Exudative Pharyngitis Research Articles

497 A NOSOCOMIAL OUTBREAK OF FATAL ADENOVIRUS TYPE 7

The CHHC has experienced, to our knowledge, the first major outbreak of adenovirus type 7 disease in a children's hospital. At least 61 hospital employees and 7 patients were involved. Patients experienced a biphasic course which consisted of croup, diarrhea, fever, exudative pharyngitis, and/or conjunctivitis which preceded an acute respiratory decompensation by 1 wk. Those patients acquiring disease were individuals with compromised airways and underlying pulmonary pathology. Mortality from overwhelming viral pneumonia was 4/6 (67%). All fatal cases grew the organism from multiple sites including lung. Widespread illness appeared among hospital employees beginning 7 days after admission of the index case. History, NP and rectal viral cultures, and serology were obtained on 336/363 (94%) of staff working during the outbreak. Conjunctivitis was reported by 61 employees (16%), which was associated with corneal infiltrates in 5 (8%). 92/336 (27%) reported diarrhea and 221/336 (66%) reported URI symptoms. Control of viral transmission was achieved only when strict isolation precautions and cohorting of infected patients was combined with extensive screening of staff, and the temporary closure of the hospital to all new admissions. While adenovirus is a frequent community pathogen, this outbreak demonstrates that nosocomial type 7 infections in patients with pulmonary compromise frequently can be fatal.

Streptococcal pharyngitis in infants: a reappraisal of its prevalence.

The prevalence of group A streptococcal pharyngitis in children under 3 years of age was determined by retrospective review of the results of throat cultures taken from children seen in a middle-class, suburban, private pediatric practice. Of 2,200 throat cultures obtained, 7% (149) were from children in this age group, and 15% (23) of these were positive for group A streptococci. All children had pharyngeal injection and the majority were symptomatic, with fever, rash, or rhinitis. Exudative pharyngitis was rare. This study suggests that pharyngeal infection with this organism in infants and young children is not uncommon, and justifies the need for throat cultures in this population.

Group B beta-hemolytic streptococci causing pharyngitis

Group B beta-hemolytic streptococci were isolated from the throats of 49 of 1,110 patients who had pharyngitis. Compared with patients whose throat cultures were negative for beta-hemolytic streptococci, those harboring group B were more likely to have enlarged tonsils (P less than 0.001), exudate (P less than 0.02), and tender enlarged anterior cervical lymph nodes (P less than 0.01). Group B should not necessarily be dismissed as a nonpathogen when identified in the pharynx of patients with exudative pharyngitis; laboratories which report beta-hemolytic streptococcal isolates from the pharynx only as group A or non-group A should be encouraged to perform definitive group identification of all beta-hemolytic isolates to further evaluate the role of other streptococcal groups as the causative agents for pharyngitis.

Infectious mononucleosis in the older patient

Six cases of infectious mononucleosis in patients more than 60 years old were reviewed. The geriatric patient with infectious mononucleosis often presents with nonspecific constitutional symptoms, without exudative pharyngitis. The disease may present as fever of obscure origin or mimic chronic lymphocytic leukemia in this age group. Diagnosis is established through characteristic findings on hematologic and serologic studies.

