Pharyngitis differential diagnosis: Difference between revisions

Jump to navigation Jump to search
Line 62: Line 62:
![[Retropharyngeal abscess]]
![[Retropharyngeal abscess]]
|-
|-
|Presentation
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[Abdominal pain|abdominal]] pain, [[nausea]] and [[vomiting]]
|
|Usually present with stridor and drooling; and other symptoms include [[difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of voice
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]]
|[[Neck pain]], [[stiff neck]], [[torticollis]]
[[fever]], [[malaise]], [[stridor]], and barking [[cough]]
|-
|Causes
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic streptococcus]].
|
|[[Hemolysis|H. influenza type b, beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' [[fungi]] and [[viruses]].
|Most common cause is viral including [[adenovirus]], [[rhinovirus]], [[influenza]], [[coronavirus]], and [[respiratory syncytial virus]]. Second most common causes are bacterial; ''[[Group A streptococcal infection|Group A streptococcal bacteria]]'',<sup>[[Epiglottitis differential diagnosis|[5]]]</sup> 
|Polymicrobial infection. Mostly; [[Streptococcus pyogenes]], [[Staphylococcus aureus]] and respiratory anaerobes (example; Fusobacteria, [[Prevotella species|Prevotella]], and Veillonella species)<sup>[[Epiglottitis differential diagnosis|[6][7][8][9][10][11]]]</sup>
|-
|Physical exams findings
|Inflammed [[pharynx]] with or without [[exudate]]
|
|[[Cyanosis]], [[Cervical]][[lymphadenopathy]], Inflammed [[epiglottis]]
|[[Fever]], especially 100°F or higher.<sup>[[Epiglottitis differential diagnosis|[17][18]]]</sup>[[Erythema]], [[edema]] and [[Exudate]] of the [[tonsils]].<sup>[[Epiglottitis differential diagnosis|[19]]]</sup> cervical [[lymphadenopathy]], [[Dysphonia]].<sup>[[Epiglottitis differential diagnosis|[20]]]</sup>
|Child may be unable to open the mouth widely. May have enlarged
[[cervical]] [[lymph nodes]] and neck mass.
|-
|Age commonly affected
|Mostly in children and young adults,
with 50% of cases identified
between the ages of 5 to 24 years.<sup>[[Epiglottitis differential diagnosis|[23]]]</sup>
|
|Used to be mostly found in
pediatric age group between 3 to 5 years,
however, recent trend favors adults
as most commonly affected individuals<sup>[[Epiglottitis differential diagnosis|[22]]]</sup>
with a mean age of 44.94 years.
|Primarily affects children
between 5 and 15 years old.<sup>[[Epiglottitis differential diagnosis|[24]]]</sup>
|Mostly between 2-4 years, but can occur in other age groups.<sup>[[Epiglottitis differential diagnosis|[25][26]]]</sup>
|-
|Imaging finding
|—
|
|[[Thumbprint sign]] on neck x-ray
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<sup>[[Epiglottitis differential diagnosis|[27][28][29]]]</sup>
|On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<sup>[[Epiglottitis differential diagnosis|[30][31]]]</sup>
|-
|Treatment
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]].
|
|Airway maintenance, p[[Parenteral|arenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. Adjuvant therapy includes [[corticosteroids]] and racemic [[Epinephrine]].<sup>[[Epiglottitis differential diagnosis|[32][33]]]</sup>
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases.
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.
|}
|}



Revision as of 22:16, 29 January 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Pharyngitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pharyngitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

Ultrasound

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pharyngitis differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pharyngitis differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pharyngitis differential diagnosis

CDC on Pharyngitis differential diagnosis

Pharyngitis differential diagnosis in the news

Blogs on Pharyngitis differential diagnosis

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pharyngitis differential diagnosis

Overview

Pharyngitis should be differentiated from other infectious causes which mimic sore throat that includes oral thrush, infectious mononucleosis, epiglottitis and peritonsilar abscess.[1]

