1. Diphtheria is caused by Corynebacterium diphtheriae bacteria and is characterized by formation of a fibrinous membrane in the throat or on skin.
2. The bacteria produce a toxin that is spread through the bloodstream, affecting organs like the heart, nerves, and adrenal glands.
3. While immunization programs have largely eliminated diphtheria in developed nations, it remains endemic in some parts of the world, with outbreaks occurring when immunization levels drop.
Diphtheria is an acute toxin-mediated disease caused by Corynebacterium diphtheriae, which are gram-positive, catalase-positive rods. It is characterized by sore throat and an adherent membrane on the tonsils, pharynx, and/or nasal cavity. The membrane firmly adheres to the mucosa and can spread down the bronchial tree, causing respiratory obstruction. Humans are the only reservoir, and it is transmitted through respiratory droplets or direct contact. Treatment involves diphtheria antitoxin and antibiotics such as erythromycin. Childhood immunization is the main preventive measure.
Atrophic rhinitis, also known as ozaena, is a chronic inflammation of the nasal mucosa that results in atrophy, squamous metaplasia, and crust formation. It is characterized by the atrophy of the nasal mucosa and turbinates, scanty viscid secretions, loss of ciliated columnar epithelium, and crust formation. The pathophysiology involves periarteritis and endarteritis of the nasal mucosa, decreasing blood supply and resulting in atrophy of mucous glands, epithelium, and metaplasia of the ciliated columnar epithelium. Treatment involves antibiotics, estrogen therapy, surgical procedures to narrow the nasal cavity and increase lubrication, and sal
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, a protistan parasite. It is characterized by polyps in the nasal cavity. It is most commonly seen in southern India and Sri Lanka. The parasite exists in both sporangial and spore forms and has a dimorphic life cycle involving both aquatic and host tissues. Clinical presentation involves polypoidal lesions in the nose that bleed easily. Treatment involves surgical removal of the polyps combined with long term dapsone medication to prevent recurrence.
Diphtheria and pertussis (whooping cough)Rizwan S A
1) Diphtheria and pertussis are acute infections caused by Corynebacterium diphtheriae and Bordetella pertussis respectively. Both diseases are vaccine preventable and capable of outbreaks.
2) Diphtheria presents as membranous sore throat and can affect other sites. Pertussis has three stages - catarrhal, paroxysmal coughing, and convalescence. Complications can be serious.
3) Control relies on early detection, isolation, treatment, and immunization. Cases and carriers of diphtheria require treatment and surveillance. Contacts of both diseases may need prophylactic antibiotics or immunization depending on vaccination status
Acute rhinosinusitis can be divided into common cold, post-viral rhinosinusitis, and acute bacterial rhinosinusitis (ABRS). ABRS is defined as having at least 3 symptoms including discolored discharge, severe local pain, and fever. Antibiotics are recommended as soon as ABRS is diagnosed. For initial treatment, amoxicillin-clavulanate is recommended over amoxicillin alone in both children and adults. Treatment duration is typically 5-7 days for adults and 10-14 days for children. Alternative management should be considered if no improvement within 3-5 days of initial antibiotics.
This document provides information on measles (rubeola), including its definition, epidemiology, pathogenesis, clinical manifestations, complications, diagnosis, treatment, vaccination, and prophylaxis. It describes measles as a highly contagious viral disease characterized by fever and rash. Key points include that measles virus is transmitted via respiratory droplets; the vaccine is live attenuated measles virus that provides 95% protection with two recommended doses at 12-15 months and 4-6 years of age.
Acute Pharyngitis is an inflammation of the pharyngeal mucosa and submucosa, mostly involving the pharyngeal lymphoid tissue. It is commonly caused by viruses or bacteria. Symptoms include fever, sore throat, pain when swallowing, and enlarged lymph nodes in the neck. Examination shows redness and swelling of the throat. Chronic Pharyngitis is a diffuse inflammation of the pharyngeal mucosa that can develop from repeated acute infections. It may cause hypertrophy or atrophy of the mucosa. Treatment focuses on identifying and eliminating the cause, using local soothing treatments, and targeting hypertrophied tissues if needed. Therapy is often unsatisfactory due to high rates
Diphtheria is an acute toxin-mediated disease caused by Corynebacterium diphtheriae, which are gram-positive, catalase-positive rods. It is characterized by sore throat and an adherent membrane on the tonsils, pharynx, and/or nasal cavity. The membrane firmly adheres to the mucosa and can spread down the bronchial tree, causing respiratory obstruction. Humans are the only reservoir, and it is transmitted through respiratory droplets or direct contact. Treatment involves diphtheria antitoxin and antibiotics such as erythromycin. Childhood immunization is the main preventive measure.
Atrophic rhinitis, also known as ozaena, is a chronic inflammation of the nasal mucosa that results in atrophy, squamous metaplasia, and crust formation. It is characterized by the atrophy of the nasal mucosa and turbinates, scanty viscid secretions, loss of ciliated columnar epithelium, and crust formation. The pathophysiology involves periarteritis and endarteritis of the nasal mucosa, decreasing blood supply and resulting in atrophy of mucous glands, epithelium, and metaplasia of the ciliated columnar epithelium. Treatment involves antibiotics, estrogen therapy, surgical procedures to narrow the nasal cavity and increase lubrication, and sal
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, a protistan parasite. It is characterized by polyps in the nasal cavity. It is most commonly seen in southern India and Sri Lanka. The parasite exists in both sporangial and spore forms and has a dimorphic life cycle involving both aquatic and host tissues. Clinical presentation involves polypoidal lesions in the nose that bleed easily. Treatment involves surgical removal of the polyps combined with long term dapsone medication to prevent recurrence.
Diphtheria and pertussis (whooping cough)Rizwan S A
1) Diphtheria and pertussis are acute infections caused by Corynebacterium diphtheriae and Bordetella pertussis respectively. Both diseases are vaccine preventable and capable of outbreaks.
2) Diphtheria presents as membranous sore throat and can affect other sites. Pertussis has three stages - catarrhal, paroxysmal coughing, and convalescence. Complications can be serious.
