Diagnosis Of Acute Pharyngitis Research Articles

Распространенность острых воспалительных оториноларингологических заболеваний у реципиентов трансплантации гемопоэтических стволовых клеток

The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p <0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p < 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.

Community clinic and emergency department physicians' adherence to acute pharyngitis antibiotic treatment guidelines.

Antibiotic treatment guidelines for common infectious diseases enable proper diagnosis and treatment and avoid unnecessary antibiotic treatment, preventing both financial expenditure and antimicrobial resistance to antibiotics. The aim of our study was to investigate whether community physicians referring patients to the medical centre and whether emergency department (ED) physicians diagnose and treat acute pharyngitis according to these guidelines. We conducted a retrospective study. Data were collected on 99 patients admitted with the diagnosis of acute pharyngitis. The patients were admitted to the medical centre between 2015 and 2014. The physicians' adherence to antibiotic guidelines for indication, type and duration of treatment for acute pharyngitis was examined. The adherence of community physicians regarding the indication for antibiotic treatment was low (16%). The adherence of community and ED physicians regarding the type of treatment was high (96% and 99%, respectively). The adherence of ED physicians regarding the duration of treatment was higher than the adherence among community physicians (58% and 13.3%, respectively, Wilcoxon signed-rank test, P<.001). Interns tended to adhere to the guidelines more than seniors (36.4% versus 12.0%, respectively, Fisher's exact test, P=.07). There is a lack of compliance with the guidelines among community physicians regarding the diagnosis and antibiotic treatment of acute pharyngitis, which is characterized by excessive antibiotic treatment. Therefore, ways to increase awareness and adherence to clinical guidelines, and to allow the conditions in the clinics to fulfil the guidelines should be investigated.

Caracterización del uso inapropiado de antibióticos en faringoamigdalitis según los criterios de McIsaac

Objetivo: Describir el uso irracional de antibióticos en base a criterios de McIsaac (criterios de Centor modificados por McIsaac), en una unidad de salud de primer nivel de atención. Métodos: Se realizó un estudio descriptivo transversal con los registros de pacientes de 3 a 19 años atendidos en el servicio de emergencia (246), con los diagnósticos de faringitis aguda, amigdalitis aguda, e infecciones respiratorias superiores agudas de múltiples sitios y sin especificar. Se estableció como prescripción inadecuada si el facultativo indicó antibióticos con un puntaje menor o igual a 1 sobre 5 puntos o si no prescribió antibióticos con puntaje mayor o 4 sobre 5 puntos. Resultados: Se estimó 24,29% de uso inadecuado de antibióticos de los registros de emergencia. Se prescribió antibióticos en 160 pacientes, de los cuales se encontró que, amoxicilina fue el más utilizado (61,87%); seguido de benzilpenicilina benzatina (28,12%) y en tercer lugar macrólidos (8,12%). Conclusión: En la unidad de primer nivel analizada se encontró que el uso inadecuado de antibióticos es superior a la prevalecía estimada de faringoamigdalitis estreptocócica para el grupo de edad estudiado. Por esto, es imperativo que se tomen las medidas necesarias a nivel institucional y comunitario para lograr su reducción y evitar las complicaciones que se derivan de esta.

Optimal therapy of inflammatory diseases in the risk groups

Topicality: Pregnant women are at increased risk of susceptibility to inflammatory diseases of the pharynx. Unfortunately, there are currently no approved protocols for the treatment of ENT diseases for such patients in Ukraine. It is very important to choose a safe and effective drug with minimal absorption in to the general blood flow. Another important point for the doctors the legal aspect, namely, the absence of contraindications to the appointment of pregnant women in the instructions for use of the medicine. These criteria are met by Celista spray for a throat, which is based on the active substance miramistin (0.1 mg/ml). Materials and methods: We conducted a study that involved 30 pregnant women. These lection criteria were pregnant women from I to III trimester with a diagnosis of acute pharyngitis / tonsillitis / tonsillopharyngitis, up to 5 days after the disease, 0-3 points on a modified McAizek-Center scale, voluntary consent and adequate attitude to the study. All patients were prescribed topical irrigation of Celista spray x 4 times a day. The examination complex included subjective assessment of the condition on a 10-point visual-analogue scale, symptom severity assessment was performed using a questionnaire on a 4-point scale by criteria such as sore throat, burning, coughing (0 – no symptom, 1 – the symptom is poorly expressed, 2 – the symptom is moderately expressed, 3 – the symptom is strongly expressed). Objective examination included assessment of the condition by criteria such as hyperemia of the posterior pharyngeal wall; hypertrophy of the follicles of the posterior wall of the pharynx; hypertrophy and swelling of the tonsils; regional lymphadenitis for 0; 3; 5; 7 days. Results: It was found that the pain index decreased by 1.6 points, laceration in the throat – by 1.78 points, cough – by 0.3 points after treatment. A similar tendency was observed in the objective status: hyperemia of the posterior pharyngeal wall decreased by 1.5 points, hypertrophy of the pharynx follicles – by 1.27 points, hyperemia and swelling of the tonsils – by 0.8 points, regional lymphadenitis – by 0.5 points. Conclusion: Thus, given that the absorption of Celista spray is actually absent, the drug has no contraindications for prescription during pregnancy, and based on our results, we can confirm the effectiveness of its use during pregnancy for the local treatment of acute inflammatory diseases of the pharynx in pregnant women in any period.

