ONE OF THE MOST FREQUENT DISEASES AND THE MOST FREQUENT CAUSES OF DISAGREEMENT BETWEEN THE THERAPISTS
Why does the acute pharyngitis concern us:
Careful diagnosis on certain rare, but serious and even life-threatening causes of throat infections that require even ventilator secure.
• Bacterial tracheitis
• Deep neck infections
Diagnosis on patients with B hemolytic streptococcus group A and require antibiotic treatment -Avoid overtreatment.
Proper implementation of international guidelines for detecting and treatment of beta-hemolytic streptococcus group A.
• 200 medical visits per 1000 people in the general population annually
• Double frequency than any other infectious disease
• 5-7 infections per year in children
• 3- 4 infections per year in adults
• Most pathogens conceal serious, even life-threatening, complications
Special infections can be life-threatening for the patient and the physician should be concerned, when a simple pharyngitis has certain additional features such as:
• Disproportionately toxic appearance of the patient
• Failed previous antibiotic treatment
• Indications of airway obstruction and respiratory distress.
STREPTOCOCCUS PHARYNGITIS CLINICAL VIEW
• Incubation: 2 to 4 days
• Duration 4 days
• Acute onset of sore throat
• Pain on swallowing
• Abdominal pain
• Nausea – Vomiting
• Erythema throat – tonsils
• Swelling of the throat – tonsils
• Petechiae of soft palate
• Anterior cervical lymphadenopathy
• Shellfish rash
Non typical points
• Anterior stomatitis
• Extensive ulcerative lesions
Acute rheumatic fever
• 20 million people affected in the developing world
• 000 new cases per year
• 000 deaths per year
• 1st cause of cardiovascular death in people under 50 years of age in the developing world
• Average incidence rate 19 per 100,000 of population
• In developed countries: 2-14 per 100,000 of population
Treating Acute Pharyngitis – Objectives
• Prevention of post streptococcal complications
• Decrease intensity – duration of symptoms and complications:
• First day but generally 2.5 days severe pharyngitis, and more than 3 days with 4 Centor criteria
• Prevention of transmitting, especially in pediatrics
Antimicrobial treatment: proven benefit only in GAS and Corynebacteria-Neisseria
Generally not necessary in asymptomatic patients except:
• Individuals with a history of rheumatic fever
• Patients experiencing pharyngitis during epidemics of rheumatic fever and streptococcal glomerulonephritis
• Domestic dispersion
Treatment for Acute Pharyngitis
• Resistance on sulfonamides and tetracyclines
• There are no reports of penicillin resistance in GAS only cases of resistance (MIC> 32)
• Resistance presents macrolides with different rates per region
• (5-38% erythromycin, ~ 10% clarithromycin)
REPETITIVE TREATMENT -AFTER POSITIVE REPEATED RSAT:
• Amoxicillin-clavulanate or benzathine penicillin or cephalosporin or clindamycin
Sample collection requirements
• Proper technique and collection time
• The sample should always be collected before the intake of antibiotics for the treatment of Acute Pharyngitis
• Samples must be collected by vigorous rubbing on both tonsils as the posterior wall pharynx.
• The tongue, oral mucosa or hard palate, are not correct sampling areas because streptococcus streptococcus does not grows there.
• The compliance of the patient to the proper collection and the ability of the physician, contribute to increase the reliability of the test.
• Especially on children, proper sample collection is considered necessary
4.800 patients each year with valid and effective diagnosis, immediate treatment and complete medical attendance, without requiring re- testing.
Alleviation of human suffering and disease impact, on patients and their families.
Individual treatment of each patient and systematic processing, even on demanding medical cases.
Accurate diagnosis using up to date medical equipment, at home or in the clinic.