Pharyngitis Slides PDF

12/12/2022 ENT TOPICS- PHARYNGITIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with pharyngitis Understand the pathophysiology asso...

12/12/2022 ENT TOPICS- PHARYNGITIS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with pharyngitis Understand the pathophysiology associated with pharyngitis Describe the clinical presentation and work up of a person with pharyngitis Develop a medical plan for a person with pharyngitis 1  12/12/2022 INTRODUCTION Pharyngitis is defined as an infection or irritation of the pharynx or tonsils (see the image below). The etiology is usually infectious, with most cases being of viral origin and most bacterial cases attributable to group A streptococci (GAS). Other causes include allergy, trauma, toxins, and neoplasia. CLASSIFICATION OF BACTERIA PHARYNGITIS Centor criteria for GAS pharyngitis include the following: Fever (1 point) Anterior cervical lymphadenopathy (1 point) Tonsillar exudate (1 point) Absence of cough (1 point) A score of 0-1 makes GAS infection unlikely; a score of 4 makes it likely. In adults, the positive predictive value of these criteria is around 40% if 3 criteria are met and about 50% if 4 criteria are met. 2  12/12/2022 PATHOPHYSIOLOGY With infectious pharyngitis, Streptococcal infections are bacteria or viruses may directly characterized by local invasion and invade the pharyngeal mucosa, release of extracellular toxins and causing a local inflammatory proteases. In addition, M protein response. Other viruses, such as fragments of certain serotypes of GAS rhinovirus and coronavirus, can cause are similar to myocardial sarcolemma irritation of pharyngeal mucosa antigens and are linked to rheumatic secondary to nasal secretions. fever and subsequent heart valve damage. PRESENTING SYMPTOMS It is difficult to distinguish viral and bacterial causes of Headache is consistent with GAS infection. pharyngitis on the basis of history and physical Cough is not usually associated with GAS examination alone. Nevertheless, the following factors infection. may help rule out or diagnose GAS pharyngitis: Vomiting is associated with GAS infection, Sudden onset is consistent with GAS pharyngitis; though not exclusively so. pharyngitis after several days of coughing or rhinorrhea is more consistent with a viral etiology. Recent orogenital contact suggests possible gonococcal pharyngitis. Contact with others who have GAS or rheumatic fever with symptoms consistent with GAS raises the A history of rheumatic fever is important. likelihood of GAS pharyngitis. 3  12/12/2022 PHYSICAL EXAM HEENT: assess for conjunctivits which may be seen with adenovirus. Scleral icterus may be seen with mono. Rhinorrhea usually is associated with a viral cause. Tonsillopharyngeal/palatal petechiae are seen in GAS infections and infectious mononucleosis. A tonsillopharyngeal exudate may be seen in streptococcal infectious mononucleosis and occasionally in M pneumoniae, C pneumoniae, A haemolyticus, adenovirus, and herpesvirus infections. Therefore, exudate does not differentiate viral and bacterial causes. Oropharyngeal vesicular lesions are seen in coxsackievirus and herpesvirus. Concomitant vesicles on the hands and feet are associated with coxsackievirus (hand-foot-and-mouth disease). Lymphadenopathy:Tender anterior cervical nodes are consistent with streptococcal infection, whereas generalized adenopathy is consistent with infectious mononucleosis or the acute lymphoglandular syndrome of HIV infection. PHYSICAL EXAM Cardiovascular: Murmurs should be documented in an acute episode of pharyngitis to monitor for potential rheumatic fever. Pulmonary: Pharyngitis and lower respiratory tract infections are more consistent with M pneumoniae or C pneumoniae, particularly when a persistent nonproductive cough is present. Abdomen: Hepatosplenomegaly can be found in infectious mononucleosis infection. A sandpapery scarlatiniform rash is seen in GAS infection→ Scarlett fever Maculopapular rashes are seen with various viral infections and with infectious mononucleosis empirically treated with penicillin. 4  12/12/2022 DIFFERENTIAL DIAGNOSIS Allergic rhinitis with postnasal drip Airway obstruction Head and neck neoplasias Gastroesophageal reflux disease (GERD) Peritonsillar cellulitis TREATMENT Only patients with a high clinical likelihood of If administered early, antibiotics can shorten GAS pharyngitis should be tested. Patients with a the duration of the illness by up to 1 day, but Centor score of 0-1 should be treated the main reason they are given is for symptomatically without testing. Score of 3-4 prevention of acute rheumatic fever should be tested or treated empirically. While this is in question, antibiotics are still This is the criterion standard for diagnosis of recommended treatment for pharyngitis. GAS infection (90-99% sensitive). GAS pharyngitis is usually a self-limited disease, Many appropriate options: Penicillin, and most signs and symptoms resolve Amoxicillin, Cephalexin, Zithromax, spontaneously in 3-4 days. Erythromycin, Clindamycin, Ceftriaxone. 5  12/12/2022 CONSIDERATIONS FOR THE GERIATRIC POPULATION The elderly are more susceptible to infection due to a weakened immune system. When left untreated, could lead to tonsillitis. Antibiotics can have many side effects with elderly. Acute rheumatic fever could be very severe in the elderly population REFERENCES Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5 ed.). St. Louis, Missouri: Mosby Elsevier. Acerram J. & Taylor, T. (2022, April 06). Pharyngitis. Retrieved June 17, 2022, from https://emedicine.medscape.com/article/764304-overview 6