Treatment of recurrent acute tonsillitis
Bacterial suppurative tonsillitis is among the most frequent paediatric infections. Group A beta-haemolytic streptococci are the most frequent cause. Other common isolates in bacterial tonsillitis are Hemophilus influenza, Streptococcus pyogenes, Streptococcus milleri and Staphylococcus aureus 97, 202, 205 . Children with acute strep-tococcal tonsillitis are significantly older than children with viral tonsillitis. The treatment of choice is penicillin administration for 10 days. Prevention of acute rheumatic fever is the principal goal of treatment. Surgical specimens of acute tonsillitis are rarely encountered. The surface epithelium may be ulcerated, and the surface and crypt epithelium is infiltrated by neutrophilic granulo-cytes producing a cryptitis with crypt abscesses. Acute bacterial infections may advance to intraparenchymal and peritonsillar abscesses (quinsy) with a lateral extension into the parapharyngeal space, base of skull and the sheath of the carotid artery 33, 64 ....
The lymphoid tissues of Waldeyer's ring play a key role in initiating immune responses against inhaled and ingested pathogens. The tonsils are responsible for the recognition and processing of antigens presented to the pharynx. The size of the tonsils is directly proportional to the amount of lymphoid tissue, which increases during antigen challenge. The reactive lymphoid hyperpla-sia of the palatine tonsils is often simply referred to as tonsillitis and in the case of the pharyngeal tonsil as The normal flora of the naso- and oropharynx includes anaerobic bacteria such as gram-positive Actinomyces and Proprionibacterium, and gram-negative bacteria such as Bacteroides, Fusobacterium and Vibrio 202 . Actinomyces israelii is a common nosocomial saprophyte in the oro- nasopharyngeal cavity. The true incidence of tonsillar manifestations of actinomyces is unknown, but has been reported to be as high as 40 57, 120 . Occasionally, actinomyces form small sulphur granules that can be seen as...
Acute tonsillitis is the inflammation of the tonsils which can be caused by a streptococcus microorganism. Patients who come down with acute tonsillitis experience a sore throat, chills, fever, aching muscles, and pain when they swallow. A throat culture is taken to determine the cause of the infection before an appropriate antibiotic is prescribed to the patient. The patient is also given acetaminophen or ibuprofen to reduce the fever and the aches and pains associated with acute tonsillitis. The patient is also encouraged to use saline gargles, lozenges, and increased fluid to soothe the soreness brought on by infected tonsils. Antibiotics are only used if a bacterial infection is suspected.
The most common causes of upper respiratory tract infections and pharyngo-tonsillitis in the general population, including infants and young children, are viruses such as influenza virus, Coxsackie's virus (group A), adenovirus, and the ubiquitous herpes virus Ep-stein-Barr virus 205 . EBV infects epithelial cells and B-lymphocytes of Waldeyer's ring, which represent the reservoir for life-long viral persistence 104, 186 . Primary infections with EBV occur early in infancy and childhood in developing countries and are generally asymptomatic. In contrast, in developed countries, primary infection occurs in adolescents and young adults. EBV infections may cause the mostly self-limiting acute disease infectious mononucleosis, affecting adolescents and young adults in the western world. In Japan, however, an endemic area for EBV, acute cases of infectious mononucleosis are commonly diagnosed in children less than 4 years of age 100 . The symptoms include enlarged swollen palatine tonsils,...
Unilateral inflammation and swelling of the pharynx suggests peritonsillar abscess. Distortion of the posterior pharyngeal wall suggests a retropharyngeal abscess. Corynebacterium diphtheriae is indicated by a dull membrane which bleeds on manipulation. Viral infections may cause oral vesicular eruptions.
Herbal therapy can also take the form of syrup. Syrups are made by drying the herb and soaking it in water or oil and then adding a sweetener to the mix. The sweetener is usually honey or sugar. The sweetened mixture is then heated until the syrup forms. Herbal syrups are used to treat colds, cough, and sore throat.
Mononucleosis is an extremely contagious disease characterized by an abnormally large number of one type of white blood cells (the monocytes). The disease affects the lymph tissue and is characterized by fever, sore throat, and inflamed lymph nodes. The spleen may become enlarged and lassitude (general tired feeling) on the part of the patient is not uncommon. Mononucleosis is thought to be a disease of viral origin that usually strikes people between the ages of ten and thirty-five. The treatment of mononucleosis is symptomatic. The disease usually runs its complete course in about four to six weeks.
