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Sore throat - Other ds :necktie: (:speech_balloon: Poststreptococcal…
Sore throat - Other ds
:necktie:
:<3:
Acute Rheumatic Fever
Immune mediated (Humoral)
Dx by
Jones criteria
Major
criteria
Carditis
Polyarthritis (migratory)
Sydenham’s chorea
Subcutaneous nodules
Painless, firm, near bony prominences
Erythema marginatum
Minor
criteria
Clinical findings
Arthralgia
Fever
Laboratory findings
:arrow_up: acute phase reactants
CRP
ESR
Prolonged PR interval on EKG
Supporting
evidence
of GAS infection
Positive Throat culture or Rapid streptococcal Ag test
:arrow_up: streptococcal Ab titer
Antistreptolysin (ASO)
AntiDNAse B
Evidence of prior GAS infection
or
2 major criteria
or
1 major + 2 minor
⇨ Indicates High prob of ARF
Rx
Goal: :arrow_down: inflammation, fever & toxicity and control HF
Including:
Anti-inflammatory
agents &
steroid
depends on severity of illness
:speech_balloon:
Poststreptococcal glomerulonephritis
Clinical
:alarm_clock:Develops
10 days after
pharyngitis
Edema, V/S:
HT
, Smoky/Rusty colored urine
Pallor, lethargy, malaise, weakness, anorexia, headache, dull back pain
Fever not prominent
PathoPSO
Immune mediated damage to Kidney ⇨ Renal dysfunction
By Nephritogenic strain of Strep pyogenes
Lab
findings
Anemia, Hematuria, Proteinuria
UA: RBCs, WBCs, casts
Dx
when
Clinical Hx + PE + Confirm
evidence
of Antecedent streptococcal infection
ASO titers
Anti-DNAse B
Therapy
Penicillin
If allergic to PN ⇨
Erythromycin
Supportive care of complication
Diphtheria
Etio agent: Corynebacterium diphtheria
Extremely rare! Tho primarily found in unimmunized pt
Gram :heavy_plus_sign: rod, nonspore forming
Strain mayb toxigenic or nontoxigenic
(exotoxin needed for ds)
Tonsillitis
Def
: infection/inflammation of tonsils
Hx
: sore throat, fever, otalgia, dysphagia
PE
: Whitish plaques, Enlarged/Tender cervical adenopathy
Etio
agent: GAS, EBV (less commonly HSV)
Rx: same as pharyngitis
Laryngitis
Def
: inflammation of mucous mb covering larynx with accompanied edema of vocal cords
Hx
: sore throat, dysphonia(hoarseness) or loss of voice, cough, possible low grade fever
PE
: can’t direcly visualize larynx on standard PE
so must use
Fiberoptic laryngoscopy
(not usu needed)
Etiology
:
Acute
(<3 wk duration)
Think abt
Infectious
M/C is
Viral
Symptoms M/C resolve in 7-10 days
Chronic
(>3 wk duration)
Think of
Inhalation of irritant fumes
Vocal misuse
GERD
Smokers
Rx
Symptomatic
care
Complete voice rest
Avoid exposure to insulting agent
Anti-reflex therapy
:!: still doesn’t support steroid use to relieve symptoms
Peritonsillar abscess
Accu of pus in tonsillar fossa ⇨ An Infectious Complication of
inappro. treated pharyngitis/tonsillitis
Hx
Antecedent sore throat 1-2 wks Prior — progressively worsens
Dysphagia
High fever
Ipsilateral throat, ear & possibly neck pain
PE
Trismus
(found 67% of cases)
:sweet_potato:
Hot potato/Muffled voice
Drooling and/or fetid breath
Look for Unilateral mass in Supratonsillar area with Possible uvula deviation
Fluctuant upon palpation
Etio
90% of aspirated culture grows
Bacterial
pathogens
GAS — M/C (~30% of cases)
S. aureus
Anaerobes (m/c peptostreptococcal microbes)
Rx
Prompt ENT consultation
for
needle aspiration
(Always send cultures) or
possible Sx drainage
Systemic ATBs
Clindamycin
and
Beta-lactam or 1st gen cephalosporin
Surgical tonsillectomy
I/C :check:
No improvement in 48 hrs
H/O recurrent abscess (3 or more) - controversial!,
:strawberry:
Scarlet fever
M/C asso. with pharyngitis
Clinical
Strawberry tongue
Rash
Generalized fine, sandpapery scarlet erythema with accentuation in Skin folds (Pastia’s lines)
Circumoral pallor
Palm & soles spares
Rx same as Strep pharyngitis