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Sore throat :frowning_face: (:dog: Pharyngitis (:hibiscus: Ddx of (Other…

- - - - Rhinovirus - Common cold
      - Coronavirus - Common cold
      - Adenovirus - Pharyngoconjunctival fever, acute respiratory illness
      - Parainfluenza virus - Common cold, Croup
      - :dango: Coxsackie virus - Herpangina
      - :dango: EBV - Infectious mononucleosis
      - HIV
    - - Group A beta-hemolytic streptococci (S. Pyogenes) (GAS)
        
        :star: M/C Bac cause of pharyngitis
        
        15-30% in children
        5-10% in adults
      - Mycoplasma pneumoniae
      - Arcanobacterium haemolyticum
      - Neisseria gonorrhea
      - Chlamydia pneumoniae
  - - - Concurrent URI Symptoms
        
        Rhinorrhea
        
        Cough
        
        Hoarseness
      - Conjunctivitis :eye:
      - Ulcerative lesions
      - Gradual onset
    - - Associated headache and/or Abdominal pain
      - Acute onset Fever & throat pain
  - - - EBV
        
        White exudate covering erythematous pharynx & tonsils
        
        Cervical adenopathy
        
        Subacute/Chronic Symptoms (Fatigue/Myalgia)
        
        Transmitted via infected saliva
        
        Hepatosplenomegaly, rash, fatigue
      - Adenovirus/Coxsackie
        
        Vesicles/ulcerative lesions present on pharynx or posterior soft palate
        
        Conjunctivitis :eye:
      - HSV
        
        Vesiculation & ulceration
    - - GAS
        
        White exudate cover pharynx & tonsil
        
        Tender anterior cervical adenopathy
        
        Palatal/Uvular petechiae
        
        Scarlatiniform rash (macular rash) Torso & Upper arms ⇨ Scarlet Fever :strawberry:
        
        Transmitted by Respiratoru particles droplets
        ⇨ :!: so NO school attendance until 24 hr after เริ่มappro. ATB therapy
      - :tada: Absense of Viral Symptoms (rhinorrhea, cough, hoarseness)
      - Diphteria
        
        Gray-white fibrinous pseudomembrane with Marked cervical lymphadenopathy
  - - - GAS (Strep pyogenes)
      - Corynebacterium diphtheriae
      - EBV
    - - GAS (Strep pyogenes)
      - HIV
      - EBV
    - - Adenovirus
    - - Retropharyngeal abscess
      - Peritonsillar abscess
      - Ludwig angina
      - Epiglottitis
      - Thrush
      - Autoimmune infection
      - Kawasaki
  - - - Otitis media
      - Sinusitis
      - Peritonsillar & Retropharyngeal abscess
      - Suppurative cervical adenitis
    - - Acute rheumatic fever
        
        :!: follows only Strep. Pharyngitis
        (not GAS skin infections)
      - Acute glomerulonephritis
        
        Follows Pharyngitis or Skin infection (pyoderma)
        
        Nephritogenic strains
  - - - CBC (for Atypical lymphocytes)
      - Mono Spot test (positive slide agglutination)
        
        Serologic rest for EBV heterophile Ab
      - EBV Ab titers
        
        Detect serum levels of EBV IgM/IgG
    - - Cold agglutination test
    - - :stars:Throat culture (Gold standard)
      - Rapid strep. antigen kits
        
        If Rapid positive & symptomatic pharyngitis ⇨ starts ATB ทันที tho without culture
        
        Defect GAS Ag via Tonsillar swab
  - - - Normal strep ⇨ Penicillin, Erythromycin, Azithromycin
      - Carrier of strep ⇨ Clindamycin, Amoxicillin clavulanic
      - Bene of Rx of Strep Pharyngitis
        
        Prevention of ARF
        (if start Rx within 9 days of illness)
        
        :arrow_down: symptoms
        
        Prevent local Suppurative complications
        
        :warning: doesn’t prevent deve of post strep sequel of Acute glomerulonephritis
      - ATBS
        
        Benzathine PCN G 1.2 million units IM ONCE
        
        If PCN allergy ⇨ Azithromycin, Clindamycin, 1st gen cephalosporins
        
        :star:Treatment of choice Oral PCN for 10 days
    - - Retropharyngeal ⇨ Drainage & ATBs
      - Peritonsillar ⇨ Aspiration & ATBs (penicillin)
    - - Supportive care
        
        Analgesics
        
        Antipyretics
        
        Fluids
      - No strong evidence of using Corticosteroid be it oral or IM for pain relief
      - ! EBV ⇨ mortality commonly asso with Abdominal trauma & splenic rupture