Acute otitis media is the most frequent diagnosis in children presenting with fever. Diagnosis in a screaming child requires diagnostic skill beyond mere assessment of tympanic membrane erythema. Drum appearance and membrane mobility are important signs. Conjunctival suffusion may be one of the diagnostic clues to Kawasaki disease. It is important to evaluate for pharyngitis (eg, group A streptococcus, EBV), peritonsillar abscess, retropharyngeal abscess, and rhinosi-nusitis (eg, upper respiratory allergic diathesis). Drooling may suggest upper airway obstruction, including retropharyngeal abscess. 5. Neck. Assess for nuchal rigidity, including Brudzinski and Kernig signs. Note that these signs become progressively less reliable in children younger than 15 months of age. Tilted head due to torticollis may indicate an inflamed node in contact with the sternocleidomastoid (eg, peritonsillar abscess).
In health clinics and hospitals, it is necessary to detect microorganisms that are associated with disease. Selective and differential media are therefore used. Selective media are made to encourage the growth of some bacteria while inhibiting others. An example of this is bismuth sulfite agar. Bismuth sulfite agar is used to isolate Salmonella typhi from fecal matter. Salmonella typhi is a gramnegative bacterium that causes salmonella. Differential media make it easy to distinguish colonies of desired organisms from nondesirable colonies growing on the same plate. Pure cultures of microorganisms have identifiable reactions with different media. An example is blood agar. Blood agar is a dark red brown medium that contains red blood cells used to identify bacterial species that destroy red blood cells. An example of this type of bacterium is streptococcus pyogenes, the agent that causes strep throat.
Agranulocytosis is a potentially catastrophic idiosyncratic reaction that usually appears within the first 3 months of therapy. Although the incidence is extremely low (except for clozapine), mortality is high. Thus, any fever, sore throat, or cellulitis is an indication for discontinuing the antipsychotic and immediately conducting white blood cell and differential counts.
Lymphangiomatous tonsillar polyps are benign tumours of the palatine tonsil, accounting for about 2 of all tonsillar neoplasms. They have been reported by a number of different names such as angiomas, angiofibromas, fibrolipoma, polypoid tumour containing fibro-adipose tissue and hamartomatous tonsillar polyp and lymphangiectatic fibrous polyp 105 . They are pedunculated, mostly unilateral proliferations in the upper pole of the palatine tonsils in adults and children (age range of reported cases 3-63 years, with a median age of 26 years). Clinical symptoms are dysphagia, sore throat and the sensation of a mass in the throat . Lymphangiomatous tonsillar polyps measure between 0.5 and 4 cm. They are covered by respiratory epithelium or glycogenated or keratinised squa-mous epithelium with foci of hyper- and parakera-tosis. Clusters of lymphocytes are found within the squamous epithelium (lymphocytic epitheliotropism) or in the submucosa beneath the basement membrane (Fig. 6.7). The...
This section gives a brief overview of lymphomas of Waldeyer's ring. For a more detailed description, including genetic characteristics of these lymphomas see the WHO classification and the revised European-American classification of lymphoid neoplasms 74, 95 . Extranodal lymphomas of Waldeyer's ring constitute about 5-10 of all lymphomas in the USA and Europe, about 15 in Hong Kong and about 10-20 in Japan. Of all lymphomas involving Waldeyer's ring, 80 are primary to this site and the tonsillar fossa is the most common location, followed by the nasopharynx and the base of the tongue. Up to 20 of patients with tonsillar lymphoma have an associated gastrointestinal involvement. Clinical presentation is that of a localised neoplasm, sore throat, dysphagias, and in cases of nasopharyngeal involvement cranial nerve, auditory and nasal symptoms. Between 85 and 90 of all non-Hodgkin's lymphomas in Waldeyer's ring are of the B-cell phenotype, the remainder are of the T-cell type, but...
Amyloidosis is usually a systemic disease of mul-tifactorial origin that may involve the head and neck area. Particularly the upper respiratory tract is commonly affected by amyloidosis with a symmetrical enlargement of the tongue. Small amounts of amyloid deposition in Waldeyer's ring have been described in plas-macytomas, nasopharyngeal carcinomas or tonsillitis. Isolated tumour-like involvement of the nasopharynx with and without immunoglobulin light chain restriction, of the entire Waldeyer's ring or the palatine tonsils without systemic disease is exceptionally rare 11, 45, 116, 156 . Involvement of the naso- and oropharynx by systemic s arcoidosis is well documented 127 . Unsuspected isolated sarcoidosis of the palatine and pharyn-geal tonsils in the absence of systemic disease is very rare 46, 126 . Histologically, the sarcoidosis granulomas are composed of densely packed epithelioid histiocytes and macrophages without central necrosis. Differential diagnoses include recurrent...