A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of Ambroxol Hard-Boiled Lozenges in Patients with Acute Pharyngitis.

IntroductionThe aim of this study was to evaluate the efficacy and safety of a new hard-boiled lozenge formulation containing ambroxol 20 mg versus placebo for the relief of sore throat in patients with acute pharyngitis.MethodsThis was a phase 3, randomized, double-blind, placebo-controlled, parallel-group multicenter trial conducted between June and September 2018 in South Africa. Patients with a diagnosis of acute pharyngitis, onset ≤ 72 h, and sore throat pain of at least moderate intensity were randomized to receive either ambroxol 20 mg or placebo hard-boiled lozenges. The primary efficacy endpoint was the normalized time-weighted sum of pain intensity differences (SPID) from baseline over 3 h following administration of the first lozenge (SPIDnorm,0–3h). Secondary efficacy endpoints included SPID 24 h after the first lozenge intake (SPIDnorm,0–24h) and patient assessment of efficacy at 3 and 24 h after the first lozenge.ResultsOf 422 patients from 11 centers, 390 were randomized to one of the two treatment groups (n = 196, ambroxol; n = 194, placebo) and 388 were analyzed (modified intention-to-treat). The mean ± standard deviation SPIDnorm,0–3h values were −0.386 (0.259) and −0.366 (0.243) in the ambroxol and placebo groups, respectively, and the adjusted mean ± standard error SPIDnorm0–3h difference between ambroxol and placebo was −0.020 (0.025) (p = 0.443). Comparable results between treatment groups were also found for SPIDnorm,0–24h and patient assessment of efficacy at 3 and 24 h after the first lozenge. The incidence of treatment-emergent adverse events (TEAEs) was similar between treatment groups (11.7% for ambroxol versus 9.3% for placebo).ConclusionAlthough marked pain relief was observed over the first 3 h of treatment, superiority of ambroxol 20 mg hard-boiled lozenges versus placebo was not demonstrated in this study.Trial RegistrationNCT03583658.FundingSanofi-Aventis Group.Electronic supplementary materialThe online version of this article (10.1007/s41030-019-00100-w) contains supplementary material, which is available to authorized users.

Comparative Study Between Integrated Management of Childhood Illness Guidelines and Traditional Methods in Management of Acute Pharyngitis among Children Under Five Years in Zagazig District, Egypt

Background: Pharyngitis is one of the most frequently faced pediatric problems with serious complications in primary care. Objective(s): To compare between Integrated Management of Childhood Illness (IMCI) guidelines and traditional management concerning diagnosis and antibiotic prescription for acute pharyngitis in children less than 5 years, as well as to determine validity of IMCI guidelines in diagnosis of acute pharyngitis by comparing their results to throat culture as a golden standard. Methods: A comparative cross-sectional study was conducted in one primary health care center and one unit where IMCI guidelines were implemented; as well as one center and one unit where traditional management of acute pharyngitis was implemented in Zagazig district, on 343 children under five years complaining of sore throat or difficult feeding. About 86 children were randomly selected from each health facility during the period of first of January until end of June 2017. Doctor’s clinical diagnosis and antibiotic prescription were reported for all children, while throat swabs were taken from children managed according to IMCI guidelines for bacterial culture. Results: According to IMCI, only 11 % of children were diagnosed as bacterial pharyngitis, antibiotic prescription was significantly lower among those managed according to IMCI compared to traditional methods (11% & 96.5% respectively, P<0.001). However, throat culture revealed that 28.5% of children managed according to IMCI guidelines had positive bacterial growth. Sensitivity of IMCI guidelines to detect bacterial cases of pharyngitis was only 36.7 % and Positive Predictive Value (PPV) was 94.7%, while their specificity to exclude bacterial and detect viral infection was about 99.2% and the Negative Predictive Value (NPV) was 79.7%. Conclusion: Application of IMCI guidelines is considered valuable in prevention of antibiotic abuse. However, the sensitivity of IMCI guidelines to detect bacterial pharyngitis was 36.7%. Key words: integrated management of childhood illness guidelines, validity, acute pharyngitis

Evaluation of the prescriptions written for upper respiratory tract infections.

