Pharyngitis differential diagnosis: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Anthony Gallo (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
6,611 edits
mNo edit summary
Aditya Ganti (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
11,402 edits
Line 8: Line 8:
== Differentiating Pharyngitis from other Diseases ==
== 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]].<ref name="pmid17054126">Del Mar CB, Glasziou PP, Spinks AB (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17054126 Antibiotics for sore throat.] ''Cochrane Database Syst Rev''  (4):CD000023. [http://dx.doi.org/10.1002/14651858.CD000023.pub3 DOI:10.1002/14651858.CD000023.pub3] PMID: [https://pubmed.gov/17054126 17054126]</ref>
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]].<ref name="pmid17054126">Del Mar CB, Glasziou PP, Spinks AB (2006) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17054126 Antibiotics for sore throat.] ''Cochrane Database Syst Rev''  (4):CD000023. [http://dx.doi.org/10.1002/14651858.CD000023.pub3 DOI:10.1002/14651858.CD000023.pub3] PMID: [https://pubmed.gov/17054126 17054126]</ref>
{| class="wikitable"
!Disease/Variable
!Presentation
!Causes
!Physical exams findings
!Age commonly affected
!Imaging finding
!Treatment
|-
|[[Peritonsillar abscess]]
|Severe [[sore throat]], [[otalgia]] [[fever]], a "hot potato" or muffled voice, [[drooling]], and [[trismus]]<ref name="pmid18246890">{{cite journal| author=Galioto NJ| title=Peritonsillar abscess. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 2 | pages= 199-202 | pmid=18246890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18246890  }} </ref>
|[[Streptococcus pyogenes|Aerobic and anaerobic]]
[[Streptococcus pyogenes|bacteria most common is]]
[[Streptococcus pyogenes|Streptococcus]]
[[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356  }} </ref><ref name="pmid18039418">{{cite journal| author=Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S| title=Changing trends in bacteriology of peritonsillar abscess. | journal=J Laryngol Otol | year= 2008 | volume= 122 | issue= 9 | pages= 928-30 | pmid=18039418 | doi=10.1017/S0022215107001144 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18039418  }} </ref><ref name="pmid1875138">{{cite journal| author=Snow DG, Campbell JB, Morgan DW| title=The microbiology of peritonsillar sepsis. | journal=J Laryngol Otol | year= 1991 | volume= 105 | issue= 7 | pages= 553-5 | pmid=1875138 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1875138  }} </ref><ref name="pmid12092281">{{cite journal| author=Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M| title=Peritonsillar abscess: a study of 724 cases in Japan. | journal=Ear Nose Throat J | year= 2002 | volume= 81 | issue= 6 | pages= 384-9 | pmid=12092281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12092281  }} </ref>
|[[Contralateral]] deflection of the [[uvula]],
the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]].
|The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890">{{cite journal| author=Galioto NJ| title=Peritonsillar abscess. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 2 | pages= 199-202 | pmid=18246890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18246890  }} </ref>
|On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.<ref name="pmid15635144">{{cite journal| author=Lyon M, Blaivas M| title=Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. | journal=Acad Emerg Med | year= 2005 | volume= 12 | issue= 1 | pages= 85-8 | pmid=15635144 | doi=10.1197/j.aem.2004.08.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15635144  }} </ref><ref name="pmid1642863">{{cite journal| author=Boesen T, Jensen F| title=Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. | journal=Eur Arch Otorhinolaryngol | year= 1992 | volume= 249 | issue= 3 | pages= 131-3 | pmid=1642863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1642863  }} </ref><ref name="pmid26637999">{{cite journal| author=Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK| title=Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. | journal=Pediatr Radiol | year= 2016 | volume= 46 | issue= 7 | pages= 1059-67 | pmid=26637999 | doi=10.1007/s00247-015-3505-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26637999  }} </ref><ref name="pmid10435129">{{cite journal| author=Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA| title=Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. | journal=J Laryngol Otol | year= 1999 | volume= 113 | issue= 3 | pages= 229-32 | pmid=10435129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10435129  }} </ref><ref name="pmid15635144">{{cite journal| author=Lyon M, Blaivas M| title=Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. | journal=Acad Emerg Med | year= 2005 | volume= 12 | issue= 1 | pages= 85-8 | pmid=15635144 | doi=10.1197/j.aem.2004.08.