Adequate ventilation and avoidance of crowding help to control the spread of streptococcal infections. Because so many strains exist, preparing a vaccine has been impractical. A basis for a vaccine is being sought, however, by identifying conserved epitopes among the different M proteins. Persons with fever and sore throat should have a throat culture for S. pyogenes so that antibiotic treatment can be given promptly and complications
Bacterial infections of the lower respiratory system are less common than those of the upper system, largely because they are stopped by body defenses at the portal of entry. Lower tract infections, however, are generally much more serious. An earache or sore throat is unlikely to be life threatening, but their causative organisms can endanger life when they infect the lung. Distinctive patterns of signs and symptoms are produced by the different kinds of organisms that infect the lower respiratory system. The pneumonias are inflammatory diseases of the lung in which fluid fills the alveoli. They top the list of infectious killers in the general population of the United States, and they are important as nosocomial, meaning hospital-acquired, infections. Whooping cough, tuberculosis, and Legionnaires' disease are other distinctive types of infection. body defenses, innate immunity, p. 372
The incubation time varies, but is usually between 10 and 14 days depending on the dose, the route of entry of the parasite, and individual factors (Krick and Remington 1978). The primary Toxoplasma infection is not commonly recognized, since the symptoms described are non-specific. Low-grade fever, sore throat, night sweats, myalgia, fatigue, malaise, and a maculopapular rash may occur, as well as, enlargement of the liver and spleen. Initially a lymphadenopathy may occur, often in the cervical region, and the nodes are usually discrete and non-tender and do not suppurate. This condition can clinically be mistaken for mononucleosis or a cytomegalovirus infection. A low number of atypical lymphocytes may be present in the blood.
Airway obstruction can occur in syndromic craniosynostosis secondary to mid-face hypoplasia (with nasopharyngeal narrowing), choanal stenosis, elongated soft palate, glossop-tosis and laryngotracheomalacia. Previous measures for managing these problems included prolonged intubation or tracheostomy. Due to the inherent problems with these measures, they are avoided if possible by conservative means, such as patient positioning, nasal stents and continuous positive airway pressure. Alternative surgical measures for those that are refractory to these therapies include adeno-tonsillectomy, palatal expansion, uvulopalato-pharyngoplasty and mid-face advancement.
Generally, aerosol administration of antimicrobial therapies is considered safe however, respiratory and nonrespiratory side effects occur frequently. Some patients experience bronchoconstriction associated with administration. This has been reported when the parenteral form of gentamicin and tobramycin was aerosolized, and may be attributed to other components of the products, including preservatives 29,30 . Cutaneous rashes have developed rarely, and a sore throat may occur.
Used to treat cervical adenitis, retropha-ryngeal cellulitis and abscess, and peritonsillar abscess. Antibiotic selection should be based on the causative agents and generally includes use of one or more of the following nafcillin, ampicillin, ampicillin-sulbactam, clindamycin, cefurox-ime, and ceftriaxone. Improvement should be seen within 48 hours.
OSAS in children differs significantly from that in adults. Excessive daytime sleepiness (EDS) and snoring with apnea are essential diagnostic elements for OSAS in adults. EDS appears to be uncommon in children with equally severe OSAS. Some children are obese like adults, but most are not. Some have large tonsils and adenoids, while some with enormous adenoids or tonsils have only mild OSAS or are completely asymptomatic. In adults enlarged tonsils and adenoids are uncommon. OSAS in adults occurs predominantly in males and postmenopausal females. In children there isn't a significant difference between males and females.
A cystic neoplasm composed of poorly differentiated non-keratinising carcinoma recapitulating tonsillar crypt epithelium (Fig. 9.13) most likely originates in the lingual or faucial tonsil 73, 96, 116 . Metastases from the tonsil are often unicystic, whereas those from the tongue are more often multicystic 96 . Since the carcinomas are deep in the tonsils, tonsillectomy rather than biopsy is needed to demonstrate the primary neoplasm 97 . A subset of these crypt carcinomas are often positive for CK 7, especially those with basaloid features (Fig. 9.14) 94 . These two types of metastatic cystic carcinoma are often mistaken for a branchial cleft cyst or branchogenic carcinomas by the unwary pathologist 73, 96, 116 .
Group A streptococcal infection can result in human illnesses ranging from sore throat to invasive infections such as necrotizing fasciitis and toxic shock syndrome to postinfectious sequelae such as glomerulonephritis and RF. The development of RF requires colonization of the pharynx by group A streptococcal infection, whereas cutaneous infection by streptococcus has not been shown to cause RF. The evidence that RF is a sequela of streptococcal pharyngitis includes the following. The epidemiology of RF mirrors that of streptococcal pharyngitis, depending on the time interval between the pharyngitis and the onset of RF antibodies to streptolysin O (ASO) and hyaluronidase are almost always present and recurrent attack of RF is always preceded by a streptococcal infection.
What are the vital signs Fever and tachycardia are common to many conditions included in the differential diagnosis, but associated hypotension may signify sepsis or group A -hemolytic streptococcal (GABHS) toxic shock syndrome. Significant tachypnea and respiratory distress can be associated with upper airway obstruction from enlarged tonsils, deep neck abscesses, epiglot-titis, and bacterial tracheitis.
