Class 3 Anuj UPadhyay

NAME – ANUJ UPADHYAY
GROUP- 23
COURSE-4TH
CLASS-3
A 19-year-old patient complains of a sore throat, aggravated by swallowing, malaise, weakness,
headache, pain in muscles, lower back, chills. I fell ill yesterday, acutely after hypothermia.
Objectively: general condition of moderate severity, body temperature 39.6°C, submandibular
and cervical lymph nodes are enlarged and painful on palpation. Pharyngoscopic: the tongue is
coated with a grayish coating, hyperemia of the arches and enlarged tonsils is determined, the
presence of yellowish plaques in the lacunaes, easily removable, do not go beyond the tonsils.
1. Disease- Acute Follicular Tonsillitis
Tonsils are the two lymph nodes located on each side of the back of throat. They
function as a defense mechanism and help prevent your body from getting an infection.
When tonsils become infected, the condition is called tonsillitis. Tonsillitis can occur at
any age and is a common childhood illness. It’s most often diagnosed in children from
preschool age through their mid-teens.
2. Signs and symptoms : sore throat, worse if swallowed, headaches, pain in the
joints of the limbs, lower back, muscle, lymph nodes are increased, tongue coated
gray bloom, enlarged tonsils, general muscle aching, increase throat secerations
3. Diagnosis :
Laboratory studies that may be helpful include the following:
 Group A beta-hemolytic streptococcal rapid antigen detection test (preferred diagnostic method
in emergency settings)
 Throat culture (criterion standard for diagnosis of GAS infection [90-99% sensitive])
 Mono spot (up to 95% sensitive in children; less than 60% sensitive in infants)
 Peripheral smear
 Gonococcal culture if indicated by the history
Imaging studies generally are not indicated for uncomplicated viral or streptococcal pharyngitis.
However, the following may be considered:
 Lateral neck film in patients with suspected epiglottitis or airway compromise
 Soft-tissue neck CT if concern for abscess or deep-space infection exists.
Feel the sides of neck to see if the lymph nodes are swollen and tender
Strep test.
4. Tonsillitis Complications ‘
Complications usually happen only if bacteria caused your infection. They include:
 A collection of pus around your tonsil (peritonsillar abscess)

 Middle ear infection
 Breathing problems or breathing that stops and starts while you sleep (obstructive sleep
apnea)
 Tonsillar cellulitis, or infection that spreads and deeply penetrates nearby tissues
5.Treatment
GAS pharyngitis is usually a self-limited disease, and most signs and symptoms resolve
spontaneously in 3-4 days. If administered early, antibiotics can shorten the duration of the
illness by up to 1 day, but the main reason they are given is for prevention of acute rheumatic
fever. This rationale is being questioned by many as the incidence of acute rheumatic fever in
the United States is extremely low. In addition, pain medications such as NSAIDs or
acetaminophen and steroids can alleviate the symptoms associated with GAS pharyngitis.
Antibiotics do not prevent acute glomerulonephritis. Steroids may be used for airway
compromise and symptomatic relief. Antifungals and antivirals are used in certain rare cases
with specialist consultation.
 -get plenty of rest.

 -drink cool drinks to soothe the throat.
 -take paracetamol or ibuprofen (do not give aspirin to children under 16)
 -gargle with warm salty water.
6. Possible complications of tonsillitis include:
 a middle ear infection (otitis media) – where fluid between the eardrum and inner ear
becomes infected by bacteria.
 quinsy (peritonsillar abscess) – an abscess (collection of pus) that develops between
one of the tonsils and the wall of the throat.
Symptomatic treatment (fever and pain): paracetamol or ibuprofen

– Centor score ≤ 1: viral pharyngitis, which typically resolves within a few days (or weeks, for IM): no antibiotic treatment.
– Centor score ≥ 2 or scarlet fever: antibiotic treatment for GAS infections3:
• If single-use injection equipment is available, benzathine benzylpenicillin is the drug of choice as streptococcus A
resistance to penicillin remains rare; it is the only antibiotic proven effective in reducing the incidence of rheumatic
fever; and the treatment is administered as a single dose.
benzathine benzylpenicillin IM
Children under 30 kg (or under 10 years): 600 000 IU single dose
Children 30 kg and over (or 10 years and over) and adults: 1.2 MIU single dose
• Penicillin V is the oral reference treatment, but poor adherence is predictable due to the length of treatment.
phenoxymethylpenicillin (penicillin V) PO for 10 days
Children under 1 year: 125 mg 2 times daily
Children 1 to < 6 years: 250 mg 2 times daily
Children 6 to < 12 years: 500 mg 2 times daily
Children 12 years and over and adults: 1 g 2 times daily
• Amoxicillin is an alternative and the treatment has the advantage of being relatively short. However, it can cause
adverse skin reactions in patients with undiagnosed IM and thus should be avoided when IM has not been excluded.
amoxicillin PO for 6 days
Children: 25 mg/kg 2 times daily
Adults: 1 g 2 times daily
• Macrolides should be reserved for penicillin allergic patients as resistance to macrolides is frequent and their efficacy
in the prevention of rheumatic fever has not been studied.
azithromycin PO for 3 days
Children: 20 mg/kg once daily (max. 500 mg daily)
Adults: 500 mg once daily
– Gonococcal or syphilitic pharyngitis: as for genital gonorrhoea ) and syphilis
– Diphtherial pharyngitis: see Diphtheria
– Vincent tonsillitis: metronidazole or amoxicillin.
– Peritonsillar retropharyngeal or lateral pharyngeal abscess: refer for surgical drainage.
– If signs of serious illness or epiglottitis are present in children: hospitalise.

Class 3 Anuj UPadhyay

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NAME – ANUJ UPADHYAY

1. Disease- Acute Follicular Tonsillitis

 A collection of pus around your tonsil (peritonsillar abscess)

 -get plenty of rest.

6. Possible complications of tonsillitis include:

Symptomatic treatment (fever and pain): paracetamol or ibuprofen

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