Differentiating Pharyngitis from other Diseases

The major goal of the differentiating patients with sore throat or acute pharyngitis is to exclude potentially dangerous causes (e.g. Group A streptococcus), to identify any treatable causes, and to improve symptoms. Identifying the treatable causes is important because timely treatment with antibiotics helps prevent complications such as acute rheumatic fever, post streptococcal glomerulonephritis.[2]

Thrush Mononucleosis Epiglottitis Peritonsillar abscess
  • Thrush is caused by candidal infection
  • Dysphagia without odynophagia which will differentiate it from pharyngitis.
  • White plaques that reveal an erythematous base when scraped
  • Usually in immunocompromised patients, including those with advanced HIV/AIDS
  • Epiglottitis is an inflammation of the epiglottis and adjacent structures that can be life-threatening caused by Hemophilus influenzae especially unimmunized children.
  • In adults, epiglottitis has widely varying presentations and symptoms:
    • Odynophagia (most commonly)
    • Fever, toxicity
    • Dyspnea, respiratory distress
    • Dysphagia
    • Drooling
    • Dysphonia
    • Inspiratory stridor
  • The classic tripod positioning (patient sits or stands leaning forward and supporting the upper body with hands on the knees), is seen only in 5% of cases
  • If epiglottitis is suspected, immediate referral to the emergency department for airway management
  • Diagnosis requires laryngoscopy
  • If the patient is in respiratory distress, prompt intubation is required to maintain airway.
  • Peritonsillar abscess is the collection of pus behind the tonsil in the superior arch of the soft palate
  • It might develop as a complication of oropharyngeal infection, such as tonsillitis
  • The most common bacteria is group A streptococci, but the causative organism could be polymicrobial
  • Symptoms include fever, malaise, dysphagia, drooling, muffled or 'hot potato' voice, and referred ear pain.
  • Diagnosis is a combination of physical examination and imaging with computed tomography (CT) or ultrasonography
  • Management requires urgent referral to a specialist or surgeon for surgical drainage, in addition to antibiotic treatment.
Variable Pharyngitis Oral thrush Epiglottitis Tonsilitis Retropharyngeal abscess
Presentation Sore throat, pain on swallowing, feverheadacheabdominal pain, nausea and vomiting Usually present with stridor and drooling; and other symptoms include difficulty breathingfever, chills, difficulty swallowinghoarseness of voice Sore throat, pain on swallowing, feverheadachecough Neck painstiff necktorticollis

fevermalaisestridor, and barking cough

Causes Group A beta-hemolytic streptococcus. H. influenza type b, beta-hemolytic streptococciStaphylococcus aureus, fungi and viruses. Most common cause is viral including adenovirusrhinovirusinfluenzacoronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,[5]  Polymicrobial infection. Mostly; Streptococcus pyogenesStaphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[6][7][8][9][10][11]
Physical exams findings Inflammed pharynx with or without exudate CyanosisCervicallymphadenopathy, Inflammed epiglottis Fever, especially 100°F or higher.[17][18]Erythemaedema and Exudate of the tonsils.[19] cervical lymphadenopathyDysphonia.[20] Child may be unable to open the mouth widely. May have enlarged

cervical lymph nodes and neck mass.

Age commonly affected Mostly in children and young adults,

with 50% of cases identified

between the ages of 5 to 24 years.[23]

Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals[22]

with a mean age of 44.94 years.

Primarily affects children

between 5 and 15 years old.[24]

Mostly between 2-4 years, but can occur in other age groups.[25][26]
Imaging finding Thumbprint sign on neck x-ray Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[27][28][29] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[30][31]
Treatment Antimicrobial therapy mainly penicillin-based and analgesics. Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[32][33] Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.

References

  1. Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
  2. Del Mar CB, Glasziou PP, Spinks AB (2006) Antibiotics for sore throat. Cochrane Database Syst Rev (4):CD000023. DOI:10.1002/14651858.CD000023.pub3 PMID: 17054126


Template:WH Template:WS