Fever and tachycardia are common to all conditions in differential diagnosis, but presence of hypotension may signify sepsis or toxic shock syndrome. Significant respiratory distress can be associated with upper airway obstruction from enlarged tonsils, deep neck abscesses, epiglottitis, and bacterial tracheitis. 2. HEENT. Enlarged, erythematous, exudative or nonexudative tonsils and an erythematous pharynx are fairly nonspecific findings when attempting to identify causative organism of pharyngitis. Drooling may be noted with any infection that causes dysphagia. Palatal petechiae are often associated with GABHS and EBV. Coxsackievirus often causes small ulcers on soft palate and buccal mucosa. HSV causes vesicles and ulcers on lips and gingival mucosa. Asymmetric tonsillar enlargement and a deviated uvula are present with peritonsil-lar abscesses. Posterior pharyngeal fullness and fluctuance may be noted with retropharyngeal abscess. Trismus may be noted with lateral...
Almost always caused by GABHS or oral anaerobes, or both. Penicillin is the drug of choice clindamycin is an alternative. Surgical intervention with needle aspiration, incision, and drainage, or tonsillectomy may be necessary. VI. Problem Case Diagnosis. On physical examination, the 8-year-old boy had asymmetric peritonsillar tissue with displacement of the uvula to the right. CT exam confirmed the diagnosis of peritonsillar abscess.
Because CFS often has an acute flu-like presentation, can follow severe viral infection (Hotopf, Noah, and Wessely 1996 White, Thomas, Amess, Grover, Kangro, and Clare 1995) and often presents with fever, sore throat and tender lymph nodes, a major hypothesis as to its cause is that it represents a form of chronic smoldering infection, perhaps by one of the family of herpes viruses. Unfortunately, our own work has not found support for the hypothesis that active viral infection (Natelson 2001 Wallace, Natelson, Gause, and Hay 1999) has an important role in CFS.
Vagoglossopharyngeal neuralgia is described as pain in the ear, tonsillar fossa, throat, larynx, pharynx, or tongue, typically with periods of long remissions. Pain is triggered by swallowing and by other movements of the face or mouth (e.g., chewing, sneezing, coughing) (23). Vagoglossopharyngeal neuralgia occurs for many reasons, mostly compression or irritation of the nervous tissue by surrounding structures that include abscess, tumor, aneurysm, tonsillitis, arachnoiditis, styloid process, styloid ligament, vertebral artery, or trauma (24,25).
Post-operative management of these patients depends on the size of the defect and whether a graft has been placed, and in the latter case, whether such graft has been quilted into place or secured by a bolster. For primary closures or wounds allowed to granulate, a post-tonsillectomy regimen suffices, but for larger surface areas covered with skin grafts, the patient may need to remain nasogastric-tube dependent for five
I received several days ago two large packets, but have as yet read only your letter for we have been in fearful distress, and I could attend to nothing. Our poor boy had the rare case of second rash and sore throat and, as if this was not enough, a most serious attack of erysipelas, with typhoid symptoms. I despaired of his life but this evening he has eaten one mouthful, and I think has passed the crisis. He has lived on port wine every three-quarters of an hour, day and night. This evening, to our astonishment, he asked whether his stamps were safe, and I told him of one sent by you, and that he should see it to-morrow. He answered, I should awfully like to see it now so with difficulty he opened his eyelids and glanced at it, and, with a sigh of satisfaction, said, All right. Children are one's greatest happiness, but often and often a still greater misery. A man of science ought to have none--perhaps not a wife for then there would be nothing in this wide world worth caring for,...
The case involved a board-certified otolaryngologist who scheduled a nonurgent tonsillectomy for his 49-year-old male patient. The patient asked whether the procedure would help his snoring. Examining the patient further, the physician diagnosed mild sleep apnea and recommended surgical treatment. The patient testified at trial that he heard the doctor say that the doctor would trim his uvula, but the physician's notes indicated surgery discussed, risks, and complications, schedule tonsillectomy, septoplasty, UVPP (uvulopharyngoplasty) (51). In fact, the defendant physician performed the UPPP procedure. At no time did the physician advise his patient as to any nonsurgical alternatives to remedy his snoring.
Another potential limitation of CPAP therapy is its application in the pediatric patient population. While tonsillectomy and adenoidectomy is the mainstay of treatment for pediatric OSA, a small but significant portion of pediatric patients with OSA will have persistent sleep-disordered breathing postoperatively, indicating a craniofacial etiology for their disease (121,122). CPAP is thus indicated for treatment until such time that surgical intervention can be performed to correct the skeletal abnormality predicating the disease. Surprisingly, CPAP is relatively well-tolerated in a large percentage of these patients, with studies indicating up to 80 adherence (123,124) however, attaining adherence in pediatric patients intolerant of CPAP is fairly difficult.
