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Academic Emergency Medicine : Official... Apr 2021
Topics: Adrenal Cortex Hormones; Humans; Intubation, Intratracheal; Pharyngitis; Postoperative Complications
PubMed: 32989848
DOI: 10.1111/acem.14143 -
Medicina 2022Since May 2022, monkeypox cases have been reported in non-endemic countries with different characteristics from the traditional description of the disease, predominantly...
Since May 2022, monkeypox cases have been reported in non-endemic countries with different characteristics from the traditional description of the disease, predominantly in men who have sex with men, with possible sexual transmission and with no documentation of mortality to date. We report what would be the first patient diagnosed in Argentina with no travel nexus to countries with viral circulation. Young, bisexual man, on antiretroviral HIV pre-exposure prophylaxis, whose presentation was exudative pharyngitis with no other documented aetiology and lymphadenopathy that progressed to necrosis, presence of characteristic asynchronous lesions on the face, neck, abdomen, extremities, and genitals, in a total of no more than 25. Polymerase-chain-reaction assay of samples from skin lesions, fauces exudate and semen were positive for monkeypox. Pharyngeal involvement with the presence of exudate after ruling out other infections could be a rarity for the epidemic form of the disease. The finding of the virus in semen, already reported in other publications, is still not enough to confirm the sexual route as a form of transmission. In conclusion: Our case warns about other possible forms of presentation of epidemic monkeypox and the need to increase the level of suspicion for its early detection as a strategy to prevent dissemination and protect vulnerable groups. Even more information is required to determine the sexual transmission of this disease.
Topics: Argentina; Homosexuality, Male; Humans; Male; Mpox (monkeypox); Pharyngitis; Sexual and Gender Minorities
PubMed: 36220036
DOI: No ID Found -
Frontiers in Immunology 2022Reports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging... (Review)
Review
BACKGROUND
Reports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging in these regions due to a higher incidence of infectious illnesses and significant resource constraints. Herein, we present our experience from North India regarding the diagnosis and management of PFAPA syndrome.
METHODS
We reviewed cases of non-monogenic periodic fever syndrome diagnosed at our center from January 2011 to December 2021. A total of 17 children who fulfilled the Marshall criteria for PFAPA syndrome were included. Data regarding basic clinical features, treatment/outcome, and performance of the recently proposed Eurofever/PRINTO and Takeuchi criteria were analyzed.
RESULTS
Besides recurrent fever, the triad of oral aphthae, pharyngitis, and adenitis was noted in only 18% of patients. Episodes of exudative pharyngitis/tonsillitis were documented in 24%. These figures were lower than the values reported from developed countries. The Takeuchi and Eurofever/PRINTO criteria were fulfilled in 76% and 71% cases, respectively. In addition to antipyretics and supportive care, intermittent steroid therapy was the main treatment modality used. Additional treatment with colchicine ( = 3) and thalidomide ( = 1) was used successfully in a few patients. Before the diagnosis of PFAPA, all patients had received multiple courses of antimicrobials (without microbiological confirmation). These included multiple courses of antibacterials for fever, pharyngotonsillitis, and/or cervical adenitis in all patients and antivirals for fever and aphthous stomatitis in a patient. Empiric antitubercular therapy had also been administered in two patients.
CONCLUSIONS
A significant proportion of patients with PFAPA seem to remain undiagnosed in the Indian subcontinent. Increased awareness and improvement in basic healthcare facilities are crucial in enhancing the recognition of PFAPA, which would eliminate the unprecedented scale of undesirable antimicrobial use in such children.
Topics: Antipyretics; Antiviral Agents; Child; Colchicine; Developing Countries; Fever; Humans; Lymphadenitis; Pharyngitis; Steroids; Stomatitis, Aphthous; Syndrome; Thalidomide; Tonsillitis
PubMed: 36203600
DOI: 10.3389/fimmu.2022.958473 -
The Pediatric Infectious Disease Journal Dec 2023Group A streptococci (GAS) are a major cause of pharyngitis in children. Recently, there were severe GAS outbreaks. The aims of this study were to assess pharyngeal...
BACKGROUND
Group A streptococci (GAS) are a major cause of pharyngitis in children. Recently, there were severe GAS outbreaks. The aims of this study were to assess pharyngeal colonization prevalence in healthy children, to assess different diagnostic definitions for GAS pharyngitis and to estimate incidence rates for these infections.