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15635144  }} </ref><ref name="pmid1642863">{{cite journal| author=Boesen T, Jensen F| title=Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. | journal=Eur Arch Otorhinolaryngol | year= 1992 | volume= 249 | issue= 3 | pages= 131-3 | pmid=1642863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1642863  }} </ref>
|[[Ampicillin-sulbactam|Ampicillin-sulbactam,]]  [[Clindamycin]], [[Vancomycin]] or [[Linezolid]]
|-
|[[Croup]]
|Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]]
|[[Parainfluenza virus]]
|[[Suprasternal notch|Suprasternal]] and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760">{{cite journal| author=Johnson D| title=Croup. | journal=BMJ Clin Evid | year= 2009 | volume= 2009 | issue=  | pages=  | pmid=19445760 | doi= | pmc=2907784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19445760  }} </ref> Inspiratory [[stridor]], expiratory [[wheezing]],  [[Sternal]] wall retractions<ref name="pmid19457602">{{cite journal| author=Giordano S, Adamo P, Monaci F, Pittao E, Tretiach M, Bargagli R| title=Bags with oven-dried moss for the active monitoring of airborne trace elements in urban areas. | journal=Environ Pollut | year= 2009 | volume= 157 | issue= 10 | pages= 2798-805 | pmid=19457602 | doi=10.1016/j.envpol.2009.04.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19457602  }} </ref>
|Mainly 6 months and 3 years old
rarely, adolescents and adults<ref name="pmid8769531">{{cite journal| author=Tong MC, Chu MC, Leighton SE, van Hasselt CA| title=Adult croup. | journal=Chest | year= 1996 | volume= 109 | issue= 6 | pages= 1659-62 | pmid=8769531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8769531  }} </ref>
|[[Steeple sign]] on neck X-ray
|[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]]
|-
|[[Epiglottitis]]
|[[Stridor]] and [[drooling]] [[Difficulty breathing|but no cough. Other symptoms include difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of [[voice]]
|[[Hemolysis|H. influenza type b,]]
[[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],''
[[fungi]] and [[viruses]].
|[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], [[Inflamed]] [[epiglottis]]
|Used to be mostly found in
pediatric age group between 3 to 5 years,
however, recent trend favors adults
as most commonly affected individuals
with a mean age of 44.94 years
|[[Thumbprint sign]] on neck x-ray
|[[Airway]] maintenance, [[Parenteral|parenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. [[Adjuvant therapy]] includes [[corticosteroids]] and [[racemic]] [[Epinephrine]].<ref name="pmid15983574">{{cite journal| author=Nickas BJ| title=A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy. | journal=J Emerg Nurs | year= 2005 | volume= 31 | issue= 3 | pages= 234-5; quiz 321 | pmid=15983574 | doi=10.1016/j.jen.2004.10.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15983574  }} </ref><ref name="pmid12557859">{{cite journal| author=Wick F, Ballmer PE, Haller A| title=Acute epiglottis in adults. | journal=Swiss Med Wkly | year= 2002 | volume= 132 | issue= 37-38 | pages= 541-7 | pmid=12557859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557859  }} </ref>
|-
|[[Pharyngitis]]
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[abdominal pain]], [[nausea]] and [[vomiting]]
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]]
[[Group A beta-hemolytic streptococci|streptococcus]].
|[[Inflamed]] [[pharynx]] with or without [[exudate]]
|Mostly in children and young adults,
with 50% of cases identified
between the ages of 5 to 24 years
|_
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]].
|-
|[[Tonsilitis]]
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], and [[cough]]
|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]]''
''[[Group A streptococcal infection|bacteria]]''<ref name="pmid3601520">{{cite journal| author=Putto A| title=Febrile exudative tonsillitis: viral or streptococcal? | journal=Pediatrics | year= 1987 | volume= 80 | issue= 1 | pages= 6-12 | pmid=3601520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3601520  }} </ref>