Chronic fatigue syndrome (CFS) is a condition of unknown etiology that is diagnosed based on patient report of an array of clinical symptoms, generally in the absence of an organic or inciting etiology. Key diagnostic features are severe fatigue of more than 6 months duration and a subset of other symptoms that can include impairments of memory or the ability to concentrate, tender lymph nodes, myalgia, arthralgia, headache, cognitive disturbances, low-grade fever, disturbed sleep, sore throat, and postexertional fatigue (Afari and Buchwald 2003 Fukuda, Straus, Hickie, Sharpe, Dobbins, and Komaroff 1994). Most patients with CFS have significant functional impairment (Buchwald, Pearlman, Umali, Schmaling, and Katon 1996) and at least one sleep disorder (Buchwald, Pascualy, Bombardier, and Kith 1994 Morriss, Sharpe, Sharpley, Cowen, Hawton, and Morris 1993).
OSA is becoming an increasingly recognized precipitant of sleepwalking (107,108). Guilleminault et al. (107) described 84 children (5 with sleep terrors and 79 with both sleep terrors and sleepwalking). Fifty-one (61 ) of 84 children with parasomnia had a diagnosis of an additional sleep disorder 49 with SDB and two with RLS. Forty-three of 49 children with SDB were treated with tonsillectomy, adenoidectomy, and or turbinate revision. In all 43 children who received surgery, PSG performed three to four months later indicated the disappearance of SDB. The recordings also showed an absence of confusional arousals. In all surgically treated cases, parents also reported subsequent absence of the parasomnia. Parasomnias persisted in the six children who were untreated for SDB. Guilleminault et al. (109) studied CAP in 32 chronic sleepwalkers as well as age-matched normal controls and patients with mild SDB. More than 90 of these patients with mild SDB had UARS. Sleepwalkers on a...
Bacteria and archaebacteria, the most abundant single-celled organisms, are commonly 1-2 m in size. Despite their small size and simple architecture, they are remarkable biochemical factories, converting simple chemicals into complex biological molecules. Bacteria are critical to the earth's ecology, but some cause major diseases bubonic plague (Black Death) from Yersinia pestis, strep throat from Streptomyces, tuberculosis from Mycobacterium tuberculosis, anthrax from Bacillus anthracis, cholera from Vibrio cholerae, food poisoning from certain types of E. coli and Salmonella.
Clearly all persons who do considerable writing do not develop writer's cramp. Likely, analogously, many patients who have blepharospasm have a history of eye symptoms, such as dry eye, before the onset of the dystonia. Patients with focal laryngeal dystonia, spasmodic dyspho-nia, often have a history of a sore throat. Hence, the most likely scenario is that, like most diseases, focal dystonias are products of a genetic background and an environmental insult. That is, for example, writer's cramp develops with excessive writing only in those persons who are genetically predisposed. There is evidence that there is a genetic influence in the focal dystonias.
Inhaled corticosteroids are generally well tolerated. In contrast to systemically administered corticosteroids, inhaled agents are either poorly absorbed or rapidly metabolized and inactivated and thus have greatly diminished systemic effects relative to oral agents. The most frequent side effects are local they include oral candidiasis, dysphonia, sore throat and throat irritation, and coughing. Special delivery systems (e.g., devices with spacers) can minimize these side effects. Some studies have associated slowing of growth in children with the use of high-dose inhaled corticosteroids, although the results are controversial. Regardless, the purported effect is small and is likely outweighed by the benefit of control of the symptoms of asthma.
A number of different species of bacteria can infect the upper respiratory system. Some, such as Haemophilus influenzae and -hemolytic streptococci of Lancefield group C, can cause sore throats but generally do not require treatment because the bacteria are quickly eliminated by the immune system. Other infections require treatment because they are not so easily eliminated and can cause serious complications. Strep Throat (Streptococcal Pharyngitis) Sore throat is one of the most common reasons that people in the United States seek medical care, resulting in about 27 million doctor visits per year. Many of these visits are due to a justifiable fear of streptococcal pharyngitis, commonly known as strep throat.
The reported symptoms of avian influenza in children have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications (Tab. 2). The majority of children have presented with fever and respiratory symptoms, although in the Vietnam cases, diarrhea was prominent. Notably,
Primary infection with EBV may cause a syndrome characterized by malaise, fever, headaches, and sore throat. PTLD may develop at any time posttransplantation manifesting as a mononucleosis syndrome with fever, adenopathy, and sore throat fever of unknown origin allograft dysfunction respiratory symptoms with pulmonary infiltrates and weight loss. The definitive diagnosis of PTLD relies on histopathologic examination of biopsy specimens. Quantitative PCR techniques may help determine patients at high risk for the development of this disease before overt signs and symptoms manifest however, this approach remains experimental.
