ACUTE TONSILLOPHARINGITIS
Waldeyer ring comprises the palatine tonsils, the pharyngeal tonsil or adenoid, lymphoid tissue surrounding the eustachian tube orifice in the
lateral walls of the nasopharynx, the lingual tonsil at the base of the tongue, and scattered lymphoid tissue throughout the remainder of the
pharynx, particularly behind the posterior pharyngeal pillars and along the posterior pharyngeal wall
Palatine tonsil consists of lymphoid tissue located between the palatoglossal fold (anterior tonsillar pillar) and the palatopharyngeal fold (posterior
tonsillar pillar) forms
Lingual tonsil Formed by the lymphoid tissue at the base of the tongue that also contains simple tonsillar crypts.
Adenoid is a single aggregation of lymphoid tissue that occupies the space between the nasal septum and the posterior pharyngeal wall.
PATHOLOGY
Acute Infection Chronic Infection
Causes: Mostly are Viruses Causes: β-lactamase–producing organisms
GABHS - most common cause of bacterial infection in the pharynx Aerobes: Streptococci, Haemophilus influenzae
Anaerobes: Peptostreptococcus, Prevotella, and Fusobacterium
Cryptic tonsillitis - tonsillar crypts can accumulate desquamated
epithelial cells, lymphocytes, bacteria, and other debris.
Tonsillolith or tonsillar concretions - calcified cryptic plugs
CLINICAL MANIFESTATIONS
GABHS infection: odynophagia, dry throat, malaise, fever and chills, S/Sx: halitosis, chronic sore throats, foreign-body sensation, or a history
dysphagia, referred otalgia, headache, muscular aches, and enlarged of expelling foul-tasting and foul-smelling cheesy lumps.
cervical nodes. Signs include dry tongue, erythematous enlarged tonsils, PE: tonsils of a range of sizes which often they contain copious debris
tonsillar or pharyngeal exudate, palatine petechiae, and enlargement within the crypts.
and tenderness of the jugulodigastric lymph nodes
Viral: Gradual onset
Moderate throat pain
Symptoms of URTI
HSV: vesicles and ulcers
Adenovirus: Conjunctivitis
DIAGNOSIS
Throat Culture Gold standard for diagnosing GABHS Pharyngitis
RADT Dx of GABHS pharyngitis
Rapid Antigen detection test Less sensitive than culture
>95% specificity
(+) culture is unnecessary
(-) Do throat culture
MANAGEMENT
Antibiotics for Penicillin 10days 250mg (<27kg) or 500mg (>27kg) 2x/day
GABHS Amoxicillin 10days 50mg/kg PO
Allergic to Penicillin
Erythromycin 10 days 40mg/kg/day PO 2x. Max 1g/day
Azithromycin Day 1: 12mg/kg
Day2-5: 6mg/kg 1x/day; Max 500mg/day
Clarithromycin 10 days 15mg/kg/day 2x /day; Max: 500mg/day
Clindamycin 10 days 20mg/kg/day PO 3x/day; Max 1.8g/day
Start antibiotics immediately even w/o - Scarlet fever
culture - Household ontact with Streptococcal pharyngitis
- Hx of acute Rheumatic fever
- Family hx of acute rheumatic fever
Tonsillectomy Recurrent streptococcal pharyngitis that is culture positive strep pharyngitis
Paradise Criteria:
≥ 7 episodes in the previous year
≥ 5 episodes in each of the preceding 2 years
≥ 3 episodes in each of the preceding 3 year
COMPLICATIONS
Rheumatic fever
Post- Streptococcal glomerulonephritis
Peritonsillar/retropharyngeal abscess