|[[Fever]], especially 100°F or higher. [[Erythema]], [[edema]] and [[exudate]] of the [[tonsils]],<ref name="pmid25587367">{{cite journal| author=Stelter K| title=Tonsillitis and sore throat in children. | journal=GMS Curr Top Otorhinolaryngol Head Neck Surg | year= 2014 | volume= 13 | issue=  | pages= Doc07 | pmid=25587367 | doi=10.3205/cto000110 | pmc=4273168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25587367  }} </ref> cervical [[lymphadenopathy]], and  [[Dysphonia]].<ref name="urlTonsillitis - Symptoms - NHS Choices" </ref>
|Primarily affects children
between 5 and 15 years old.
|Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518  }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659  }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805  }} </ref>
|Primarily affects children
between 5 and 15 years old.
|Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518  }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659  }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805  }} </ref>
||[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases.
|-
|[[Retropharyngeal abscess]]
|[[Neck pain]], [[stiff neck]], [[torticollis]], [[fever]], [[malaise]], [[stridor]], and barking [[cough]]
|Polymicrobial infection.
Mostly; [[Streptococcus pyogenes|Streptococcus]]
[[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory [[anaerobes]] (example; Fusobacteria, [[Prevotella species|Prevotella]],
and Veillonella species)<ref name="pmid23520072">{{cite journal| author=Cheng J, Elden L| title=Children with deep space neck infections: our experience with 178 children. | journal=Otolaryngol Head Neck Surg | year= 2013 | volume= 148 | issue= 6 | pages= 1037-42 | pmid=23520072 | doi=10.1177/0194599813482292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23520072  }} </ref><ref name="pmid22481424">{{cite journal| author=Abdel-Haq N, Quezada M, Asmar BI| title=Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus. | journal=Pediatr Infect Dis J | year= 2012 | volume= 31 | issue= 7 | pages= 696-9 | pmid=22481424 | doi=10.1097/INF.0b013e318256fff0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22481424  }} </ref><ref name="pmid18948832">{{cite journal| author=Inman JC, Rowe M, Ghostine M, Fleck T| title=Pediatric neck abscesses: changing organisms and empiric therapies. | journal=Laryngoscope | year= 2008 | volume= 118 | issue= 12 | pages= 2111-4 | pmid=18948832 | doi=10.1097/MLG.0b013e318182a4fb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948832  }} </ref><ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356  }} </ref><ref name="pmid18427007">{{cite journal| author=Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ| title=Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 4 | pages= 408-13 | pmid=18427007 | doi=10.1001/archotol.134.4.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18427007  }} </ref><ref name="pmid2235179">{{cite journal| author=Asmar BI| title=Bacteriology of retropharyngeal abscess in children. | journal=Pediatr Infect Dis J | year= 1990 | volume= 9 | issue= 8 | pages= 595-7 | pmid=2235179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2235179  }} </ref>
|Child may be unable to open the mouth widely. May have enlarged [[cervical]] [[lymph nodes]] and neck mass.
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558">{{cite journal| author=Craig FW, Schunk JE| title=Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 6 Pt 1 | pages= 1394-8 | pmid=12777558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777558  }} </ref><ref name="pmid1876473">{{cite journal| author=Coulthard M, Isaacs D| title=Neonatal retropharyngeal abscess. | journal=Pediatr Infect Dis J | year= 1991 | volume= 10 | issue= 7 | pages= 547-9 | pmid=1876473 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1876473  }} </ref>
|On CT scan, a mass impinging on the posterior [[pharyngeal]] wall with rim enhancement is seen<ref name="pmid15667676">{{cite journal| author=Philpott CM, Selvadurai D, Banerjee AR| title=Paediatric retropharyngeal abscess. | journal=J Laryngol Otol | year= 2004 | volume= 118 | issue= 12 | pages= 919-26 | pmid=15667676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667676  }} </ref><ref name="pmid12761699">{{cite journal| author=Vural C, Gungor A, Comerci S| title=Accuracy of computerized tomography in deep neck infections in the pediatric population. | journal=Am J Otolaryngol | year= 2003 | volume= 24 | issue= 3 | pages= 143-8 | pmid=12761699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12761699  }} </ref>
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]].
|}