Streptococcus pyogenes was introduced in the chapters on skin and respiratory infections as the cause of strep throat, scarlet fever, and other conditions. It is also a common cause of wound infections, which have generally been easy to treat since the bacteria are consistently susceptible to penicillin. Occasionally, however, S. pyogenes infections can progress rapidly, even leading to death despite antimicrobial treatment. These more severe infections are called invasive and include pneumonia, meningitis, puerperal or childbirth fever, necrotizing fasciitis or flesh-eating disease, and worst of all, streptococcal toxic shock, which is similar to staphylococcal toxic shock. Deaths from invasive strep infections have caused widespread popular concern as S. pyogenes became the flesh-eating bacterium of the tabloid press. This section will focus on necrotizing fasciitis (figure 27.5), a rare but dramatic complication of S. pyogenes infection. Streptococcus pyogenes, p. 565...
Patients with NHL of the lip, buccal mucosa, gingiva, floor of mouth, tongue or palate usually present with ulcer, swelling, discoloration, pain, paraesthe-sia, anaesthesia, or loose teeth. Those with NHL of the Waldeyer ring (tonsils) or oropharynx usually present with a sensation of fullness of the throat, sore throat, dysphagia, or snoring. The high-grade tumours often show rapid growth. Systemic symptoms such as fever and night sweat are uncommon 201 . Clinical examination reveals solitary or multiple lesions, in the form of an exo-phytic mass, ulcer or localized swelling. Some cases may mimic inflammatory
That reside harmlessly in the throat often cause a type of hemoly-sis called alpha hemolysis, which is characterized by a zone of greenish clearing around the colonies. In contrast, Streptococcus pyogenes, which causes strep throat, causes beta hemolysis, which is characterized by a clear zone of hemolysis. Still other bacteria have no effect on red blood cells. Streptococcus pyogenes, p. 565
During throat infection by S. pyogenes, several streptococcal peptides are generated by antigen-presenting cells (APCs). These peptides, mainly from the M protein (Figure 9.3), are associated with HLA class II molecules (Figure 9.2) and, when presented to T cells, are able to trigger an inflammatory immune response. Since cytokines are likely to be important second signals following an infection triggering effective immune response in most individuals and probably a deleterious response in autoimmune disease, the cytokine production by mononuclear cells from RF RHD patients was studied by several groups.
On examination, the 10-year-old girl had clear drainage involving both eyes, but no pruritus or pain. She complained of sore throat. Conjunctivae were injected in both eyes. No foreign body was visible. Eyelids were not edematous, and extraocular muscles and vision were intact. Preauricular adenopathy was noted bilaterally, and the oropharynx was injected without exudate. Clinical diagnosis is viral conjunctivitis (probably adenovirus). Patient's mother was counseled about use of cool compresses for comfort and importance of washing hands to prevent transmission. Family was asked to follow up in 3 days, and to call back sooner if worrisome features develop or symptoms worsen.
No one looks forward to the cold season when many of us come down with a sore throat, the sniffles, and a cough and feel utterly dreadful. A lot of chicken soup and TLC usually is the cure. Chicken soup is not a drug but it does contain a mucous-thinning amino acid called cysteine and is considered grandma's remedy for the common cold. Actually, time is the best cure and most people feel better in 7 to 10 days with or without chicken soup.
Pneumonia is an infection in the lungs that can be caused by a variety of microorganisms including viruses, bacteria, or fungus. It often starts after an upper respiratory infection. Symptoms can occur 2 to 3 days after a cold or sore throat. Symptoms include fever, chills, cough, rapid breathing, wheezing and or grunting respirations, labored breathing, vomiting, chest pain, abdominal pain, loss of appetite, decreased activity, and, in extreme cases, signs of hypoxia (low oxygen levels) or cyanosis such as a bluish tint around the mouth or fingernails. There are vaccines to prevent certain types of pneumonia. Pneumonia is treated based on the underlying cause. Viral pneumonia is usually treated symptomati-cally. That is, bronchodilators, antipyretics (fever reducing), analgesics such as ibuprofen, cough medications that include expectorants, mucolytics, as well as suppressants to help the patient sleep. Bacterial and fungal pneumonia are treated with antimicrobials as well as the...
Streptococcus pyogenes, the cause of strep throat, is a Gram-positive coccus that grows in chains of varying lengths (figure 23.2). It can be differentiated from other steptococci that normally inhabit the throat by its characteristic colonial morphology when grown on blood agar. Streptococcus pyogenes produces hemolysins, enzymes that lyse red blood cells, which result in the colonies being surrounded by a zone of -hemolysis (see figure 22.6). Because of their characteristic hemolysis, S. pyogenes and other streptococci that show a similar phenotype are called -hemolytic streptococci. In contrast, species of Streptococcus that are typically part of the normal throat flora are either non-hemolytic, or they produce a-hemolysis, characterized by a zone of incomplete, often greenish clearing around colonies grown on blood agar. streptococcal hemolysis, p. 94
Streptococcal infections spread readily by respiratory droplets generated by yelling, coughing, and sneezing, especially in the range of about 2 to 5 feet from an infected individual. If strep throat is untreated, the person may be an asymptomatic carrier for weeks. People who carry the organism in their nose spread the streptococci more effectively than do pharyngeal carriers. Anal carriers are not common but can be a dangerous source of nosocomial infections. Epidemics of strep throat can originate from food contaminated by S. pyogenes carriers. Some people become long-term carriers of S. pyogenes. In these cases, the infecting strain usually becomes deficient in M protein and is not a threat to the carrier or to others. The peak incidence of strep throat occurs in winter or spring and is highest in grade school children. Among students visiting a clinic because of sore throat at a large West Coast university, less than 5 had strep throat. With some groups of military recruits,...
