Transcript SORE THROAT(rhinorrhea) Dr OShea

SORE THROAT(rhinorrhea)
Dr Eoghan O’Shea
NEJM 2011;34:648-55
• STREPTOCOCCAL PHARYNGITIS
• DR MICHAEL R. WESSELS
10 YEAR OLD GIRL
• C/O SORE THROAT AND FEVER X 1/7
HISTORY
NKDA
NO SURGERIES
NO MEDICAL
RX NIL
FAMILY HISTORY NON CONTRIB
FINDINGS
• T= 39
• TENDER BILAT ANT CERVICAL LYMPH
GLANDS
• TONSILS RED,WHITE YELLOW
EXUDATES
• NORMAL EARS
• CHEST CLEAR
NOW WHAT ?
• THINC VD
• VINDICATE
CAUSES
• INFECTIOUS
• NON INFECTIOUS e.g. allergic or chronic
rhinitis
.OTHER :TRAUMA,FOREIGN
BODY,NEOPLASM
ORGANISMS
• VIRAL
• BACTERIAL
• OTHER
VIRUS
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RHINO
INFLUENZA
COXSACKIE hand foot and mouth
HERPES SIMPLEX gingivostomatitis
EBV mono
CMV mono like
HIV
BACTERIA
• GROUP A STREP pharyngitis, scarlet
fever
• GROUP C,G pharyngitis
• MIXED ANEROBES vincents angina
• FUSOBACTERIUM lemierre’s syndrome
septic thrombophlebitis of int jug vein
• STI g.c.,chlamydia,treponema pallidum
SCORING SYSTEM
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CRITERIA
POINTS
T > 38
1
ABSENCE OF COUGH
1
ANT CERVIC GLANDS
1
TONS SWELLING EXUDATE
1
AGE 3<15
1
AGE 15-45
0
AGE >45
-1
RISK
• POINTS
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0
1
2
3
4
%
1-2.5
5-10
11-17
28- 35
51-53
Mono ??
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Rash with AMOXIL
CBC,MONOSPOT
SWAB
RAPID ANTIGEN DETECTION TEST
ANTIBIOTICS
• DRUG
• PEN V
• AMOXIL
DOSE,ROUTE,DURATION
<27 KG 40mg/kg/day bid-tid
40 mg/kg/day
bid-tid
• To prevent rheumatic fever,post strep g.n.
10 days
Penicillin allergy
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Clarithromycin
Azithromycin
Erythromycin
Cephalexin
Cefadroxil
Clindamycin
Miscellaneous
• In India, rheumatic fever still an issue,use
IM PEN G
• Know if you have access to rapid antigendetection test.Positive test very useful.If
neg in adults,no further rx,in
children:SWAB