OBJECTIVE:We aimed to determine frequency of antibiotic use and retrospectively evaluate prescriptions written for the patients with diagnosis of acute pharyngitis, acute nasopharyngitis and acute tonsillitis by our hospital emergency department physicians in January 2014.METHODS:Records of the patients who were admitted to the education and research hospital between January 1st, 2014 to January 31st 2014 were analyzed in this study. Records of all the patients with the diagnosis of acute nasopharyngitis (J.00), acute pharyngitis (J.02) and acute tonsillitis (J.03) were analyzed, and patients with a second diagnosis or haven’t any prescription were excluded from the study. Frequency of antibiotic and other symptomatic medications use were analyzed in prescriptions of 5261 patients.RESULTS:Antibiotics were prescribed for 63.5% of the patients included in the study, and the most preferred antibiotics were penicilin and beta-lactamase combination (38.8%) and cephalosporins (26.2%). Combined preparations were the most preferred medications in symptomatic treatment (65.9%). Dexketoprofen was the most preferred among nonsteroidal anti-inflammatory drugs (63%). In each prescription, average number of 3.26 drugs were prescribed.CONCLUSION:Excessive and improrer use of antibiotics in the treatment of respiratuary tract infection is a global problem. The use of excess agents in symptomatic medication leads to polypharmacy. Training of physicians and patients on principles of rational drug use will contribute to the solution of this problem.

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

Objective.To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.Design.Retrospective cohort study.Setting.All encounters to 25 pediatric primary care practices sharing an electronic health record.Methods.Streptococcal pharyngitis was defined by anInternational Classification of Diseases, Ninth Revisioncode for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.Results.Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P&lt; .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.Conclusions.Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.

Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.

To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices. Retrospective cohort study. All encounters to 25 pediatric primary care practices sharing an electronic health record. Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation. Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing. Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.

Hypoglycorrhachia in herpes zoster associated encephalitis of an immunocompetent young male

Sirs: A thirty-one year old male was admitted to the Department of Medicine in Yan Chai Hospital with fever and headache. He had history of fever and sore throat for one week. His family doctor made a diagnosis of acute pharyngitis and gave him a course of amoxicillin. Few days later, he developed bilateral hearing loss and increasing early morning headache, exacerbated by cough. His temperature was 38 °C. There was no sign of meningeal irritation. Scattered blisters were noted over the left side of his neck along the distribution of cervical nerve C3 and C4. Bilateral hearing loss was present. Audiometry test revealed neurosensory hearing loss in both ears. His complete blood count, renal and liver functions, chest radiograph, electrocardiogram and CT of the brain were normal. Lumbar puncture revealed clear CSF with an opening pressure of 200 mm H2O, white cell count 240 WBC per mm3 (polymorphs 10 %, lymphocyte 90 %), protein 1.8 g/L, glucose 1.9 mmol/L. Simultaneous serum glucose was 6.9 mmol/L. CSF bacterial antigen test, cryptococcal antigen, fungal culture, PCR for TB and herpes simplex virus (HSV) DNA were negative. Brain MRI showed nonenhancing signal change in the lower pons and medulla, which was hypodense on T1-weighted images, hyperintense on T2-weighted and FLAIR images. The features were compatible with rhomboencephalitis (Fig. 1). IV acyclovir 10 mg/kg q8h was administered for 14 days. His fever came down on day 3 after the treatment began. His blisters and headache resolved gradually. Follow-up lumbar puncture showed normalization of CSF sugar with improvement in CSF protein and white cell counts. CSF viral titer revealed a 4-fold rise for IgG against varicella (pre-treatment titer 1: < 4, follow-up titer 1:16). PCR varicella-zoster DNA in his CSF before treatment was positive. He had mild residual neurosensory hearing loss and reported occasional tinnitus six months after the encephalitis. This case is a reminder that despite being a rare entity, a strikingly low CSF glucose can occur in herpes zoster-associated encephalitis. It can be potentially confusing to the attending clinician by mimicking other common infectious disease such as tuberculosis. Among 2 case reports in the past [1, 2], anti-tuberculous therapy was given to one patient before serological confirmation of varicella zoster meningoencephalitis. With the help of PCR assays, an early diagnosis can be achieved through detection of VZV DNA in CSF as soon as 24 hours after the onset of symptoms [3]. Compared with antibody indices [4], the intrathecal production of antibody is rarely detected before day 5 after onset of neurological symptoms, limiting the use of antibody index for early diagnosis of CNS infection. Currently available VZV DNA PCR assay methods have high specificity and do not cross-react with herpes simplex infection. The diagnostic sensitivity, however, ranges from 29 % to 100 % [5]. Therefore, we suggest that simultaneous analysis of CSF for both varicella-zoster virus DNA and antibody level should be studied in all suspected cases of herpes-zoster associated encephalitis. The presence of either or both in CSF in the typical clinical setting helps the clinician to establish the diagnosis of herpes-zoster associated encephalitis. This approach is particularly useful in Asian regions such as Hong Kong where the prevalence of mycobacterium tuberculous infection is high. Our case illustrated that, though rare, hypoglycorrhachia can occur in herpes zoster associated encephalitis, which has a mortality rate of 4 % to 30 % [6, 7] and residLETTER TO THE EDITORS

The role of the selective throat culture for beta hemolytic streptococci in the diagnosis of acute pharyngitis.

The role of the selective throat culture for beta hemolytic streptococci in the diagnosis of acute pharyngitis.