18FDG PET is valuable for the evaluation of recurrent head and neck tumors (67). High sensitivity and specificity have been recorded for the use of 18FDG PET in this circumstance. However, there are a number of normal variants for the uptake of 18FDG in the head and neck that present potential pitfalls with false positive interpretation, particularly when normal symmetrical uptake is lost. For example, lymphatic tissue in Waldeyer's ring often shows moderate uptake of 18FDG. Apparent increased uptake is seen on the untreated side after tonsillectomy, soft palatal resection, and also radiotherapy to the head and neck, and this should not be mistaken for pathology. It is in this circumstance, that careful correlation with the clinical history and also co-registered PET and MRI or CT imaging is especially helpful (9). False positive uptake has been observed within the early period after radiotherapy due to the inherent inflammatory reaction, but this usually subsides by four to six...
Many different kinds of infectious agents can produce the same symptoms and signs of respiratory disease. Emotional stress significantly increases the risk of contracting a cold, but exposure to cold temperatures probably does not. Persons suffering a cold are most likely to transmit it if symptoms are severe, and during the first few days of illness. Adenovirus infections can mimic colds, pinkeye, strep throat, and whooping cough.
Pulmonary complications of giant cell arteritis occur in approximately 10 per cent of patients. The respiratory symptoms can be the presenting features, and they include cough, sore throat, and hoarseness. A population-based study of 94 patients with giant cell arteritis found pulmonary symptoms in up to 30 per cent. It should be considered in any older patient with a new cough or throat pain without obvious cause. Disease of the small airways has been observed in 46 per cent of patients with giant cell arteritis however, the abnormalities have not been significant. Chest radiograph abnormalities consist of pulmonary nodules, interstitial infiltrates, and occlusion and aneurysms of the pulmonary artery.
Hodgkin lymphoma (HL) is predominantly a nodal-based disease, and primary extranodal presentation is very rare. When it presents in extranodal tissues, the Waldeyer ring, particularly the palatine tonsil, is a common site 1274,1756 . Most patients present with localized disease (stage I II), with symptoms of chronic tonsillitis or tonsillar enlargement, with or without enlarged cervical lymph nodes. Other reported sites include the oropharynx 44,1756 , alveolar crest of mandible 1659 , and maxillary gingiva 2554 .
Patient presents with fever, sore throat, and tender cervical adenopathy. Headache, nausea, vomiting, and abdominal pain are common. Marked erythema of throat is present, with hyperemic, exudative tonsils and palatal petechi-ae. Nasal congestion and rhinorrhea is usually absent. More common in late winter and early spring. 6. Other causes. The most common viral cause of pharyngitis is rhinovirus (approximately 20 ). Coronavirus, influenza, parainfluenza, and cytomegalovirus are other viral causes. Patients with HIV acute retroviral syndrome often present with sore throat, fever, lymphadenopathy, lethargy, and nonexuda-tive tonsillitis. Other bacterial causes include mycoplasma, Neisseria gonorrhea, and Chlamydia pneumoniae. D. Peritonsillar Abscess. The most common deep neck infection in children. Occurs in older children and younger adolescents. Initial presentation is fever and sore throat followed by gradual onset of dysphagia, dysphonia ( hot-potato voice), drooling, and...
It has been tacitly believed that only certain streptococcal strains are rheumatogenic even in patients not receiving prophylaxis.121-123 Streptococci with large mucoid capsules and those with high M protein load are particularly virulent.10 Whereas strains such as the M type 5 18' 3' 6' 14' 19' and 24 have resulted in large epidemics' others such as M2' 4' 12' and 28 have not caused significant RF even during epidemics of streptococcal sore throat.10 Bacterial strains have shown unexplained spontaneous alterations in virulence over the years'10'124'125 and such a change has been proposed to account for the resurgence of RF in the United States.126 Similarly' streptococcal types common during previous epidemics are now being isolated less frequently' which may partially account for a decline in the prevalence of RHD.
