PHARYNGITIS AND TONSILITIS

Definition
PHARYNGITIS AND TONSILITIS

Pharyngitis is an inflammatory illness of the mucous membrane and underlying structures of the throat, include tonsillitis, tonsillopharyngitis, and nasopharyngitis. Involved nasopharynx, uvula, and soft palate

Etiology
PHARYNGITIS AND TONSILITIS

With nasal symptoms (nasopharyngitis) : virus : - Adenovirus - Influenza virus - Para influenza virus - Enterovirus, coxackievirus, echovirus - Epstein-Barr virus Without nasal symptoms : wide variety Streptococcal tonsillopharyngitis :
Renal, Heart, Rheumatic fever

Pathophysiology
PHARYNGITIS AND TONSILITIS

Infectious agent inoculated localized inflammation erythema pharynx, tonsil Exudate : adenovirus, herpes symplex v, S.pyogenes, C.diphteriae, A.haemolyticum, Epstein-Barr virus, and Candida species. Ulceration : herpes symplex v and enterovirus

PHARYNGITIS AND TONSILITIS

Pharyngeal involvement overshadowed by other symptom : - cough and coryza (parainfluenza virus) - fever, exanthem, meningitis (enterovirus) Tonsillopharyngeal involvement exudate cause by Epstein-Barr v group A streptococci bacterial is the cause of this tonsillitis

Clinical manifestation
PHARYNGITIS AND TONSILITIS

Usually sudden : fever, sore throat, anorexia. headache, nausea, vomiting, abdominal pain, enlarge & tender cervical lymph node, pharyngeal erythema, follicle, ulcer, petechiae, generalized exudate. Petechial lesions on soft palate : Stafilococcus pyogenes, Epstein-Barr v, measles v, and rubella v.

PHARYNGITIS AND TONSILITIS

Self limited Lasting 4 10 days Excellent prognosis 0.3% - 3.0% Streptococcal throat infection rheumatic fever All cases of acute pharyngitis streptococcal disease must be considered Clinical distinction unreliable Retropharyngeal/parapharyngeal abscess complicate bacterial pharyngitis/tonsilitis Nasal infaction, ulceration, and conjunctivitis viral

Investigation
PHARYNGITIS AND TONSILITIS

Throat swab S. pyogenes Detecting group A streptococcal Ag (10 minutes) negative culture

Management
PHARYNGITIS AND TONSILITIS

Symptomatic :

- drinking warm fluids - saltwater gargles - analgesic - throat lozenges soothing Decongestants & antihystamines no place Antibiotic : - S. pyogenes to prevent development rheumatic fever & elemination - Penicillin V oral - Benzathine Penicillin IM - PNC Allergy Erythromycin - 10 days efficacy 40 yrs - cephalosporin = PNC

PHARYNGITIS AND TONSILITIS

Adenoidectomy & tonsillectomy - recurrent sore throat scientific basis ? - rate last 2 decades - most important indication : OSA - tonsillar/adenoidal size not always reliable indicator - some benefit frequent : > 5 episodes / 2 yrs - peritonsillar abscess ? drainage alone - recurrent / chronic otitis media