{| class="wikitable"
{| class="wikitable"

Revision as of 12:51, 4 April 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 retropharyngeal 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]

Disease/Variable Presentation Causes Physical exams findings Age commonly affected Imaging finding Treatment
Peritonsillar abscess Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[3] Aerobic and anaerobic

bacteria most common is

Streptococcus

pyogenes.[4][5][6][7]

Contralateral deflection of the uvula,

the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema.

The highest occurrence is in adults between 20 to 40 years of age.[3] On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[8][9][10][11][8][9] Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid
Croup Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever Parainfluenza virus Suprasternal and intercostal indrawing,[12] Inspiratory stridor, expiratory wheezing, Sternal wall retractions[13] Mainly 6 months and 3 years old

rarely, adolescents and adults[14]

Steeple sign on neck X-ray Dexamethasone and nebulised epinephrine
Epiglottitis Stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice H. influenza type b,

beta-hemolytic streptococci, Staphylococcus aureus,

fungi and viruses.

Cyanosis, Cervical lymphadenopathy, Inflamed epiglottis Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals

with a mean age of 44.94 years

Thumbprint sign on neck x-ray Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16]
Pharyngitis Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting Group A beta-hemolytic

streptococcus.

Inflamed pharynx with or without exudate Mostly in children and young adults,

with 50% of cases identified

between the ages of 5 to 24 years

_ Antimicrobial therapy mainly penicillin-based and analgesics.
Tonsilitis Sore throat, pain on swallowing, fever, headache, and cough Most common cause is

viral including adenovirus,

rhinovirus, influenza,

coronavirus, and

respiratory syncytial virus.

Second most common

causes are bacterial;

Group A streptococcal

bacteria[17]

Fever, especially 100°F or higher. Erythema, edema and exudate of the tonsils,[18] cervical lymphadenopathy, and Dysphonia.Invalid parameter in <ref> tag[19][20] Primarily affects children

between 5 and 15 years old.

Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[21][19][20] Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases.
Retropharyngeal abscess Neck pain, stiff neck, torticollis, fever, malaise, stridor, and barking cough Polymicrobial infection.

Mostly; Streptococcus

pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella,

and Veillonella species)[22][23][24][4][25][26]

Child may be unable to open the mouth widely. May have enlarged cervical lymph nodes and neck mass. Mostly between 2-4 years, but can occur in other age groups.[27][28] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[29][30] Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.


Variable Pharyngitis Oral thrush Mononucleosis Epiglottitis Tonsilitis Retropharyngeal abscess
Presentation Dysphagia without odynophagia which will differentiate it from pharyngitis. Usually presents with a classic triad of Usually present with stridor and drooling; and other symptoms include difficulty breathing, 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 streptococcus. candidal infection Epstein-Barr virus 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 bacteria,[5]  Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (e.g. Fusobacteria, Prevotella, and Veillonella species)[22][23][24][4][25][26]
Physical exams findings Inflammed pharynx with or without exudate White plaques that reveal an erythematous base when scraped Diffuse lymphadenopathy, particularly bilateral and posterior cervical,Splenomegaly in 50% of cases, Hepatomegaly in 10% of cases, Pharyngeal petechiae, Rash in 90% of patients will develop a pruritic, maculopapular rash after the use of ampicillin or amoxicillin Cyanosis, Cervicallymphadenopathy, Inflammed epiglottis Fever, especially 100°F or higher.Erythema, edema and Exudate of the tonsils.cervical lymphadenopathy, Dysphonia.[31][32][18][33] 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.[34]

Usually in immunocompromised patients, including those with advanced HIV/AIDS Common in adolescents between 15-25 Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals with a mean age of 44.94 years.[35]

Primarily affects children

between 5 and 15 years old.[36]

Mostly between 2-4 years, but can occur in other age groups.[27][28]
Imaging finding — — — Thumbprint sign on neck x-ray Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[21][19][20] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen.[29][30]
Treatment Antimicrobial therapy mainly penicillin-based and analgesics. oral fluconazole Supportive therapy

Glucocorticoids may be indicated in such cases of severe airway obstruction.

Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] 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.



Variable Croup Epiglottitis Pharyngitis Bacterial tracheitis Tonsilitis Retropharyngeal abscess Subglottic stenosis
Presentation Cough ✔ — Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting Barking cough, stridor,

fever, chest pain,

ear pain, difficulty breathing, headache, dizziness.