3) Control relies on early detection, isolation, treatment, and immunization. Cases and carriers of diphtheria require treatment and surveillance. Contacts of both diseases may need prophylactic antibiotics or immunization depending on vaccination status
Acute rhinosinusitis can be divided into common cold, post-viral rhinosinusitis, and acute bacterial rhinosinusitis (ABRS). ABRS is defined as having at least 3 symptoms including discolored discharge, severe local pain, and fever. Antibiotics are recommended as soon as ABRS is diagnosed. For initial treatment, amoxicillin-clavulanate is recommended over amoxicillin alone in both children and adults. Treatment duration is typically 5-7 days for adults and 10-14 days for children. Alternative management should be considered if no improvement within 3-5 days of initial antibiotics.
This document provides information on measles (rubeola), including its definition, epidemiology, pathogenesis, clinical manifestations, complications, diagnosis, treatment, vaccination, and prophylaxis. It describes measles as a highly contagious viral disease characterized by fever and rash. Key points include that measles virus is transmitted via respiratory droplets; the vaccine is live attenuated measles virus that provides 95% protection with two recommended doses at 12-15 months and 4-6 years of age.
Acute Pharyngitis is an inflammation of the pharyngeal mucosa and submucosa, mostly involving the pharyngeal lymphoid tissue. It is commonly caused by viruses or bacteria. Symptoms include fever, sore throat, pain when swallowing, and enlarged lymph nodes in the neck. Examination shows redness and swelling of the throat. Chronic Pharyngitis is a diffuse inflammation of the pharyngeal mucosa that can develop from repeated acute infections. It may cause hypertrophy or atrophy of the mucosa. Treatment focuses on identifying and eliminating the cause, using local soothing treatments, and targeting hypertrophied tissues if needed. Therapy is often unsatisfactory due to high rates
Both acute and chronic pharyngitis are common diseases and they are important for the students to understand, Moreover acute tonsillitis is also very common and it becomes one of the most important causes of throat pain and fever.
Poliomyelitis uploaded by Samrat GurungSamrat Gurung
Polio is a highly infectious disease caused by an RNA virus that affects children under 5 years old. It can cause paralysis if the virus infects the central nervous system. Three types of poliovirus exist. While most infections are asymptomatic, paralysis occurs in less than 1% of cases. Transmission is primarily through the fecal-oral route. Nepal was declared polio-free in 2014 through vaccination efforts. Oral polio vaccine is effective at inducing immunity and spreading to non-immunized individuals. Maintaining high vaccination coverage is important to prevent new outbreaks.
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
The document summarizes acute epiglottitis, an inflammatory condition of the supraglottic structures including the epiglottis, aryepiglottic folds, and arytenoids that can cause airway obstruction. It describes the anatomy of the epiglottis, causes including H. influenzae infection, symptoms of sore throat and difficulty swallowing, signs of fever and swelling of the epiglottis, diagnosis through examination and imaging, complications of spread of infection, treatment with antibiotics, steroids, and intubation if needed, and good prognosis with timely treatment but risk of sudden airway obstruction.
Neisseria meningitidis is a leading cause of bacterial meningitis worldwide. It commonly causes epidemics in sub-Saharan Africa and sporadic cases elsewhere. Clinical features include sudden onset of fever, headache, and neck stiffness. Diagnosis is made by identifying the bacteria in spinal fluid. Antibiotics like penicillin and ceftriaxone are effective treatments but prevention through vaccination is important for controlling outbreaks.
This document discusses various conditions affecting the external ear canal, including:
- Otitis externa (swimmer's ear), which can range from mild to severe bacterial infections. Pseudomonas and Staph are common causes. Treatment involves cleaning, topical antibiotics, and pain control.
- Otomycosis is a fungal infection of the ear canal most often caused by Aspergillus or Candida. Symptoms are similar to bacterial otitis but with more pruritus. Treatment involves thorough cleaning and topical antifungals.
- Necrotizing external otitis is a potentially lethal Pseudomonas infection seen in diabetics and immunocompromised patients.
1. The document describes a case of meningococcal meningitis in a 14-year-old male student who presented with high fever, headache, nausea, vomiting, stiff neck and confusion. Examination found a positive Kernig's sign and white blood cell counts were elevated in both blood and cerebrospinal fluid.
2. The document then provides background information on meningococcal meningitis, including that it is caused by Neisseria meningitidis bacteria, signs and symptoms, routes of transmission, risk groups, treatment which includes antibiotics and supportive care, and prevention through vaccination and chemoprophylaxis of close contacts.
3. Differential diagnoses and diagnostic testing are also
Acute tonsillitis is usually caused by streptococcal bacteria or viruses like adenovirus. Common symptoms include sore throat, fever, and pain when swallowing. On examination, the tonsils are red and swollen with pus or debris in the crypts and enlarged lymph nodes. Treatment involves rest, fluids, antibiotics if bacterial, and surgery for complications like abscesses or recurrent infections. Chronic tonsillitis is caused by repeated acute infections and leads to tonsil enlargement, scarring, and sore throat. Tonsillectomy may be recommended for recurring infections, obstructive symptoms, or focal infection.
Although diphtheria is not very common but its also not very uncommon. Although there is immunization regarding diphtheria in expanded program of immunization in Pakistan but still we find cases off and on
This ppt contains all information about epidemiology of mumps. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
This document discusses epistaxis (nosebleeds), including:
- The blood supply and common bleeding sites in the nose, especially Little's area.
- Causes of epistaxis including local factors like trauma, infections, and tumors as well as general factors like hypertension.
- Differences between anterior and posterior nosebleeds.
- Management approaches like first aid, cauterization, nasal packing, and ligation of arteries in severe cases.
- Measures like bed rest, monitoring, antibiotics, and treating underlying causes are also important.
Measles is an acute viral infection characterized by a maculopapular rash accompanied by high fever. It is highly contagious, spreading via respiratory droplets. The infection begins with prodromal symptoms like fever and cough, followed by appearance of the pathognomonic Koplik spots. A red rash then develops on the face and spreads to the rest of the body over several days. Treatment is supportive with rest, fluids and fever relief. Complications can include pneumonia and death, so vaccination is recommended at 12-15 months with potential earlier vaccination in outbreak situations.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Scarlet fever is an upper respiratory tract infection associated with a characteristic rash caused by infection with pyrogenic exotoxin-producing group A streptococcus. The rash makes the skin have a goose-pimple appearance and the tongue appear strawberry-like. For patients with classic scarlet fever, antibiotic therapy with penicillin should be started immediately, as penicillin is the drug of choice. Erythromycin is recommended for patients allergic to penicillin.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
This document provides information on rubella (German measles), including:
- It is a viral disease that mainly affects children and causes a rash and lymph node swelling.