Polymicrobial bacteremia associated with pharyngotonsillitis

TIlE REPORTED INCIDENCE of polymicrobial bacteremia among patients with septicemia is generally quoted as 6 to 10%. 1-~ The overwhelming majority of these patients have severe underlying disease, nlost commonly hematologic malignancy or gastrointestinal disorders, or have been receiving immunosuppressiv e therapy. : ~ The occurrence of polymicrobial bacteremia in an otherwise healthy patient is a highly unusual event. The subject of this report is a previously healthy adolescent who, during an episode of acute exudative pharyngitis, had seven microorganisms isolated from a single blood sample. CASE REPORT q-he patient, a 15-year-old boy, was in good health until one week prior to hospitalization, ',,,'hen he presented with fever, sore throat, and anorexia. Physical examination at that time revealed bilaterally enlarged palatine tonsils covered with thick, white mucopurulent exudate, and tender, 2 cm anterior cervical nodes. Tliroat culture was negative for group A beta hemolytic streptococcus; heterophil antibody titers were also negative. The patient was treated with fluids and aspirin and was next seen two days later with persistent fever and shaking chills. Examination was unchanged. Repeat throat culture grew no pathogens. Hemoglobin was 14 gm/dl and the white blood count was 4,900/mm 3, with 75% neutrophils, 10% band cells, and occasional atypical lymphocytes; chest radiograph was normal. The presumptive diagnosis remained severe viral pharyngitis, and no antibiotics were administered. Over the next three days the patient's sore throat slowly improved, but he continue to have spiking fevers, myalgia, and shaking chills, and was hospitalized for further evaluation. Physical examination revealed an acutely ill-appearing boy. Temperature was 39~ heart rate 104/minute~ and blood pressure 110/70 mm Hg. A thick, yellow membrane coated the tongue. The tonsils remained mildly enlarged and hyperemic, but the exudate had largely dis'appeared; there ',,,'as no evidence of peritonsillar or retropharyngeal abscess. No other abnormalities were found. Multiple cultures of blood, urine, stool, sputum, and upper respiratory tract was obtained at admission. On the next day, the

Treatment of Sore Throat-Reply

Dr Ravenel and I both agree that the available evidence suggests that penicillin treatment produces only a modest acceleration in the resolution of symptoms. For reasons I will describe, I wonder if the available evidence is applicable to current practice. If it is not, we may never have the relevant evidence, since a controlled trial of penicillin therapy at this point in history would raise ethical questions. The study by Denny et al1and another report from the Warren Air Force Base by Brink et al2are pertinent. Both report controlled trials of penicillin therapy in young adult men with exudative pharyngitis, most of whom had streptococcal infection. In both studies history and physical examination data were collected meticulously. At the same time, certain limitations of these studies should be noted. Both are almost 30 years old and were performed at a time when the severity

Acute Pharyngotonsillitis Caused by Herpesvirus Type 2

HERPES simplex virus (HSV) type 1 is now recognized as a common nonbacterial cause of acute pharyngitis in young adults.1Herpes simplex virus type 2 is most often associated with urogenital infections of men or women and is generally transmitted venereally.4Acute exudative pharyngitis and tonsillitis developed in a bisexual man following oral-genital sex with male and female partners. Herpes simplex virus type 2 was recovered from the pharynx and identified in a biopsy specimen of tonsillar tissue. Report of a Case A 25-year-old bisexual man had fever, chills, odynophagia, and inability to swallow oral secretions for four days. He had received one dose of intramuscularly administered penicillin and had taken ampicillin orally for three days without relief. He had engaged in oral-genital sex with male and female partners ten days previously. He denied previous oral or genital herpes but had been treated for syphilis in the past.

Infectious Mononucleosis and Fatal Myocarditis

Mycocarditis is an uncommon manifestation and, very rarely, a lethal complication of infectious mononucleosis. A 14-year-old girl initially had exudative pharyngitis and splenomegaly and developed refractory ventricular fibrillation. The diagnosis of infectious mononucleosis was confirmed by both a strongly positive heterophil antibody test and a high titer of Epstein-Barr virus. Pathologic studies demonstrated extensive histiocytic and lypmhocytic infiltration of the myocardium.

Tularemia: An Unappreciated Cause of Exudative Pharyngitis

A boy with a persistent febrile illness accompanied by exudative pharyngitis found to be due to tularemia is described. The role of tularemia as a cause of exudative pharyngitis is discussed.

A Penicillin Shot Without Culturing the Child's Throat

ENTHUSIASM for throat cultures varies widely among physicians in practice. Some rely solely and precariously on their clinical acumen. Although clinical findings are important in diagnosing streptococcal sore throat, they are not sufficiently distinctive to provide the basis for a foolproof diagnosis. 1,2 The batting average among experienced physicians in predicting which sore throats will be culture-positive for β-hemolytic streptococci is poor (only slightly better than 50% without cultures, about 75% if they have the advantage of culture results from other patients). Red throats are nonspecific. Exudate occurs frequently in streptococcal pharyngitis, but it may not appear until the second day and may also be found in viral infections. In infants, exudative pharyngitis is rarely streptococcal in cause. Anterior cervical nodes that are tender to palpation are one of the most reliable clinical indicators of streptococcal infection, 3 but they are not present in all patients. The rash we associate

Meningococcal arthritis simulating gonococcemia.

