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Streptococal tonsillitis

Main inflammatory throat diseases:

Pharyngitis

Tonsillitis, tonsillopharyngitis

Adenoiditis

Paratonsillar abscess

Retropharyngeal abscess

 

Classification of pharyngitis:

Catarrhal pharyngitis

- viral infections

Exudative pharyngitis

- at viral infections (adenovirus, ??V)

- purulent-exudative (GAS)

Membranous pharyngitis

Diphtheria

pseudomembranous pharyngitis

EBV infection

Lysteriosis

Syphilis

Leukemia

Burnt pharyngitis

Oropharyngeal candidosis

Herpetic pharyngitis (?SV, enterovirus)

Non-infectious pharyngitis:

SLE

Kawasaki Syndrome

Stivens-Johnson syndrome

Leukemia

Radiation damage

Burnt pharyngitis

Etiology of infectious pharyngitis:

Bacteria (35-30 %) Group A Streptococcus (65-80%) Group C and G Streptococcus (5-10 %) Arcanobacterium haemolyticum Neisseria gonorrheae Corynebacterium diphtheriae Mycoplasma pneumoniae Chlamydia pneumoniae Francisella tularensis Coxiella burnetii Viruses (65-70 %) Rhinovirus Adenovirus Epstein-Barr virus Influenza Parainfluenza Enterovirus Herpes simplex virus Coronavirus RS-virus

Clinics of viral pharyngitis:

Catarrhal pharyngitis

- Moderate sore throat, dryness

- Moderate pharyngeal hyperemia

- Follicular tonsillar hyperplasia

- Serous exudate (+/-) at adenoviral and EBV infections

Presence of other catarrhal signs: cough, rrhynitis, conjunctivitis

Moderate fever

Disease course 3-7 days

Pharyngitis at primary HIV infection:

Incubation period is 3 to 5 weeks

Catarrhal pharyngitis sometimes with ulcers

Lymphadenopathy week before fever and pharyngitis

Other signs of HIV infection: arthralgias, myalgias, macule-papule rash, drowsiness

Pharyngitis at enteroviral infection:

Common signs:

Season ? summer (?summer flu?)

High fever

Mild pharyngeal hyperemia

Not typical:

- tonsillar exudate,

- cervical lymphadenitis

Specific oropharyngeal signs :

-herpangina ? ?oxsackievirus A, B, Echovirus

(papule-vesicles or nodules with hyperemia around on posterior pharyngeal wall, 1-2 mm, with further ulcers and disappearance 5-7 days later)

- ?hand-foot-mouth disease? - coxsackievirus A 16

(painful vesicles or ulcers in mouth cavity, on palms and soles; fever subfebrile)

Primary herpetic gingivostomatitis:

Cause: HSV-1,2

In children under 5 years

High fever

Intense mouth pain (possible dehydration)

Ulcers in mouth: on lips, posterior pharynx, soft and hard palate

Disease course 1-2 weeks

Epidemiology of GAS:

Source: sick, carrier

Ways of transmission:Airborne, food-borne, watery

Season: Spring ?Summer

Susceptible group:children of 5-15 years

Streptococcal (GAS) infection (Classification of GAS ? associated diseases):



1. Purulent diseases:

- respiratory infections;

- skin and soft tissue infections;

- systemic purulent infections.

2. Toxin ? mediated infections (scarlet fever, TSS, erysipelas).

Infectious ? allergic complications (rheumatic fever, carditis, glomerulonephritis, PANDAS)

Streptococcal pharyngitis:

Associated with hemolytic Streptococcus of groups ?, ?, G

Fever 39.5 ? and higher, chills

Prominent throat pain and difficulty of swallowing

PE: ?burning throat?, uvualr edema, Yellowish purulent covers in lacunas or tonsillar follicules

?Strawberry tongue? (papules + color)

Tense and painful tonsillar lymph nodes

Laboratory diagnosis of streptococcal pharyngitis:

Strep culture

Reaction with bacitracin (inhibit growth of only GAS)

Express tests: lattex agglutination, co-agglutination (Strep-test ) ? determination of group polysaccharide antigen

Detection of GAS DNA ? (PCR, DNA-hybridization )

Titer of anti-streptolysin O ? 2-3 weeks later. Diagnostic titer - 1:300

GAS:

is the only widely spread etiology of pharyngitis which requires antibiotic therapy

Antibiotics at streptococcal pharyngitis:

Penicillins (oral, parnetheral)

Cephalosporins of 1-2 generation

Macrolides


Date: 2016-06-12; view: 7


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