- The virus was isolated in the 1960s and a live attenuated vaccine was developed in 1967.
- Infection during pregnancy can cause congenital rubella syndrome in the baby.
- Transmission is via respiratory droplets and the infection is usually mild but can cause birth defects if a woman is infected during pregnancy.
- Rubella vaccination is recommended to control the disease.
Tonsillitis and diphtheria are inflammatory conditions caused by infections. Tonsillitis is inflammation of the tonsils which can be caused by viruses like adenovirus or bacteria like streptococcus. Diphtheria is caused by the Corynebacterium diphtheriae bacteria which produces a toxin. It forms a gray membrane in the throat or nose and can lead to complications affecting the heart, nerves, or kidneys. Diagnosis involves culturing the bacteria. Treatment is with diphtheria antitoxin and antibiotics like penicillin. Prevention involves vaccination and antibiotics for contacts of infected individuals.
Takreem Ilyas presented on diphtheria, caused by Corynebacterium diphtheriae, which produces a toxin that can cause membrane formations in the throat and on the skin. The document discussed the etiology, epidemiology, pathogenesis, clinical manifestations including respiratory and cutaneous forms, complications, diagnosis through culture and PCR, treatment including diphtheria antitoxin and antimicrobial therapy, and prevention through vaccination.
Both acute and chronic pharyngitis are common diseases and they are important for the students to understand, Moreover acute tonsillitis is also very common and it becomes one of the most important causes of throat pain and fever.
Poliomyelitis uploaded by Samrat GurungSamrat Gurung
Polio is a highly infectious disease caused by an RNA virus that affects children under 5 years old. It can cause paralysis if the virus infects the central nervous system. Three types of poliovirus exist. While most infections are asymptomatic, paralysis occurs in less than 1% of cases. Transmission is primarily through the fecal-oral route. Nepal was declared polio-free in 2014 through vaccination efforts. Oral polio vaccine is effective at inducing immunity and spreading to non-immunized individuals. Maintaining high vaccination coverage is important to prevent new outbreaks.
This document discusses chronic rhinosinusitis (CRS). It defines CRS and outlines its main subtypes and symptoms. It describes the histopathology and pathomechanisms involved, as well as common comorbidities. Diagnosis involves nasal endoscopy, CT scans, and allergy testing. Treatment includes topical corticosteroids, antibiotics, antifungals, and surgery for refractory cases.
The document summarizes acute epiglottitis, an inflammatory condition of the supraglottic structures including the epiglottis, aryepiglottic folds, and arytenoids that can cause airway obstruction. It describes the anatomy of the epiglottis, causes including H. influenzae infection, symptoms of sore throat and difficulty swallowing, signs of fever and swelling of the epiglottis, diagnosis through examination and imaging, complications of spread of infection, treatment with antibiotics, steroids, and intubation if needed, and good prognosis with timely treatment but risk of sudden airway obstruction.
Neisseria meningitidis is a leading cause of bacterial meningitis worldwide. It commonly causes epidemics in sub-Saharan Africa and sporadic cases elsewhere. Clinical features include sudden onset of fever, headache, and neck stiffness. Diagnosis is made by identifying the bacteria in spinal fluid. Antibiotics like penicillin and ceftriaxone are effective treatments but prevention through vaccination is important for controlling outbreaks.
This document discusses various conditions affecting the external ear canal, including:
- Otitis externa (swimmer's ear), which can range from mild to severe bacterial infections. Pseudomonas and Staph are common causes. Treatment involves cleaning, topical antibiotics, and pain control.
- Otomycosis is a fungal infection of the ear canal most often caused by Aspergillus or Candida. Symptoms are similar to bacterial otitis but with more pruritus. Treatment involves thorough cleaning and topical antifungals.
- Necrotizing external otitis is a potentially lethal Pseudomonas infection seen in diabetics and immunocompromised patients.
1. The document describes a case of meningococcal meningitis in a 14-year-old male student who presented with high fever, headache, nausea, vomiting, stiff neck and confusion. Examination found a positive Kernig's sign and white blood cell counts were elevated in both blood and cerebrospinal fluid.
2. The document then provides background information on meningococcal meningitis, including that it is caused by Neisseria meningitidis bacteria, signs and symptoms, routes of transmission, risk groups, treatment which includes antibiotics and supportive care, and prevention through vaccination and chemoprophylaxis of close contacts.
3. Differential diagnoses and diagnostic testing are also
Acute tonsillitis is usually caused by streptococcal bacteria or viruses like adenovirus. Common symptoms include sore throat, fever, and pain when swallowing. On examination, the tonsils are red and swollen with pus or debris in the crypts and enlarged lymph nodes. Treatment involves rest, fluids, antibiotics if bacterial, and surgery for complications like abscesses or recurrent infections. Chronic tonsillitis is caused by repeated acute infections and leads to tonsil enlargement, scarring, and sore throat. Tonsillectomy may be recommended for recurring infections, obstructive symptoms, or focal infection.
Although diphtheria is not very common but its also not very uncommon. Although there is immunization regarding diphtheria in expanded program of immunization in Pakistan but still we find cases off and on
This ppt contains all information about epidemiology of mumps. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.
This document discusses epistaxis (nosebleeds), including:
- The blood supply and common bleeding sites in the nose, especially Little's area.
- Causes of epistaxis including local factors like trauma, infections, and tumors as well as general factors like hypertension.
- Differences between anterior and posterior nosebleeds.
- Management approaches like first aid, cauterization, nasal packing, and ligation of arteries in severe cases.
- Measures like bed rest, monitoring, antibiotics, and treating underlying causes are also important.
Measles is an acute viral infection characterized by a maculopapular rash accompanied by high fever. It is highly contagious, spreading via respiratory droplets. The infection begins with prodromal symptoms like fever and cough, followed by appearance of the pathognomonic Koplik spots. A red rash then develops on the face and spreads to the rest of the body over several days. Treatment is supportive with rest, fluids and fever relief. Complications can include pneumonia and death, so vaccination is recommended at 12-15 months with potential earlier vaccination in outbreak situations.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Scarlet fever is an upper respiratory tract infection associated with a characteristic rash caused by infection with pyrogenic exotoxin-producing group A streptococcus. The rash makes the skin have a goose-pimple appearance and the tongue appear strawberry-like. For patients with classic scarlet fever, antibiotic therapy with penicillin should be started immediately, as penicillin is the drug of choice. Erythromycin is recommended for patients allergic to penicillin.
Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa. There are two main types: bilateral ethmoidal polyps and antrochoanal polyps. Bilateral ethmoidal polyps commonly arise from inflammatory conditions like rhinosinusitis or disorders of ciliary motility. Antrochoanal polyps originate from the maxillary sinus near its opening and grow into the nasal cavity and nasopharynx. Symptoms include nasal obstruction, loss of smell, headache and discharge. Signs include pale grape-like masses seen on nasal examination. Treatment involves polypectomy or endoscopic sinus surgery. Recurrence is less common for antrochoanal polyps if completely removed from their
This document provides information on rubella (German measles), including:
- It is a viral disease that mainly affects children and causes a rash and lymph node swelling.
- The virus was isolated in the 1960s and a live attenuated vaccine was developed in 1967.
- Infection during pregnancy can cause congenital rubella syndrome in the baby.
- Transmission is via respiratory droplets and the infection is usually mild but can cause birth defects if a woman is infected during pregnancy.
- Rubella vaccination is recommended to control the disease.
Tonsillitis and diphtheria are inflammatory conditions caused by infections. Tonsillitis is inflammation of the tonsils which can be caused by viruses like adenovirus or bacteria like streptococcus. Diphtheria is caused by the Corynebacterium diphtheriae bacteria which produces a toxin. It forms a gray membrane in the throat or nose and can lead to complications affecting the heart, nerves, or kidneys. Diagnosis involves culturing the bacteria. Treatment is with diphtheria antitoxin and antibiotics like penicillin. Prevention involves vaccination and antibiotics for contacts of infected individuals.
Takreem Ilyas presented on diphtheria, caused by Corynebacterium diphtheriae, which produces a toxin that can cause membrane formations in the throat and on the skin. The document discussed the etiology, epidemiology, pathogenesis, clinical manifestations including respiratory and cutaneous forms, complications, diagnosis through culture and PCR, treatment including diphtheria antitoxin and antimicrobial therapy, and prevention through vaccination.
Presentation on meningitis and epiglottis. We made this presentation on epiglottis and meningitis. Their pathogenesis, mode of action, transmission, diagnosis, treatment, microbial group , symptoms , medication, and prevention been discussed in here.
Staphylococcus aureus and Streptococcus pyogenes are common Gram-positive bacterial infections that cause issues like skin lesions, pneumonia, and rheumatic fever. They produce toxins and adhere to host cells to cause illness. Gram-negative bacteria like Neisseria meningitidis, Bordetella pertussis, and Pseudomonas aeruginosa can lead to meningitis, whooping cough, and pneumonia through virulence factors and invasion of tissues. Yersinia pestis caused the bubonic plague through proliferation in lymph nodes and necrosis of tissues.
Systemic mycoses can result from inhalation of fungal spores that then differentiate into yeast or other forms in the lungs. This document focuses on four specific systemic mycoses: Coccidioides, Histoplasma, Blastomyces, and Paracoccidioides. Coccidioides causes valley fever through inhalation of spores in dry soil in the southwestern US and Central/South America. Paracoccidioides causes a similar disease through inhalation in parts of Central/South America. Both fungi exist as molds in soil and yeasts in tissues. Symptoms range from asymptomatic to disseminated disease. Diagnosis involves microscopy, culture, and ser
The provisional diagnosis is faucial diphtheria caused by Corynebacterium diphtheriae based on the 4-year old boy's symptoms of fever, sore throat, thick white tonsillar exudate and membrane in the nasopharynx. C. diphtheriae is a gram-positive rod that forms metachromatic granules and colonies on selective media. It produces a toxin that causes local tissue damage and systemic effects by inhibiting protein synthesis. Transmission occurs through respiratory droplets. Treatment involves diphtheria antitoxin, antibiotics, isolation and active immunization with DPT vaccine.
Tonsillitis syndrome in children. Diphtheria Eneutron
The document discusses acute tonsillitis and diphtheria. It notes that tonsillitis is a common childhood illness that doctors must distinguish from tonsillitis occurring with other infections. Diphtheria is described as a serious infectious disease caused by Corynebacterium diphtheriae that can cause membranes to form and lead to intoxication, cardiovascular and neurological issues if vaccination levels drop below 95%. The document outlines different clinical forms of diphtheria including localized tonsil, pharyngeal and laryngeal forms and discusses diagnosis and treatment with antitoxin serums.
Upper respiratory tract infections are common illnesses that affect the nasal passages, sinuses, pharynx and larynx. The common cold is the most frequent viral illness, often caused by rhinoviruses. Other viral infections like influenza and RSV can cause pharyngitis. Bacterial sinusitis is usually preceded by a viral infection. Acute laryngitis is commonly caused by inhalation of irritants or viral infections. Croup is most often caused by parainfluenza viruses in young children. Nasopharyngeal carcinoma is associated with Epstein-Barr virus and more common in Chinese populations. Laryngeal tumors include non-cancerous lesions like nodules and papillomas as well as
This document provides information on meningococcal infection. It begins by defining meningococcal infection and describing its causative agent, Neisseria meningitidis. It then covers the epidemiology, pathogenesis, clinical forms, clinical manifestations, diagnosis and treatment of meningococcal infection. Key points include that it is transmitted via air droplets and can cause meningitis, meningococcemia, or both. Clinical features depend on the form but may include fever, rash, headache and vomiting. Diagnosis involves examining cerebrospinal fluid which shows pleocytosis. Meningococcal infection is a serious public health issue worldwide.
Upper respiratory tract and the lung (1)Abdu Shumakhi
This document discusses the upper respiratory tract and lung. It begins by describing lesions of the upper respiratory tract including acute infections like rhinitis, sinusitis, tonsillitis, and pharyngitis. It then discusses specific conditions in more detail such as common cold, allergic rhinitis, acute sinusitis, tonsillitis, pharyngitis, epiglottitis, and laryngitis. It also covers nasal polyps, upper respiratory tract tumors, and causes of epistaxis. Next, it describes the normal lung anatomy and histology. It concludes by discussing lung diseases including obstructive diseases like asthma, emphysema, chronic bronchitis, bronchiolitis and bronchiectasis
Arboviruses are viruses spread by arthropods like mosquitoes. They are found worldwide depending on the mosquito species present. Prevention includes avoiding mosquito bites by wearing repellent and clothing, and removing standing water where mosquitoes can breed. Common arboviruses include Eastern Equine encephalitis, Western Equine encephalitis, and dengue.