A 19-year-old man was admitted to the hospital with acute onset of fever, sore thoart, and leg pain. He gave a history of recent sexual activity and was found to have an exudative pharyngitis, two pustular skin lesions, and a hot, swollen left knee. Laboratory studies were consistent with an acute septic arthritis and the diagnosis of the gonococcal arthritis-dermatitis syndrome was entertained. He responded to high doses of penicillin, and Neisseria meningitidis, group B, subsequently was cultured from the blood and pharynx. The same organism was isolated from the throats of three of 11 asymptomatic contacts.

Spontaneous cytomegalovirus mononucleosis. Clinical and laboratory observations in nine cases.

Nine cases of cytomegalovirus mononucleosis in previously healthy persons were seen during a 10-month period. All were women between 19 and 28 years of age. Their illnesses were characterized by malaise, myalgia, fever, atypical lymphocytosis, and abnormal liver functions. Five patients noted sore throat, but none had exudative pharyngitis. Generalized lymphadenopathy was present in two patients and splenomegaly in three. Heterophil agglutination and ox cell hemolysin tests were uniformly negative. Seven patients had mild illnesses, one developed ascending polyneuritis (Guillain-Barré syndrome), and another had a prolonged illness complicated by splenic infarction. Persistent viruria was noted in all patients; cytomegalovirus was also recovered from oropharyngeal secretions in five patients and other sites in one patient. Cytomegalovirus mononucleosis may be common among young adults. This diagnosis should be considered in all patients with heterophil-antibody-negative mononucleosis, including those with lymphadenopathy and splenomegaly.

Investigations on mycoplasma in infectious mononucleosis.

Certain observations have raised the possibility of an etiologic association between mycoplasmas and infectious mononucleosis (IM). For example, an exudative pharyngitis is produced by the DC 63 strain of Mycoplasma hominis type 1, although systemic manifestations are mild [1]. Furthermore, the appearance of anti-i cold agglutinins against human erythrocytes in many patients with IM suggests that an agent related to mycoplasmas might be responsible [2]. Against the likelihood that mycoplasmas are the sole etiologic agent in IM is the failure of chlortetracycline and chloramphenicol therapy to alter the course of the illness in controlled studies [3], and the fact that Mycoplasma pneumoniae and certain other mycoplasma species are susceptible in vitro to these antimicrobial agents [4, 5]. Recently it has been reported that patients with IM develop antibodies to the EB virus antigens of cultured Burkitt lymphoma cells, and related if not identical antigens have been demonstrated in cultured leucocytes of patients with infectious mononucleosis [6, 7]. The present report deals with the possible etiologic or synergistic role of mycoplasmas in IM

Epidemic of pharyngitis due to streptococci of Lancefield group G.

Abstract An epidemic of pharyngitis due to a virulent strain of group-G streptococci at a college in October, 1968, is described. The attack-rate for clinical pharyngitis among the 502 members of the student body was 31%. The symptoms and predominant physical findings were similar to those produced by group-A streptococcal respiratory-tract infections and included the development of exudative pharyngitis in a significant number of the ill students. An epidemiological investigation indicated that the outbreak was food-borne and incriminated an egg salad as the vehicle of transmission. Despite a high treatment-failure rate and the development of significant antistreptolysin 0 responses in many of the ill students, no sequelae similar to those produced by group-A streptococci were detected.