Sore throat, pain on swallowing, fever, headache, cough Neck pain, stiff neck, torticollis

fever, malaise, stridor, and barking cough

Depends on severity. May have respiratory distress at birth, exercise-induced dyspnea, intermittent wheezing. Inspiratory stridor. [37]
Stridor ✔ ✔
Drooling — ✔
Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice
Causes Parainfluenza virus H. influenza type b, beta-hemolytic streptococci, Staphylococcus aureus, fungi and viruses. Group A beta-hemolytic streptococcus. Staphylococcus aureus Most common cause is viral including adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,[17]  Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[22][23][24][4][25][26] Congenital, trauma
Physical exams findings Suprasternal and intercostal indrawing,[12] Inspiratory stridor[38], expiratory wheezing,[38] Sternal wall retractions[39] Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis Inflammed pharynx with or without exudate Subglottic narrowing with purulent secretions in the trachea[40][41] Fever, especially 100°F or higher.[31][32]Erythema, edema and Exudate of the tonsils.[18] cervical lymphadenopathy, Dysphonia.[33] Child may be unable to open the mouth widely. May have enlarged

cervical lymph nodes and neck mass.

Signs of respiratory distress, intermittent wheezing. Inspiratory stridor. [37]
Age commonly affected Mainly 6 months and 3 years old

rarely, adolescents and adults[14]

Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals[35]

with a mean age of 44.94 years.

Mostly in children and young adults,

with 50% of cases identified

between the ages of 5 to 24 years.[42]

Mostly during the first six years of life Primarily affects children

between 5 and 15 years old.[36]

Mostly between 2-4 years, but can occur in other age groups.[27][28] May be congenital congenital or acquired. Mean age in acquired is 54.1 years[43]
Imaging finding Steeple sign on neck X-ray Thumbprint sign on neck x-ray — Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[21][19][20] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[29][30] Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.[44]
Treatment Dexamethasone and nebulised epinephrine Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] Antimicrobial therapy mainly penicillin-based and analgesics. Airway maintenance and antibiotics 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. Endoscopic balloon dilation for patients with low-grade subglottic stenosis,[45] glucocorticoid injections, and resection.[46]