Cutaneous tuberculosis is a rare form of tuberculosis that infects the skin through direct inoculation or hematogenous spread. It can present in several forms including tuberculids, lupus vulgaris, scrofuloderma, orificial tuberculosis, and acute miliary tuberculosis. Diagnosis is based on medical history, physical exam showing characteristic lesions, positive tuberculin test, and biopsy revealing epithelioid granulomas. Treatment involves a combination of antitubercular medications for at least 6-12 months.
Bacterial infections can cause diseases that manifest in the oral cavity. Some diseases like scarlet fever are caused by specific bacteria, while others can be caused by a broad group of microorganisms. Common bacterial infections discussed in the document include scarlet fever caused by Streptococcus pyogenes, diphtheria caused by Corynebacterium diphtheriae, and tuberculosis caused by Mycobacterium tuberculosis. These bacteria can cause lesions, ulcers, and pseudomembranes in the oral cavity. Diagnosis involves identifying the bacteria through cultures or identifying their characteristics through microscopic examination after staining.
The document discusses various viral, bacterial, fungal and protozoal infections that affect the skin. It provides details on chickenpox, shingles, measles, rubella, smallpox and warts which are viral infections. Bacterial infections covered include acne, anthrax, gas gangrene, leprosy and various Staphylococcus and Streptococcus infections. Fungal infections discussed are various types of ringworm. Lastly, it mentions leishmaniasis as a protozoal infection. For each infection, it provides information on causative agents, transmission, signs/symptoms and diagnosis.
This document provides information on dengue fever and dengue hemorrhagic fever. It defines dengue fever as an acute febrile illness characterized by fever, headache, muscle and joint pains, and rashes. Dengue hemorrhagic fever is more severe and involves plasma leakage that can lead to dengue shock syndrome. The document discusses the dengue virus, including its structure and transmission via mosquito vectors. It also covers the pathogenesis of dengue infection and potential mechanisms for severe disease manifestations.
Actinomycosis is a chronic bacterial infection caused by Actinomyces species. It presents as lumps in the soft tissues of the face or neck that form draining sinus tracts and abscesses. Tetanus is an infection of the nervous system caused by Clostridium tetani bacteria, presenting as painful muscle spasms. Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum that progresses through primary, secondary, and tertiary stages if left untreated, causing lesions of the skin and mucous membranes.
Diseases caused by Bacteria, Spirochaetes & Mycobacteria BY Dr. ROOPAM JAINDr. Roopam Jain
This document discusses diseases caused by bacteria, spirochaetes, and mycobacteria. It covers staphylococcal infections including skin, respiratory, bone, and blood infections. It also discusses streptococcal infections caused by different streptococcal groups. Clostridial diseases covered include gas gangrene, tetanus, and clostridial food poisoning. Fungal diseases discussed are mycetoma, candidiasis, and cutaneous superficial mycosis caused by dermatophytes.
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Diphtheria. Differential diagnostics of Acute tonsillitis
1. DEPARTMENT OF INFECTIOUS DISEASESDEPARTMENT OF INFECTIOUS DISEASES
THEME: Diphtheria.
Differential diagnostic
of acute tonsillitis.
Infectious diseasesInfectious diseases
2. Diphtheria is an acute infections disease
caused by Corynebacterium diphtheriae (Leffler bacilli),
transmitted mainly in an air-drop way and
characterized by the symptoms of general
intoxication, local inflammation of the mucous
membranes mainly with the formation of
fibrinogenous fur and typical complications on the part
of the nervous system, cardiovascular system and
excretory system.
Klebs discovered the diphtheria pathogen
Corynebacterium diphtheriae in the sections of
diphtheria membranes in 1883. In 1884 Leffler
extracted it in clean culture.
DIPHTHERIADIPHTHERIA
3. C. diphtheriae is aerobic
and facultatively anaerobic,
growing best on a blood- or
serum-containing medium at
35-37°C. On agar medium
containing tellurite, colonies
of C. diphtheriae are
characteristically black or
gray after 24-48 h.
EtiologyEtiology
Biotypes of C. diphtheriae named gravis,
intermedius or mitis are genomically similar variants
exhibiting distinct biochemical features and cultural
morphology.
4. The distinctive qualities of the diphtheria
microbes are their polymorphism. Gram-positive
coloring and the typical location of rods in the form of
"bristling fingers" or V-figures. The diphtheria
microbes are immobile, they don't produce spores,
and do not have capsules or flagellums.
EtiologyEtiology
The main biological quality of the
diphtheria microbe is its capacity
to produce toxin (exotoxin) that
causes the pathogenicity of this
microbe.
6. Diphtheria has virtually disappeared inDiphtheria has virtually disappeared in
developed countries following mass immunization indeveloped countries following mass immunization in
the 1940s, but is still endemic in many regions of thethe 1940s, but is still endemic in many regions of the
world. About 50000 cases of diphtheria occurred in theworld. About 50000 cases of diphtheria occurred in the
newly independent states of the former Soviet unionnewly independent states of the former Soviet union
during 1990-1996, leading to infection in short-termduring 1990-1996, leading to infection in short-term
visitors from Western Europe. The important feature ofvisitors from Western Europe. The important feature of
epidemic of a diphtheria in 90-th years was prevalenceepidemic of a diphtheria in 90-th years was prevalence
cases among adults.cases among adults.
EpidemiologyEpidemiology
7. Infection is confined to man and usually involvesInfection is confined to man and usually involves
contact with a diphtheria case or carrier. The mostcontact with a diphtheria case or carrier. The most
important mode of spread is person-to-personimportant mode of spread is person-to-person
transmission by aerosolized droplets when an infectedtransmission by aerosolized droplets when an infected
person coughs, sneezes or talks, or by direct contactperson coughs, sneezes or talks, or by direct contact
with skin lesions. Most clinical infections are probablywith skin lesions. Most clinical infections are probably
contracted from carriers rather than symptomaticcontracted from carriers rather than symptomatic
patients. Prolonged close contact with an infectedpatients. Prolonged close contact with an infected
person and intimate contact increases the likelihood ofperson and intimate contact increases the likelihood of
transmission.transmission.