METHODS
A 2-year longitudinal study was conducted in healthy children in the United States. Pharyngeal swabs were cultured every 3 months for GAS colonization. Serum antistreptolysin O, antideoxyribonuclease B (DNaseB) and antistreptococcal C5a peptidase (SCP) antibody titers were assessed at baseline. When participants developed a sore throat, pharyngeal swabs were collected for rapid antigen detection test (RADT) and culture, and antibody titers were determined in serum samples. A range of case definitions were used for GAS pharyngitis.
RESULTS
A total of 422 children 3-12 years old were enrolled (140, 141 and 141 were 3-5, 6-9 and 10-12 years of age, respectively). The overall prevalence of GAS colonization during the study was 48%. Baseline antistreptolysin O, anti-DNaseB and anti-SCP antibody titers were higher for children older than 5 years. The incidence of GAS pharyngitis per 100 person-years was 15.9 for RADT/culture-proven and 4.6 for serologically confirmed pharyngitis.
CONCLUSIONS
GAS throat colonization and pharyngitis were frequent in children 3-12 years old. The case definition employed impacted the measured incidence of GAS pharyngitis, with higher rates detected using RADT/culture-based definitions. These data suggest that case definition is important and that young children are exposed to GAS, which may inform plans for vaccine development and implementation.
Topics: Child; Humans; Child, Preschool; Longitudinal Studies; Antistreptolysin; Streptococcal Infections; Sensitivity and Specificity; Streptococcus pyogenes; Pharyngitis
PubMed: 37768176
DOI: 10.1097/INF.0000000000004111 -
International Journal of Occupational... 2015Ambient air pollution, as many publications indicate, may have associations with skin condition. The aim of this study has been to examine such common relations for...
OBJECTIVES
Ambient air pollution, as many publications indicate, may have associations with skin condition. The aim of this study has been to examine such common relations for cellulitis and pharyngitis. The hypothesis is that ambient ground-level ozone may help bacteria to penetrate skin or throat.
MATERIAL AND METHODS
We used the emergency department (ED) visits data in Edmonton, Canada for the period from 1992 (April) to 2002 (March). We retrieved all the diagnosed ED visits for cellulitis and pharyngitis. Case-crossover design was used to study potential association between ozone and those visits. Conditional logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (95% CI).
RESULTS
The results are reported for the interquartile range (IQR = 17.9 ppb) for 8 h maximum ozone. Positive and statistical significant results were obtained as follows: for lags from 0 to 3 (OR = 1.07, 95% CI: 1.03-1.12, lag 2); for lags from 0 to 6 days (OR = 1.08, 95% CI: 1.03-1.12, lag 3); for lags from 0 to 4 (OR = 1.06, 95% CI: 1.03-1.09, for lag 2 and 3).
CONCLUSIONS
The findings suggest the response to exposure to ambient ground-level ozone for skin and pharyngitis considered separately and jointly.
Topics: Air Pollution; Alberta; Cellulitis; Emergency Service, Hospital; Environmental Exposure; Female; Follow-Up Studies; Humans; Incidence; Male; Odds Ratio; Ozone; Particulate Matter; Pharyngitis; Retrospective Studies; Seasons; Streptococcal Infections; Streptococcus
PubMed: 26216315
DOI: 10.13075/ijomeh.1896.00267 -
Pediatric Dermatology Jul 2019A 10-year-old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky-positive desquamation, as well as... (Review)
Review
A 10-year-old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky-positive desquamation, as well as ulcerations of her oral and genital mucosa. She denied recent travel, sick contacts, or preceding and concurrent use of medications, including over-the-counter and herbal supplements. A comprehensive viral polymerase chain reaction (PCR) panel, Mycoplasma pneumoniae PCR and IgM, streptococcal molecular antigen test, urine culture, blood culture, and rheumatologic serologies were negative. Based on the patient's clinical presentation and biopsy results, she was diagnosed with idiopathic toxic epidermal necrolysis.
Topics: Adolescent; Biopsy, Needle; Female; Follow-Up Studies; Humans; Immunohistochemistry; Pharyngitis; Severity of Illness Index; Stevens-Johnson Syndrome; Streptococcal Infections; Time Factors
PubMed: 30931535
DOI: 10.1111/pde.13820 -
Enfermedades Infecciosas Y... Nov 2016Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among... (Review)
Review
Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy.
