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Streptococcal sore throat resembles (and cannot be reliably distinguished clinically from) pharyngitis caused by adenoviruses, Epstein-Barr virus, Arcanobacterium haemolyticum (which also may cause a rash), and other agents Pharyngitis and lymphadenopathy are common findings in primary HIV infection Generalized lymphadenopathy, splenomegaly, atypical lymphocytosis, and a positive serologic test distinguish mononucleosis from streptococcal pharyngitis Diphtheria is characterized by a pseudomembrane; candidiasis shows white patches of exudate and less erythema; and necrotizing ulcerative gingivostomatitis (Vincent s fusospirochetal disease) presents with shallow ulcers in the mouth Retropharyngeal abscess or bacterial epiglottitis should be considered when odynophagia and difficulty in handling secretions are present and when the severity of symptoms is disproportionate to findings on examination of the pharynx
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May 4, 2015 · PDF file open and show on the windows form in DOT NET Application by using C# code.Duration: 10:16
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Strep throat is characterized by a sudden onset of fever, sore throat, pain on swallowing, tender cervical adenopathy, malaise, and nausea The pharynx, soft palate, and tonsils are red and edematous There may be a purulent exudate The Centor clinical criteria for the diagnosis of streptococcal pharyngitis are temperature > 38 C, tender anterior cervical adenopathy, lack of a cough, and pharyngotonsillar exudate The rash of scarlet fever is diffusely erythematous, resembling a sunburn, with superimposed fine red papules, and is most intense in the groin and axillas It blanches on pressure, may become petechial, and fades in 2 5 days, leaving a fine desquamation The face is flushed, with circumoral pallor, and the tongue is coated with enlarged red papillae (strawberry tongue)
Antimicrobial therapy has a modest effect on resolution of symptoms and primarily is administered for prevention of complications Antibiotic therapy can be safely delayed until
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mal skin by contact with other infected individuals or by preceding streptococcal respiratory infection
the diagnosis is established on the basis of a positive antigen test or culture Empiric therapy usually is not a cost-effective approach to the management of most adults with pharyngitis because in typical clinical settings, the prevalence of streptococcal pharyngitis is likely to be no more than 10 20% and the positive predictive value of clinical criteria is low Clinical criteria, such as the Centor criteria, are useful for identifying patients in whom a rapid antigen test or throat culture is indicated Patients who meet two or more of these criteria merit further testing When three of the four are present, laboratory sensitivity of rapid antigen testing exceeds 90% When only one criterion is present, streptococcal pharyngitis is unlikely In high-prevalence settings or if clinical suspicion for streptococcal pharyngitis is high, a negative antigen test or culture should be confirmed by a follow-up culture
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Impetigo is a focal, vesicular, pustular lesion with a thick, amber-colored crust with a stuck-on appearance Erysipelas is a painful superficial cellulitis that frequently involves the face It is well demarcated from the surrounding normal skin It affects skin with impaired lymphatic drainage, such as edematous lower extremities or wounds
Cultures obtained from a wound or pustule are likely to grow group A streptococci Blood cultures are occasionally positive
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Parenteral antibiotics are indicated for patients with facial erysipelas or evidence of systemic infection Penicillin, 2 million units intravenously every 4 hours, is the drug of choice However, staphylococci infections may at times be difficult to differentiate from streptococcal infections In practice, initial therapy for patients with risk factors for Staphylococcus aureus (eg, injection drug use, diabetes, wound infection) should cover this organism Nafcillin, 15 g every 6 hours intravenously, and cefazolin, 1 g intravenously or intramuscularly every 8 hours, are reasonable choices In the patient with a serious penicillin allergy (ie, anaphylaxis), vancomycin, 1000 mg intravenously every 12 hours, should be used Patients who do not require parenteral therapy may be treated with amoxicillin, 750 mg twice daily for 7 10 days A first-generation oral cephalosporin, eg, cephalexin, 500 mg four times daily, or clindamycin, 300 mg orally three times daily, is an alternative to amoxicillin
Penicillin VK, 500 mg orally four times a day (or amoxicillin, 750 mg orally twice daily), is effective, but compliance may be poor after the patient becomes asymptomatic in 2 4 days
Erythromycin, 500 mg orally four times a day, or azithromycin, 500 mg orally once daily for 3 days, is an alternative for the penicillin-allergic patient Macrolides are less effective than penicillins and are considered second-line agents Macrolide-resistant strains almost always are susceptible to clindamycin, a suitable alternative to penicillins; a 10-day course of 300 mg orally twice daily is effective
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