EpidemiologyEpidemiology
8. The most epidemically dangerous are theThe most epidemically dangerous are the
bacteria-carriers who discharge microbes for a longbacteria-carriers who discharge microbes for a long
time (up to 1 month and longer), it is more oftentime (up to 1 month and longer), it is more often
observed in patients with chronic diseases of theobserved in patients with chronic diseases of the
upper respiratory tracts particularly with tonsillitis.upper respiratory tracts particularly with tonsillitis.
The periodicity and seasonal prevalence of theThe periodicity and seasonal prevalence of the
case rate are characteristic of diphtheria as ancase rate are characteristic of diphtheria as an
infection with a dropping mechanism of transmission.infection with a dropping mechanism of transmission.
These epidemiological peculiarities were moreThese epidemiological peculiarities were more
considerably expressed during the prevaccinating timeconsiderably expressed during the prevaccinating time
when the periodic growth of the sickness rate waswhen the periodic growth of the sickness rate was
observed every 10 years.observed every 10 years.
EpidemiologyEpidemiology
9. PathogenesisPathogenesis
To cause disease C. diphtheriae must:
• colonize and proliferate in local tissues;
• produce toxin.
In the upper respiratory tract, diphtheria bacilli
elicit an inflammatory exudates and cause necrosis of
the cells of the faucial mucosa. The diphtheria toxin
possibly assists colonization of the throat or skin by
killing epithelian cells or neutrophils.
10. PathogenesisPathogenesis
The organisms do not penetrate deeply into the
mucosal tissue and bacteraemia does not usually
occur. The exotoxin is produced locally and is spread
by the bloodstream to distant organs, with a special
affinity for heart muscle, the peripheral nervous
system and the adrenal glands.
C. diphtheriae can colonize the throats of people
who have been immunized against diphtheria or who
have become immune as a result of natural exposure.
11. PathogenesisPathogenesis
The diphtheria toxin is a heat-stable
polypeptide, composed of two fragments: A (active)
and B (binding). The toxin binds to a specific receptor
on susceptible cells and enters by receptor-mediated
endocytosis. The A subunit is cleaved and released
from the B subunit as it inserts and passes through
the membrane into the cytoplasm. Fragment A
catalyses of ADP-ribose from nicotinamide adenine
dinucleotide to the eukaryotic elongation factor 2,
which inhibits the function of the latter in protein
synthesis. Inhibition of protein synthesis is probably
responsible for both the necrotic and neurotoxic
effects of the toxin.
12.
13. PathogenesisPathogenesis
Implanting in the organism through covering
tissues the diphtheria pathogens form local foci of
histic damage. More often it happens on the mucous
membranes of the stomatopharynx, nasal-courses
where the microbes utilize slime as a medium, less
often the foci develop on the skin and even less often
on the mucous membranes of an eye and other
localizations. Alongside with classic exotoxin; which is
a true lethal factor, the diphtheria microbes in the
zone of inoculation produce numerous solvable local-
acting factors (hyaluronidase and neuraminidase)
damaging the cells and facilitating the diffusion of
bacteria and toxins in the tissues.
14. PathogenesisPathogenesis
Hyperemia, retardation of the blood flowand
sharp rising of the permeability of hystohematic
barriers promote the formation of exudate which is
rich in protein and fibrinous membranes in the
damaged tissue area.
Fibrinous inflammation is the pathomorphologic
manifestation of the macro- and microorganism
interaction in diphtheria. The form of this inflammation
directly relates to the constitution of the affected
mucous membrane.
15. PathogenesisPathogenesis
If the process develops on the mucous
membrane covered with the single-layer cylindrical
epithelium (for example in the respiratory tracts),
croupous inflammation develops; the cover that
develops includes a necrotic epithelial layer. The cover
is not firmly connected with the underlying tissue and
can be easily separated from it. If the process
develops on the mucous membranes covered with a
multilayer flat epithelium (lumen of fauces, pharynx),
it is not only the epithelial layer that necropsies, but
partially the joint tissue basis of the mucous
membrane (tunica propria mucosae). A thick fibrinous
cover develops, it can be hardly removed from the
underlying tissues. It is diphtheria inflammation.
16. PathogenesisPathogenesis
The regional lymph nodes get involved in the
process: they are enlarged owing to the expressed
plethora, edema and the proliferation of the cell-like
predominantly reticuloendothelial elements. Local
necroses develop in them. In the toxic form of
diphtheria develops the edema of the fauces mucous
membrane, pharynx, and also the edema of cervical
fat in the immediate proximity of the affected regional
lymph nodes. In the basis of this edema there is a
serous inflammation in the form of numerous cell-like
infiltrates.
17. PathogenesisPathogenesis
The diphtheria intoxication is characterized by
the affection of the nervous system (mainly the
peripheral nerves of the sympathetic ganglions),
cardio-vascular system, paranephroses and
nephroses.
The changes of the peripheral nerves are
manifested by multiple toxic parenchymatous neuritis.
The cardiovascular system is considerably affected in
the diphtheria intoxication.
18. PathogenesisPathogenesis
Nontoxigenic strains of C. diphtheriae may
cause pharyngitis and cutaneous abscesses. Systemic
disease, including endocarditis, septic arthritis and
ostesmyelitis, has also been reported. The viulence
factors of these strains remain unknown. Conversion
of a nontoxigenic strain to a toxigenic strain by phage
infection can occur in human populations.
19. In accordance with “International classification”
of WHO diphtheria is divided by the followings
clinical forms
A. After by localization of local process:
diphtheria of tonsil;
diphtheria of nasopharynx;
diphtheria of front department of nose;
diphtheria of larynx and trachea;
diphtheria of other localization (diphtheria of
skin, of wound and other).
Classification.Classification.
20. Classification.Classification.
B. After by expressed of general toxic, by
character select the followings variants the
terms of appearance and weight of
complications motion of diphtheria:
subclinical;
easy;
middle-severe ;
heavy;
hypertoxic;
bacterium carrier.
21. Classification.Classification.
C. After by widespread a process:
localized;
widespread;
combined.
D. After by character of local changes:
catarrhal;
islands;
membrano-fibrinous.
22. Clinical manifestationClinical manifestation
The incubation period of diphtheria is 2-5 days,
with a range of 1-10 days.
