Pharyngitis overview: Difference between revisions
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'''Centor criteria:''' | '''Centor criteria:''' | ||
It is important to evaluate for definitive diagnosis to exclude GAS and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither microbiologic tests nor antimicrobial therapy are necessary.The Centor score to use for children and adults with a sore throat to estimate probability of Streptococcus pyogenes infection.<ref name="pmid25229278">Anjos LM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25229278 Streptococcal acute pharyngitis.] ''Rev Soc Bras Med Trop'' 47 (4):409-13. PMID: [https://pubmed.gov/25229278 25229278]</ref> | It is important to evaluate for definitive diagnosis to exclude GAS and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither microbiologic tests nor antimicrobial therapy are necessary.The Centor score to use for children and adults with a sore throat to estimate probability of Streptococcus pyogenes infection.<ref name="pmid25229278">Anjos LM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25229278 Streptococcal acute pharyngitis.] ''Rev Soc Bras Med Trop'' 47 (4):409-13. PMID: [https://pubmed.gov/25229278 25229278]</ref> | ||
{| border="1" | {| border="1" | ||
| colspan="2" align="center"|'''Modified Centor criteria''' | | colspan="2" align="center" |'''Modified Centor criteria''' | ||
| | |||
| colspan="3" |'''Appropriate management according to the total score''' | |||
|- | |- | ||
|align="center"|'''Criteria''' | | align="center" |'''Criteria''' | ||
|align="center"|'''Points''' | | align="center" |'''Points''' | ||
| | |||
|'''Total score''' | |||
|'''Chance of streptococcal infection in community''' | |||
'''with usual levels of infection, %''' | |||
|'''Suggested management''' | |||
|- | |- | ||
|align="left" |Fever (temperature > 38°C) | | align="left" |Fever (temperature > 38°C) | ||
| +1 | | +1 | ||
| | |||
|0 | |||
|2-3 | |||
| rowspan="2" |No culture or antibiotic is required | |||
|- | |- | ||
|align="left" |Absence of cough | | align="left" |Absence of cough | ||
| +1 | | +1 | ||
| | |||
|1 | |||
|4-6 | |||
|- | |- | ||
|align="left" |Swollen and tender anterior cervical nodes | | align="left" |Swollen and tender anterior cervical nodes | ||
| +1 | | +1 | ||
| | |||
|2 | |||
|10-12 | |||
| rowspan="2" |Culture all; | |||
treat only if culture result is positive | |||
|- | |- | ||
|align="left" |Tonsillar swelling or exudates | | align="left" |Tonsillar swelling or exudates | ||
| +1 | | +1 | ||
| | |||
|3 | |||
|27-28 | |||
|- | |- | ||
|align="left" |Age 3–14 yr | | align="left" |Age 3–14 yr | ||
| +1 | | +1 | ||
| | |||
|4 | |||
|38–63 | |||
|Culture all; | |||
treat with penicillin on clinical grounds | |||
|- | |- | ||
|align="left" |Age 15–44 yr | | align="left" |Age 15–44 yr | ||
|0 | |0 | ||
| | |||
| | |||
| | |||
| | |||
|- | |- | ||
|align="left" |Age ≥ 45 yr | | align="left" |Age ≥ 45 yr | ||
| -1 | | -1 | ||
| | |||
| | |||
| | |||
| | |||
|- | |- | ||
|} | |} | ||
Revision as of 16:05, 29 December 2016
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Pharyngitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pharyngitis overview On the Web |
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American Roentgen Ray Society Images of Pharyngitis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Pharyngitis is the inflammation of the pharynx, manifested by sore throat. It is a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils, tonsillitis may occur simultaneously.[1] Sore throat is one of the most common reasons for visits to physicians.[2] It is usually caused by viruses but may be caused by bacterial or fungal etiology. Gastroesophageal reflux disease (GERD) or particularly extraesophageal reflux (EER) can also cause an acid pharyngitis in adults and children.[3]
Diagnosi
The major goal of the evaluation of 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 group A streptococcus (GAS) is important because timely treatment with antibiotics helps prevent poststreptococcal complications such as acute rheumatic fever.[4] The evaluation includes a thorough history, focused physical examination, and diagnostic testing in selected patients.
Key points in the evaluation of acute pharyngitis
- Essential to diagnosis is the identification of treatable causes (e.g. Group A streptococcus) to prevent complications.s[5]
- Signs and symptoms of GAS pharyngitis include acute onset of sore throat with tonsillar or pharyngeal exudates, tender anterior cervical lymphadenopathy, and fever.
- Signs and symptoms consistent with viral etiologies include conjunctivitis, coryza, oral ulcers, cough, and diarrhea.
- Testing for GAS pharyngitis should not be pursued in those with signs and symptoms indicative of a viral etiology.
- Rapid antigen detection tests (RADTs) alone are sufficient for the diagnosis of GAS in adults, but negative results should be backed up by throat culture in children.
- Specific techniques should be used to identify other causes where appropriate.
Centor criteria: It is important to evaluate for definitive diagnosis to exclude GAS and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither microbiologic tests nor antimicrobial therapy are necessary.The Centor score to use for children and adults with a sore throat to estimate probability of Streptococcus pyogenes infection.[6]
| Modified Centor criteria | Appropriate management according to the total score | ||||
| Criteria | Points | Total score | Chance of streptococcal infection in community
with usual levels of infection, % |
Suggested management | |
| Fever (temperature > 38°C) | +1 | 0 | 2-3 | No culture or antibiotic is required | |
| Absence of cough | +1 | 1 | 4-6 | ||
| Swollen and tender anterior cervical nodes | +1 | 2 | 10-12 | Culture all;
treat only if culture result is positive | |
| Tonsillar swelling or exudates | +1 | 3 | 27-28 | ||
| Age 3–14 yr | +1 | 4 | 38–63 | Culture all;
treat with penicillin on clinical grounds | |
| Age 15–44 yr | 0 | ||||
| Age ≥ 45 yr | -1 | ||||
References
- ↑ Acute Pharyngitis - Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/adult-acute-pharyngitis.html July 28, 2016
- ↑ Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
- ↑ Cohen, J (2010). Infectious diseases. Edinburgh: Mosby/Elsevier. ISBN 978-0323045797.
- ↑ 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
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Anjos LM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP (2014) Streptococcal acute pharyngitis. Rev Soc Bras Med Trop 47 (4):409-13. PMID: 25229278