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
  3. ↑ 3.0 3.1 Galioto NJ (2008). "Peritonsillar abscess". Am Fam Physician. 77 (2): 199–202. PMID 18246890.
  4. ↑ 4.0 4.1 4.2 4.3 Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
  5. ↑ Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S (2008). "Changing trends in bacteriology of peritonsillar abscess". J Laryngol Otol. 122 (9): 928–30. doi:10.1017/S0022215107001144. PMID 18039418.
  6. ↑ Snow DG, Campbell JB, Morgan DW (1991). "The microbiology of peritonsillar sepsis". J Laryngol Otol. 105 (7): 553–5. PMID 1875138.
  7. ↑ Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M (2002). "Peritonsillar abscess: a study of 724 cases in Japan". Ear Nose Throat J. 81 (6): 384–9. PMID 12092281.
  8. ↑ 8.0 8.1 Lyon M, Blaivas M (2005). "Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department". Acad Emerg Med. 12 (1): 85–8. doi:10.1197/j.aem.2004.08.045. PMID 15635144.
  9. ↑ 9.0 9.1 Boesen T, Jensen F (1992). "Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis". Eur Arch Otorhinolaryngol. 249 (3): 131–3. PMID 1642863.
  10. ↑ Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK (2016). "Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections". Pediatr Radiol. 46 (7): 1059–67. doi:10.1007/s00247-015-3505-7. PMID 26637999.
  11. ↑ Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA (1999). "Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis". J Laryngol Otol. 113 (3): 229–32. PMID 10435129.
  12. ↑ 12.0 12.1 Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  13. ↑ Giordano S, Adamo P, Monaci F, Pittao E, Tretiach M, Bargagli R (2009). "Bags with oven-dried moss for the active monitoring of airborne trace elements in urban areas". Environ Pollut. 157 (10): 2798–805. doi:10.1016/j.envpol.2009.04.020. PMID 19457602.
  14. ↑ 14.0 14.1 Tong MC, Chu MC, Leighton SE, van Hasselt CA (1996). "Adult croup". Chest. 109 (6): 1659–62. PMID 8769531.
  15. ↑ 15.0 15.1 15.2 Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
  16. ↑ 16.0 16.1 16.2 Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
  17. ↑ 17.0 17.1 Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
  18. ↑ 18.0 18.1 18.2 Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
  19. ↑ 19.0 19.1 19.2 19.3 Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections". Laryngoscope. 125 (11): 2604–7. doi:10.1002/lary.25313. PMID 25946659.
  20. ↑ 20.0 20.1 20.2 20.3 Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J; et al. (2015). "Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess". Laryngoscope. 125 (12): 2799–804. doi:10.1002/lary.25354. PMID 25945805.
  21. ↑ 21.0 21.1 21.2 Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
  22. ↑ 22.0 22.1 22.2 Cheng J, Elden L (2013). "Children with deep space neck infections: our experience with 178 children". Otolaryngol Head Neck Surg. 148 (6): 1037–42. doi:10.1177/0194599813482292. PMID 23520072.
  23. ↑ 23.0 23.1 23.2 Abdel-Haq N, Quezada M, Asmar BI (2012). "Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus". Pediatr Infect Dis J. 31 (7): 696–9. doi:10.1097/INF.0b013e318256fff0. PMID 22481424.
  24. ↑ 24.0 24.1 24.2 Inman JC, Rowe M, Ghostine M, Fleck T (2008). "Pediatric neck abscesses: changing organisms and empiric therapies". Laryngoscope. 118 (12): 2111–4. doi:10.1097/MLG.0b013e318182a4fb. PMID 18948832.
  25. ↑ 25.0 25.1 25.2 Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ (2008). "Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess". Arch Otolaryngol Head Neck Surg. 134 (4): 408–13. doi:10.1001/archotol.134.4.408. PMID 18427007.
  26. ↑ 26.0 26.1 26.2 Asmar BI (1990). "Bacteriology of retropharyngeal abscess in children". Pediatr Infect Dis J. 9 (8): 595–7. PMID 2235179.
  27. ↑ 27.0 27.1 27.2 Craig FW, Schunk JE (2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
  28. ↑ 28.0 28.1 28.2 Coulthard M, Isaacs D (1991). "Neonatal retropharyngeal abscess". Pediatr Infect Dis J. 10 (7): 547–9. PMID 1876473.
  29. ↑ 29.0 29.1 29.2 Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess". J Laryngol Otol. 118 (12): 919–26. PMID 15667676.
  30. ↑ 30.0 30.1 30.2 Vural C, Gungor A, Comerci S (2003). "Accuracy of computerized tomography in deep neck infections in the pediatric population". Am J Otolaryngol. 24 (3): 143–8. PMID 12761699.
  31. ↑ 31.0 31.1 Tonsillitis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm. Accessed May 2nd, 2016.
  32. ↑ 32.0 32.1 "Tonsillitis - NHS Choices".
  33. ↑ 33.0 33.1 "Tonsillitis - Symptoms - NHS Choices".
  34. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  35. ↑ 35.0 35.1 Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
  36. ↑ 36.0 36.1 Sharav, Yair; Benoliel, Rafael (2008). Orofacial Pain and Headache. Elsevier. ISBN 0723434123.
  37. ↑ 37.0 37.1 Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
  38. ↑ 38.0 38.1 Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
  39. ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  40. ↑ Liston SL, Gehrz RC, Siegel LG, Tilelli J (1983). "Bacterial tracheitis". Am J Dis Child. 137 (8): 764–7. PMID 6869336.
  41. ↑ Liston SL, Gehrz RC, Jarvis CW (1981). "Bacterial tracheitis". Arch Otolaryngol. 107 (9): 561–4. PMID 7271556.
  42. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  43. ↑ Nicolli EA, Carey RM, Farquhar D, Haft S, Alfonso KP, Mirza N (2017). "Risk factors for adult acquired subglottic stenosis". J Laryngol Otol. 131 (3): 264–267. doi:10.1017/S0022215116009798. PMID 28007041.
  44. ↑ Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
  45. ↑ Cui PC, Luo JS, Zhao DQ, Guo ZH, Ma RN (2016). "[Management of subglottic stenosis in children with endoscopic balloon dilation]". Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 51 (4): 286–8. doi:10.3760/cma.j.issn.1673-0860.2016.04.009. PMID 27095722.
  46. ↑ Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
Retrieved from "https://www.wikidoc.org/index.php?title=Pharyngitis_differential_diagnosis&oldid=1304518"