Topics: Acute Disease; Adult; Algorithms; Anti-Bacterial Agents; Humans; Penicillins; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 25869058
DOI: 10.1016/j.eimc.2015.02.010 -
Medicine Feb 2024Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal...
Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal diseases (EEDs), such as noncardiac chest pain. However, evidence demonstrating potential causal relationships is lacking. This study evaluated the potential causal relationship between GERD and EEDs, including throat and chest pain, asthma, bronchitis, chronic rhinitis, nasopharyngitis and pharyngitis, gingivitis and periodontal disease, cough, using multiple Mendelian randomization (MR) methods, and sensitivity analysis was performed. The Mendelian randomization Pleiotropy RESidual Sum and Outlier and PhenoScanner tools were used to further check for heterogeneous results and remove outliers. MR with inverse-variance weighted (IVW) showed a significant causal relationship between GERD and EEDs after Bonferroni correction. IVW results indicated that GERD increased the risk of chronic rhinitis, nasopharyngitis and pharyngitis (odds ratio [OR] = 1.482, 95% confidence interval [CI] = 1.267-1.734, P < .001], gingivitis and periodontal disease (OR = 1.166, 95% CI = 1.046-1.190, P = .001), throat and chest pain (OR = 1.585, 95% CI = 1.455-1.726, P < .001), asthma (OR = 1.539, 95% CI = 1.379-1.717, P < .001), and bronchitis (OR = 1.249, 95% CI = 1.168-1.335, P < .001). Sensitivity analysis did not detect pleiotropy. Leave-one-out analysis shows that MR results were not affected by individual single nucleotide polymorphisms. The funnel plot considers the genetic instrumental variables to be almost symmetrically distributed. This MR supports a causal relationship among GERD and EEDs. Precise moderation based on causality and active promotion of collaboration among multidisciplinary physicians ensure high-quality diagnostic and treatment recommendations and maximize patient benefit.
Topics: Humans; Nasopharyngitis; Mendelian Randomization Analysis; Gastroesophageal Reflux; Pharyngitis; Asthma; Bronchitis; Chest Pain; Gingivitis; Periodontal Diseases; Rhinitis; Genome-Wide Association Study
PubMed: 38363933
DOI: 10.1097/MD.0000000000037054 -
Microbiology Spectrum Jul 2019The human oral-nasal mucosa is the primary reservoir for infections. Although the most common infection of consequence in temperate climates is pharyngitis, the past 25... (Review)
Review
The human oral-nasal mucosa is the primary reservoir for infections. Although the most common infection of consequence in temperate climates is pharyngitis, the past 25 years have witnessed a dramatic increase in invasive disease in many regions of the world. Historically, has been associated with sepsis and fulminate systemic infections, but the mechanism by which these streptococci traverse mucosal or epidermal barriers is not understood. The discovery that can be internalized by mammalian epithelial cells at high frequencies (1-3) and/or open tight junctions to pass between cells (4) provides potential explanations for changes in epidemiology and the ability of this species to breach such barriers. In this article, the invasins and pathways that uses to reach the intracellular state are reviewed, and the relationship between intracellular invasion and human disease is discussed.
Topics: Animals; Cytoplasm; Humans; Pharyngitis; Receptors, Cell Surface; Streptococcal Infections; Streptococcus pyogenes
PubMed: 31267891
DOI: 10.1128/microbiolspec.GPP3-0049-2018 -
PloS One 2014Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.
OBJECTIVE
To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.
DATA SOURCES
MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.
STUDY SELECTION
Culture as reference standard, all languages.
DATA EXTRACTION AND SYNTHESIS
Study characteristics, quality.
MAIN OUTCOME(S) AND MEASURE(S)
Sensitivity, specificity.
RESULTS
We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I(2)] 88%) and specificity (I(2) 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79-92%) and the pooled specificity was 92% (95% CI, 88-95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I(2) 61%) and specificity (I(2) 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81-91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I(2) 88%).
CONCLUSIONS
RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.
Topics: Chromatography, Affinity; Humans; Immunoenzyme Techniques; Pharyngitis; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes
PubMed: 25369170
DOI: 10.1371/journal.pone.0111727