At first, patients present with malaise, sore
throat and moderate fever. The tonsils are swollen
either both or mostly, the erythema is strictly
localized. By the end of the first day or by the
beginning of the second day the cover gets a
characteristic diphtheria cover properties: it is dirty-
gray or yellowish, rather thick, rises above the
mucous membrane surface, it cannot be removed
without bleeding; plenty of fibrin and diphtheria bacilli
can be discovered under the microscope in it.
23. Clinical manifestationClinical manifestation
The manifestations of the general intoxication
remain insignificant: a headache, malaise, poor
appetite. In the cases when the disease is not treated
with serum, the cover appears on the uvula, soft
palate, nasopharynx, nasal cavity or the process goes
downwards to the larynx. Laryngeal involvement
leads to obstruction of the larynx and lower airways.
24. Clinical manifestationClinical manifestation
Toxic diphtheria.
The typical form sometimes develops on the 3-
5th day of the disease from the localized form when
the process affects the nasopharynx and oral cavity,
more often it develops as it is from the very
beginning. In this case the disease has an acute
oncoming, which is more rapid than in localized
diphtheria. The temperature immediately rises up to
39-40°C, there is a headache, repeated vomiting. The
pulse is rapid: 140-160 beats per minute, the face is
pale, there is malaise, sleeplessness.
25. Clinical manifestationClinical manifestation
The submandibular glands are enlarged, painful;
it is possible to see a pasty edema of the cellular
under the low jaw angle, usually on one side;
sometimes an edema develops only on the second
day.
At the mouth examination you can see that the
tongue is dry, the fauces are dark-red and hydropic;
there is usually dirty-gray fur on one tonsil, it cannot
be removed by a cotton plug. This cover affects the
entire tonsil, passes to the uvula, sometimes to the
soft palate extremely fast, within several hours. On
the second or third day the disease is in full swing,
and it is not difficult to clinically diagnose toxic
diphtheria.
26. Clinical manifestationClinical manifestation
Cutaneous diphtheria mostly occurs in tropical
countries. The lesion is usually characterized by an
ulcer covered by a necrotic pseudomembrane and
may involve any area of the skin and systemic toxic
manifestation.
33. ComplicationsComplications
The most frequent diphtheria complication for
adults is myocarditis. The affection of the heart is
especially typical for the toxic forms of the disease.
The severe form of myocarditis develops only in the
patients with toxic diphtheria at overdue (after the
5th day of the disease) specific treatment and is often
accompanied by complications on the side of the
kidneys and nervous system. Death is most
commonly due to congestive heart failure and cardiac
arrhythmias.
34. ComplicationsComplications
The complications caused by the affection of
the nervous system are observed less frequently. In
the mild forms of diphtheria develop only the soft
palate paresis — mononeuritis, which has an easy
short-term course (no more than 10-14 days),
characterized by a snuffling voice and chokes while
eating liquid food.
In more than 30 % cases toxic diphtheria is
complicated by polyneuritis in various combinations
and polyradiculoneuritis. Among the cranial nerves
the IX, X, III, VII, XII pairs are affected more often.
35. ComplicationsComplications
The severe forms of polyradiculoneuritis
develop, as a rule, in patients with concomitant
alcoholism, they are characterized by deep wide-
spread paralyses of the extremities, body, neck,
respiratory muscles in combination with the affection
of the cranial nerves, resulting not only in the long-
lived disorders of the working capacity, but also in
lethal outcomes.
36. Laboratory diagnosticLaboratory diagnostic
The diagnosis is made on clinical grounds,
supported by a history of diphtheria among contacts,
lack of prior immunization or travel in countries
where diphtheria is endemic.
The role of the laboratory is to confirm the
diagnosis by recovery of C. diphtheriae in culture
followed by appropriate tests for detection of toxin
production. The clinician should inform the laboratory
of the presumptive diagnosis of diphtheria because
isolation of C. diphtheriae requires special media. The
modem microbiologic diagnostics of diphtheria is
based on the clean culture isolation and identification
of the pathogen by the cultural-morphological,
biochemical and toxicogenic properties.
37. Laboratory diagnosticLaboratory diagnostic
Toxigenicity testing is essential. Production of
diphtheria toxin is demonstrated by the agar
immunoprecipitation test. The toxin gene can be
detected by the polymerase chain reaction (PCR). The
detection of the tox gene by PCR directly from clinical
specimens is feasible. All biotypes are potentially
toxigenic.
Measurement of antibodies to diphtheria toxin
in serum collected before administration of antitoxin
may support the diagnosis when cultures are
negative.
38. TreatmentTreatment
If diphtheria is strongly suspected on clinical
grounds, treatment should not await laboratory
confirmation, which may take several days.
Diphtheria antitoxic serum (hyperimmune horse
serum) is given, since antibiotics have no effect on
preformed toxin which rapidly diffuses from the local
lesions and soon becomes irreversibly bound to tissue
cells. Because antitoxic serum neutralizes only
circulating toxin it should be administered promptly.
39. Doses of diphtheria antitoxic serum
Patient’s statePatient’s state Doses of serumDoses of serum
EasyEasy 3030000000 -- 4040000000 IUIU
Middle-severeMiddle-severe 5050000000 -- 8080000000 IUIU
HeavyHeavy 9090000000 -- 120120000000 IUIU
HypertoxicHypertoxic 120120000000 –– 150150000000 IUIU
40. TreatmentTreatment
Treatment with parenteral penicillin or oral
erythromycin eradicates the organism and terminates
toxin production. C. diphtheriae is universally
sensitive to penicillins but some strains are resistant
to erythromycin, tetracyclines and rifampicin.
Erythromycin may be preferred to penicillin for
elimination of the bacilli from the throat, particularly
in treatment of persistent carriers.
Patients should be placed in strict isolation,
nursed by staff whose immunization history is
documented and have daily platelet counts and
electrocardiograms.
41. ProphylaxisProphylaxis
• The basic method of specific prophylactic of a
diphtheria is vaccination.
• Now is used diphtheria toxoid.
• A level of 0.1 IU/ml (International Units per
milliliter) diphtheria antitoxin in a serum is desirable
for individual protection.
42. Tonsillopharyngitis (more simply,
pharyngitis) is a common complaint characterized by
inflammation of the mucous membranes of the throat.
Up to 40 million office visits are made annually
by persons of all ages because of this illness, primarily
during colder seasons, and it may account for up to
100 million days lost from work each year.