The term virulence is a quantitative term that refers to the degree of pathogenicity of an organism it reflects both the proportion of infected people who have obvious symptoms and the relative severity of those symptoms. An organism that is described as highly virulent has more disease-promoting attributes than do other less virulent strains of the same species the virulent organism is more likely to cause disease, particularly severe disease, than might otherwise be expected. Streptococcus pyogenes causes strep throat, for example, but certain strains are particularly virulent, causing diseases such as necrotizing fasciitis ( flesh eating disease ). necrotizing fasciitis, p. 696 Acute infections are characterized by symptoms that have a rapid onset but last only a short time an example is strep throat.
A 26-year-old woman, a kindergarten teacher, had pharyngitis last year treated with ampicillin for 3 days. She stopped the ampicillin when she learned her throat culture was negative. Three days after she stopped the ampicillin, she developed a rash. Her physician noted symmetrical erythematous confluent macular-papular eruptions on her extremities with no urticaria. The physician diagnosed non-IgE-mediated ampicillin eruption. Now the patient returns with new fever and sore throat. She has no cough or rash. Her physical examination is normal except for fever, tender anterior cervical lymphadenopathy, and tonsillar exudate. Her rapid streptococcal test of a pharyngeal specimen is positive. Which of the following would be the most appropriate treatment for this patient
In late August 1999, eight concurrent cases of patients having encephalitis and or profound muscle weakness surfaced in Queens, New York. Geographically, the reported cases were traced to a two by two-mile area of a residential neighborhood, immediately sparking exposure concerns. By the end of the year, 59 patients were hospitalized in New York City, and seven deaths were reported.33 Cases presented with a mild 3-6-day symptomatic period, including sudden onset of malaise, nausea, vomiting, headache, rash, cough, and sore throat. Less than 1 of those infected developed neurologic disease (i.e., encephalitis) 34 reported deaths were among the young, elderly, or immunocompromised. Also during this initial period it was noticed that several birds throughout the New York area were dying. The birds seemed to be dying from a neurological condition. Samples were sent to the CDC for identification.
Rabies is one of the most feared of all diseases because its terrifying symptoms almost invariably end with death. Like many other viral diseases, it begins with fever, head and muscle aches, sore throat, fatigue, and nausea. The characteristic symptom that strongly suggests rabies is a tingling or twitching sensation at the site of viral entry, usually an animal bite. These early symptoms generally begin 1 to 2 months after viral entry and progress rapidly to symptoms of encephalitis, agitation, confusion, hallucinations, seizures, and increased sensitivity to light, sound, and touch. The body temperature then rises steeply, and increased salivation combined with difficulty swallowing result in frothing at the mouth. Hydrophobia, painful spasm of the throat and respiratory muscles provoked by swallowing or even seeing liquids, occurs in half the cases. Coma develops, and about 50 of patients die within 4 days of the first appearance of symptoms, the rest soon after.
The first symptoms of HIV disease appear after an incubation period of 6 days to 6 weeks and usually consist of fever, headache, sore throat, muscle aches, enlarged lymph nodes, and a generalized rash. Some subjects develop central nervous system symptoms ranging from moodiness and confusion to seizures and paralysis. These symptoms constitute the acute retroviral syndrome (ARS), and they typically subside within 6 weeks. Many HIV infections are asymptomatic, however, or the symptoms are mild and attributed to the flu. Following the acute illness, if any, there is an asymptomatic period that typically lasts for years, even though the disease advances in the infected person and can be transmitted to others. The asymptomatic period may end with persistent enlargement of the person's lymph nodes, a condition known as lymphadenopathy syndrome (LAS). Other symptoms heralding immunodeficiency include fever, weight loss, fatigue, and diarrhea, referred to as the AIDS-related complex (ARC)....
Acute pharyngitis is inflammation of the throat. It is more commonly known as a sore throat. The patient may have an elevated temperature, a cough, and pain when swallowing. Pharyngitis is caused by a virus (viral pharyngitis) or by bacteria (bacteria pharyngitis) such as the beta-hemolytic streptococci. Patients know this as strep throat. A throat culture is taken to rule out beta-hemolytic streptococcal infection. Sometimes patients experience acute pharyngitis along with other upper respiratory tract disease such as a cold, rhinitis, or acute sinusitis. Patients who have a viral pharyngitis are given medications that treat the symptoms rather than attacking the underlying virus. Acetaminophen or ibupro-fen is given to reduce the patient's temperature and discomfort. Saline gargles, lozenges, and increased fluid are usually helpful to soothe the sore throat.
Streptococcal pharyngitis typically is characterized by redness of the throat, with patches of adhering pus and scattered tiny hemorrhages, and fever. The lymph nodes in the neck are enlarged and tender. Abdominal pain or headache may be prominent in older children and young adults. Not usually present are red, weepy eyes, cough, or runny nose. Most patients with streptococcal sore throat recover spontaneously after about a week. In fact, many infected people have only mild symptoms or no symptoms at all.