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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: 47
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