Professional Documents
Culture Documents
IV Module
CASE I
“Kizzin Cuzzins”
Topics for Case 1
Grp A B-hemolytic Streptococcus
C. diphtheriae
Grp C B-hemolytic Streptococcus Candida Albicans
N. gonorrheae
S. aureus
Adenovirus
Epstein Barr virus
Coxsackie virus (Herpangina)
Herpes simplex virus
Adenovirus
Parainfluenza virus
Influenza virus
Mumps
Questions/Tasks
1. How would you approach the problem of sore throat?
2. What are the etiologic agents of Tonsillopharyngitis in
children?
3. What is/are the distinguishing feature/s of
Tonsillopharyngeal diphtheria?
4. What differentiates the ‘bull-neck” appearance of
Diphtheria from Mumps?
5. What laboratory tests/procedures is/are indicated to
confirm the diagnosis of Diphtheria?
6. What complications of Diphtheria can be anticipated?
7. Give the curative and preventive principles of therapy
for diphtheria
8. What is the drug of choice and acceptable alternative
therapies for Streptococcal tonsillopharyngitis?
9. What is the rationale and goals of treatment of Grp A
B-hemolytic Streptococcal tonsillopharyngitis?
Case 1 – “Kizzin Cuzzins”
• Em-em, 9 years old; female
• Chief complaint: high fever and sore
throat with difficulty of swallowing
accompanied by vomiting and chilly
sensation.
• Mother Had “colds” characterized by
watery nasal discharge, sneezing and an
itchy throat 3 days earlier
• PE: Temp. 39.40C; CR-120/min.; RR-
33/min.; appeared acutely ill and toxic.
Case 1 – “Kizzin Cuzzins
• Posterior pharynx, palatine tonsils and
uvula acutely inflamed, bright red and
edematous; tonsils markedly enlarged
(“kissing”) with several discrete white to
gray exudates noted over each tonsillar
area.
• Right tympanic membrane was dull and
slightly edematous
Question 1:
How would you approach
the problem of sore
throat?
Approach
• The best presenting manifestation for this
patient is sore throat.
• “Sore throat” is one of the most common
complaints of children seen for medical
treatment.
• Infection may involve the pharynx diffusely
(acute pharyngitis) or localized predominantly to
the palatine tonsils (acute tonsillitis).
• The diagnosis is made by carefully visualizing the
throat. Erythema, exudates and swollen tonsils
are all signs of infection.
• The clinician faces the basic problem of
differentiating self-limiting viral infections
from bacterial infections that require
antibiotic tx
Question 2:
What are the etiologic
agents of
Tonsillopharyngitis in
children?
Etiologic agents
• Eichenwald estimates that 80 –90% of ATP’s
are due to viral agents. Adenovirus,
Parainfluenzae and influenzae etc. have
implicated in infections of the pharynx and
tonsils.
• Enteroviruses, EBV, Herpes simplex virus may also present
as oral lesions
• GABHS is the most common cause of bacterial
infection in the pharynx
– Others: Group C;S. aureus, Gram (-) organisms, M.
pneumoniae and rarely N. gonorrhea and
Corynebacterium diphtheriae. ( see p.1396 NELSON)
• Candida occur in the immunocompromised or
those chronically treated with antibiotics
Common Etiologic Agents for
Acute Pharyngitis
Types of Pharyngeal Lesions: (in diminishing frequency)
• Erythematous – S. pyogenes, Adenovirus,
C.pneumoniae
• Follicular – Adenovirus, S. pyogenes (to a much lesser
degree)
• Exudative – C. diphtheriae, EBV, S. pyogenes
• Ulcerative – Herpes simplex, Enterovirus
• Petechial – S. pyogenes, EBV
Modified from:
Cherry JD, Textbook of Pediatric Infectious Disease
4th edition
Epstein-Barr virus
infection
Infectious mononucleosis
• The tonsils are swollen and
covered with uniform white
exudates. Uvula looks
swollen and the patient’s
speech is nasal
• The typical exudate are
patches forming thick
plaques of opaque white
membrane
Anginose variety of
Infectious Mononucleosis
Epstein-Barr virus
infection
Infectious Mononucleosis
• Moderate leukocytosis
develops between the 1st and
2nd week – the result of an
absolute increase in
circulating lymphocytes many
of which are abnormal
• A large number of atypical
mononuclear cells in
peripheral blood is one of the
characteristics of the
disease Atypical lymphocytes
Herpangina (Enterovirus)
Herpangina:
• Caused by type A
coxsackievirus
• Characterized by an
acute onset with high
fever, sore throat and
dysphagia.
• Throat is inflamed and
small discrete vesicles
surrounded by a band of
erythema may be seen
scattered over the
palate, fauces and
pharynx
Herpes simplex Infection
Herpetic stomatitis:
• Presents as vesicular
(ulcerative) eruptions
but tend to affect the
anterior half of the
buccal cavity whereas
herpangina is confined
to the posterior
Herpetic gingivostomatitis
Herpes simplex Infection