Difference between revisions of "Pharyngitis"

(Redirected page to Sore throat)
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#REDIRECT [[Sore throat]]
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==Background==
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*Peak in 5-15yr old
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*Rare in <2yr of age
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*Accounts for only 15-30% of pharyngitis
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 +
==Clinical Features==
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[[File:Pos strep.jpg|thumb|culture positive strep pharyngitis with typical tonsillar exudate]]
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*[[Sore throat]]
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*Painful swallowing
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*[[Fever]]
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*[[Nausea and vomiting]]
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*Tonsillar exudate
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*Palatal petechiae
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===Complications===
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*[[Acute rheumatic fever]]
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*[[Scarlet fever]]
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*[[Toxic shock syndrome]]
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*[[Post-streptococcal glomerular nephritis]]
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*PANDAS syndrome
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*[[Peritonsillar abscess]]
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*Cervical lymphadenitis
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*[[Mastoiditis]]
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==Differential Diagnosis==
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{{Sore throat DDX}}
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{{DDX oral rashes and lesions}}
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==Evaluation==
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===Modified Centor Criteria<ref name=Review09>Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.</ref>===
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One point is given for each of the criteria:<ref name=Review09/>
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#Absence of a cough
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#Swollen and tender cervical lymph nodes
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#Temperature >38.0 °C (100.4 °F)
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#Tonsillar exudate or swelling
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#Age less than 15^
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#*Subtract a point if age >44
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^Testing is not needed in children <3 years old as both group A strep and [[rheumatic fever]] are rare, except if they have a sibling with the disease.<ref name=IDSA2012>Shulman, ST; Bisno, AL; Clegg, HW; Gerber, MA; Kaplan, EL; Lee, G; Martin, JM; Van Beneden, C (Sep 9, 2012). "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America.". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 55 (10): e86–102. doi:10.1093/cid/cis629. PMID 22965026.</ref>
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 +
{| class="wikitable"
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|+ Modified Centor score
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!Points||Probability of Strep||Management
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|-
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| 1 or fewer|| <10%||No antibiotic or culture needed
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|-
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| 2        ||11–17%||rowspan="2"|Antibiotic based on rapid strep or culture
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|-
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| 3        ||28–35%
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|-
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| 4 or 5  ||52%||Empiric antibiotics
 +
|}
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 +
==Management==
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===[[Antibiotics]]===
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{{Streptococcal Pharyngitis Antibiotics}}
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 +
===[[Steroids]]===
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*Single dose of [[dexamethasone]] shortens duration of pain<ref>Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012 Oct 17;10:CD008268. PMID: 23076943.</ref>
 +
**[[Dexamethasone]] 0.6mg/kg PO - maximum of 10mg
 +
 
 +
==Disposition==
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*Discharge
 +
 
 +
==See Also==
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*[[Sore Throat]]
 +
 
 +
==References==
 +
<references/>
 +
 
 +
[[Category:Pediatrics]]
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[[Category:ENT]]
 +
[[Category:ID]]

Revision as of 16:32, 23 January 2017

Background

  • Peak in 5-15yr old
  • Rare in <2yr of age
  • Accounts for only 15-30% of pharyngitis

Clinical Features

culture positive strep pharyngitis with typical tonsillar exudate

Complications

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Oral rashes and lesions

Evaluation

Modified Centor Criteria[2]

One point is given for each of the criteria:[2]

  1. Absence of a cough
  2. Swollen and tender cervical lymph nodes
  3. Temperature >38.0 °C (100.4 °F)
  4. Tonsillar exudate or swelling
  5. Age less than 15^
    • Subtract a point if age >44

^Testing is not needed in children <3 years old as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.[3]

Modified Centor score
Points Probability of Strep Management
1 or fewer <10% No antibiotic or culture needed
2 11–17% Antibiotic based on rapid strep or culture
3 28–35%
4 or 5 52% Empiric antibiotics

Management

Antibiotics

Treatment can be delayed for up to 9 days and still prevent major sequelae

Penicillin Options:[4]

  • Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent or adult)
  • Bicillin L-A <27 kg: 0.6 million units; ≥27 kg: 1.2 million units IM x 1

Penicillin allergic (mild):[4]

  • Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d

Penicillin allergic (anaphylaxis):[4]

  • Clindamycin 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR
  • Azithromycin 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5

Steroids

Disposition

  • Discharge

See Also

References

  1. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  2. 2.0 2.1 Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.
  3. Shulman, ST; Bisno, AL; Clegg, HW; Gerber, MA; Kaplan, EL; Lee, G; Martin, JM; Van Beneden, C (Sep 9, 2012). "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America.". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 55 (10): e86–102. doi:10.1093/cid/cis629. PMID 22965026.
  4. 4.0 4.1 4.2 Shulman, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):1279–82
  5. Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012 Oct 17;10:CD008268. PMID: 23076943.