GAS/Pharyngitis/Tonsilitis Flashcards Preview

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Flashcards in GAS/Pharyngitis/Tonsilitis Deck (12):
1

Epidemiology:
- When is pharyngitis/tonsilitis more common
- At which age is it more common

- season: GAS pharyngitis more common in late winter or early spring; viral all year long
- age: GAS pharyngitis peak incidence at 5-12 yr of age and uncommon <3 yr; viral pharyngitis affects all ages

2

Symptoms of tonsilitis

- viral:
• sore throat (often mild), conjunctivitis, cough, rhinorrhea, hoarseness, diarrhea, flu-like symptoms (fever, malaise, myalgias)
- GAS:
• sore throat (may be severe), absence of cough, high fever, malaise, headache, abdominal pain, N/V, absence of other URTI symptoms

3

Scarlet fever:
- What is it
- Natural history
- DDx

• = delayed-type hypersensitivity reaction to pyrogenic exotoxin produced by GAS
• Rash fades after 3-4 days
- Dengue - can look sunburnt

4

Compare signs in viral vs bacterial pharyngitis.

- GAS:
Febrile, pharyngeal/tonsillar erythema, tonsillar exudates (giving 'strawberry and cream' appearance', enlarged (>1 cm) and tender anterior cervical lymph nodes, palatal petechiae, strawberry tongue, scarlatiniform rash (most discriminatory feature)

- viral:
afebrile, absent/mild tonsillar exudates, minor and non-tender adenopathy, viral exanthems

5

What Mx options are there for tonsilitis?

- Supportive: hydration, analgesia, anti-pyretic
- Abx
• Routine use is no longer indicated (only e.g. ATSI, requires hospitalisation)
• Phenoxymethylpenicillin for 10 days/cephalexin

- Corticosteroids can be added to antibiotic therapy if symptoms are very severe (eg restricted swallowing, drooling)

- F/U not needed if uncomplicated
- prophylaxis: consider tonsillectomy for proven, recurrent streptococcal tonsillitis

6

What are some non-suppurative complications of GAS (esp in children)?

- acute rheumatic fever
- post-strep GN
- reactive arthritis
- PANDAS

7

How does quinsy present?

trismus, severe unilateral throat pain, high fever and/or a change in voice

8

What is the spectrum of disease that GAS can cause?

• Pharyngitis
• Impetigo, erysipelas, cellulitis
• Bacteraemia
• Pneumonia
• Necrotising fasciitis
• Myositis
• Osteomyelitis, septic arthritis
• Perianal cellulitis
• Endocarditis
• Streptococcal toxic shock syndrome

9

Clinical features of scarlet fever

- Fever, sore throat, strawberry tongue
- Scarlatiniform/sandpaper rash 24-48h after:
- diffuse blanching erythema with papular elevations
- Pastia's lines - arked in skin folds and pressure points e.g. groin, axillae, cubital fossa
- Palms, soles, perioral area spared 
- non-pruritic/tender

10

Which is more common cause of pharyngitis/tonsilitis: virus/bacteria (and which)

- viral (~80%):
• adenoviruses, enteroviruses, coxsackie, upper respiratory tract viruses, EBV, CMV

- bacterial (~20%):
• 15-30% of all cases are GAS pharyngitis (peak of incidence 3-15yo)
• M. pneumoniae (older children)

11

What are some red flags for airway obstruction with complicated pharyngitis/tonsilitis?

- Voice changes
- Drooling
- Stridor
- Torticollis
- Trismus
- Swelling below the mandible

12

What are the conditions that can cause airway obstruction with pharyngitis/tonsilitis?

- Peritonsilllar abscess (Quinsy)
- Infectious mononucleosis (EBV)
- Epiglottitis/Bacterial Tracheitis
(more likely if unimmunised against H. influenzae)
- Retropharyngeal abscess/Lateral pharyngeal abscess