery.

Indications for T&A

7+ episodes of recurrent or chronic infection in last year, OR 5+ per year for 2 years, OR 3+ per year for 3 years with relevant clinical findings (fever, adenopathy, exudate, positive strep test)
Obstructive sleep apnea
Peritonsillar abscess/cellulitis (more than 1 infection)
Recurrent middle ear infections due to enlargement
Vocal alterations from obstruction
Nasal obstruction

Adenoid Hypertrophy

Allergic (adenoidal) face (long face syndrome) due to swollen adenoids (behind nose and throat).

T&A Procedure

Pre-op verification, child receives general anesthesia, IV access secured.
Pre-procedure use of dexamethasone may be indicated for post-op nausea/vomiting.
Tonsils and adenoids resected using various techniques, bleeding controlled.

T&A Complications

Bleeding
Dehydration
Failure to improve sleep apnea, nasal obstruction
Infection
Pneumonia
Post-op airway obstruction/laryngospasm/bronchospasm
Oral burns
TMJ problems
Tongue numbness
Regrowth of tonsil tissue
Nasal regurgitation (rare)

Pre-Treatment Care for T&A

Explanation of procedure, informed consent, lab tests (clotting, blood type, crossmatch).
Prohibitation from aspirin/NSAIDs close to surgery.
Information provided regarding post-op pain and fluids
Assessment of loose teeth.

Post-Treatment Care for T&A

Prevent airway obstruction, suction, encourage liquids when gag reflex returns.
Avoid straws initially.
Pain management, assess and monitor regularly.
Monitoring of blood, respiration, hydration, intake/output, drooling; assess for indications of bleeding, respiratory issues

Pertussis (Whooping Cough)

Infection caused by Bordetella pertussis.
Droplet precautions necessary.
Often milder in adults; more serious in children and infants.
Higher prevalence during summer (June) and fall (September).
Immunization (dTap/Tdap).

Disease Progression of Pertussis

Initial stage (catarrhal): cold-like symptoms, low fever
Paroxysmal stage: rapid coughs followed by vomiting/exhaustion, whooping sound
Convalescent stage: gradual reduction in coughing but susceptibility to other infections
Usual source is an unrecognized infection in a family member. Infants present with unique findings.

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Description

This quiz explores the inflammation of the pharynx, commonly known as pharyngitis, highlighting its viral and bacterial causes. It covers peak incidence periods, particularly among children, and features details about associated pathogens. Test your knowledge on the pathogenesis and symptoms of this condition.