TONSILLOPHARYNGITISTONSILLOPHARYNGITIS
43. Pharyngitis caused by a variety of pathogenic
microorganisms, the majority of which are viral. A
minority of pharyngitis episodes are bacterial.
Viral pharyngitis is caused by respiratory viruses
such as rhinoviruses, coronaviruses, adenoviruses,
influenza, and EBV.
Bacteria causing pharyngitis include group A
and non-group A streptococci, Corynebacterium
diphtheria, Corynebacterium pseudodiphtherium,
Neisseria gonorrhoeae, Yersinia enterocolitica,
Arcanobacterium hemolyticum, and anaerobic
bacterial species.
TONSILLOPHARYNGITISTONSILLOPHARYNGITIS
44. Many patients and clinicians are aware of the
importance of group A β-hemolytic streptococci
(Streptococcus pyogenes) as a cause of pharyngitis,
and concern for this pathogen must be a major focus
in the management of sore throat. It is also felt to be
the only commonly encountered pathogen for which
treatment is clearly indicated. However, numerous
other potentially treatable causes of this illness exist,
and most cases of pharyngitis in adults are not caused
by S. pyogenes.
TONSILLOPHARYNGITISTONSILLOPHARYNGITIS
45. Clinical manifestationClinical manifestation
The severity of the pharyngitis may vary from
mild to life threatening depending on the etiologic
agent. Symptoms of mild pharyngitis are irritation or
sore throat. With increasing severity there may be
severe pain that increases on swallowing or talking,
plus cervical lymphadenopathy with or without fever.
Pharyngitis can be life threatening with inflammatory
edema of pharyngeal walls and extension to the
larynx leading to respiratory distress.
46. Clinical manifestationClinical manifestation
An erythematous pharynx with or without
exudates or cervical lymphadenopathy is the common
finding on examination. Because it impacts therapeutic
decision-making, it is important to attempt clinical
differentiation between viral and bacterial pharyngitis.
However, this may be difficult. Associated clinical signs
and symptoms provide diagnostic clues to formulate a
differential diagnosis. Mild pharyngeal symptoms with
rhinorrhea usually suggest a viral etiology.
Pharyngeal exudates suggest streptococcal pharyngitis
or EBV. Presence of vesicles and ulcers is seen with
herpes simplex and coxsackievirus. Coxsackievirus-
related vesicles often occur on the hard palate.
47. Clinical manifestationClinical manifestation
Adenoviral pharyngitis is associated with
conjunctival congestion. EBV, A hemolyticum, and
streptococcal toxic shock can present with pharyngitis
and a generalized rash. Pharyngitis with elevated
transaminases, splenomegaly, and atypical
lymphocytosis is the typical manifestation of EBV-
induced infectious mononucleosis.
Aseptic meningitis along with pharyngitis should
suggest an acute HIV or enteroviral syndrome.
Systemic viral infections with CMV, measles, and
rubella, among others, can present with acute
pharyngitis.
48. Clinical manifestationClinical manifestation
GAS (Streptococcus pyogenes) pharyngitis
frequently presents with fever of > 38.3 o
C, chills,
sudden-onset sore throat, painful and difficult
swallowing, and tender cervical lymph nodes.
Lymphadenopathy is more likely to be anterior and
tender in GAS pharyngitis, unlike viral pharyngitis,
which is more likely to be generalized and nontender.
Exudate with intense pharyngeal and tonsillar
pillars erythema is seen. Occasionally patients,
especially children, present with systemic symptoms of
nausea, vomiting, and headache.
49. Streptococcal tonsillitis. Intense erythema of the tonsilsStreptococcal tonsillitis. Intense erythema of the tonsils
and surrounding tissue with a creamy-yellow exudate.and surrounding tissue with a creamy-yellow exudate.
50. Group A streptococcal pharyngitis with localizedGroup A streptococcal pharyngitis with localized
erythema and edema of the tonsils and soft palate.erythema and edema of the tonsils and soft palate.
51. Laboratory diagnosticLaboratory diagnostic
Laboratory values may not be of considerable
help. Testing for GAS should be done in all patients in
whom GAS pharyngitis cannot be confidently
excluded on clinical grounds. Diagnosis of GAS
pharyngitis can be made by RADT, which has a
sensitivity of 80-95% and specificity of 95%. Use of
RADT significantly increases the number of patients
receiving appropriate antibiotic treatment. Because of
its relatively lower sensitivity, a negative test should
be confirmed with a throat culture. Throat cultures
taken from the tonsillar fossae and posterior
pharyngeal wall are 90-95% sensitive for the
diagnosis of GAS pharyngitis.
52. TreatmentTreatment
In patients with a clinical picture consistent with
GAS pharyngitis, empirical therapy should be started to
prevent suppurative and nonsuppurative complications, to
decrease infectivity and transmissibility, and to induce
clinical improvement of symptoms. Patients with a high
index of suspicion for GAS pharyngitis but negative or
pending RADT/culture results can be given empirical
antibiotics until the results are available. An alternative
approach is to withhold antibiotics until the culture is
positive for S. pyogenes. Delaying therapy against GAS
does not increase the incidence of rheumatic heart disease
or recurrences with the same strain of S. pyogenes.
Following the latter course will decrease inappropriate
antibiotic use and control the increase in antibiotic
resistance.
53. TreatmentTreatment
Antibiotic selection is based on efficacy, ease of
administration, cost, compliance, and spectrum of the
antibiotic. The treatment of choice is penicillin V or
amoxicillin for 10 d to treat and eradicate carriage.
Intramuscular benzathine penicillin G may be given in
patients unlikely to complete a 10-d course. Shorter
courses are not recommended until more definitive
studies are available.
Erythromycin or other macrolides (such as
clarithromycin or azithromycin), or oral
cephalosporins are the recommended alternatives for
bacterial pharyngitis in patients who are allergic to
penicillin.
54. TreatmentTreatment
Absence of penicillin-resistant GAS and limited
(5%) resistance to erythromycin make it imperative
to choose a cheaper alternative to the newer more
expensive antibiotics. In some patients with recurrent
GAS pharyngitis, penicillin is unable to eradicate
nasopharyngeal carriage. In such patients, rifampin,
clindamycin, or amoxicillin/clavulanate use may
decrease colonization. Patients with negative throat
RADT/cultures should have antibiotics discontinued.
General measures for symptomatic relief
include fluids, warm saline gargles, and nonsteroidal
anti-inflammatory drugs.