Nonstreptococcal pharyngitis

In a prospective study of 154 patients with nonstreptococcal pharyngitis, an adenoviruswas recovered from 23 per cent, herpes simplex virus from 8 per cent, ECHO virus from 5 per cent, and a Group B Coxsackie virus from 3 per cent of the patients. If viral cultures were negative for adenovirus or herpes simplex virus, no additional evidence of infections with either of these agents was found with complement-fixation tests on paired sera. Serologic evidence of infectious mononucleosis was found in only 3 of 93 patients with nonstreptococcal febrile exudative pharyngitis. Clinical diphtheria with recovery of a toxigenic strain of C. diphtheriae was observed once. Two other patients had a nontoxigenic diphtheria bacillus recovered without clinical manifestations of diphtheria. Mycoplasma hominis type 1 was rarely recovered during the present study. In a prospective study of 154 patients with nonstreptococcal pharyngitis, an adenoviruswas recovered from 23 per cent, herpes simplex virus from 8 per cent, ECHO virus from 5 per cent, and a Group B Coxsackie virus from 3 per cent of the patients. If viral cultures were negative for adenovirus or herpes simplex virus, no additional evidence of infections with either of these agents was found with complement-fixation tests on paired sera. Serologic evidence of infectious mononucleosis was found in only 3 of 93 patients with nonstreptococcal febrile exudative pharyngitis. Clinical diphtheria with recovery of a toxigenic strain of C. diphtheriae was observed once. Two other patients had a nontoxigenic diphtheria bacillus recovered without clinical manifestations of diphtheria. Mycoplasma hominis type 1 was rarely recovered during the present study.

Group A Streptococci, Mycoplasmas, and Viruses Associated With Acute Pharyngitis

Methods for identification of bacteria, viruses, and mycoplasmas were used to study pharyngitis in patients from a pediatric practice. Etiologic agents were recovered from 50% of 715 cultures from patients with pharyngitis and from 22% of 206 cultures from asymptomatic household contracts. Pharyngitis was diagnosed most often in children ages 6 through 8 years, and over one half of these illnesses were associated with group A streptococcus infections. Viruses were the most important cause of pharyngitis in infants, and Mycoplasma pneumoniae was associated with pharyngitis in early adolescence. Disease produced by viruses or M pneumoniae could not be distinguished from classical streptococcal pharyngitis. Mycoplasma hominis, which has produced exudative pharyngitis in adult volunteers, was not recovered from persons in this investigation; however, in other studies performed concurrently, M hominis was isolated from 0.5% of subjects including three adults with pharyngitis.

The non-ß-hemolytic streptococcal etiology of exudative tonsillar pharyngitis in children under the age of three

The non-ß-hemolytic streptococcal etiology of exudative tonsillar pharyngitis in children under the age of three

GROUP A STREPTOCOCCAL INFECTIONS IN A CHILDREN'S HOME

All children admitted to a children's home infirmary for illnesses other than skin diseases or trauma during a period of 2 years were cultured for Group A streptococci and viruses. Almost 90% of the children with fever and unequivocal exudative pharyngitis had throat cultures containing more than 10 colonies of Group A streptococci. About 90% of the illnesses with sore throat or minimal erythema without fever or exudate were not associated with a similarly positive culture. About 50% of the children with only two of the three features of fever, pharyngeal exudate, and erythema had positive cultures, and it was this group of patients for whom throat cultures were most useful. Although Group B Coxsackie viruses and adenoviruses were recovered from some of the children, Group A streptococci were clearly the most frequent cause of moderate or severe pharyngitis in children of school age and were recovered from 50% of all children with an oral temperature of 38.3°C (101°F) or higher.

Controlled Studies of Streptococcal Pharyngitis in a Pediatric Population

PROMPT and adequate penicillin therapy of A pharyngitis due to Group A streptococci has proved effective in preventing primary attacks of rheumatic fever in military populations.1 , 2 Such treatment has been widely recommended for the control of rheumatic fever in the civilian population as well.3 The attack rate of rheumatic fever after such infections has been determined primarily from studies of epidemic, exudative pharyngitis or scarlet fever.4 5 6 Approximately 3 per cent of these infections have been followed by rheumatic fever.7 Within a given population, however, this rate has varied directly with the degree of the host's immune response to streptococcal disease. . . .

The isolation of adenovirus type 1 from a fatal case of viral pneumonitis.

The etiology of acute respiratory infections of childhood and infancy often remains obscure. Progress has been made, however, in the classification of these illnesses by the recent discovery of a new group of viruses, subdivided into distinct serotypes, which are now referred to as adenoviruses, 1 formerly the APC, 2 RI, 3 or ARD 4 groups. Adenoviruses have been shown to be a cause of undifferentiated acute respiratory disease, nonstreptococcal exudative pharyngitis, and primary atypical pneumonia. They were also found to be associated with a clinical entity designated pharyngoconjunctival fever, which may assume epidemic proportions. 3-8 Other illnesses have been ascribed to these agents which include epidemic keratoconjunctivitis 9,10 and mesenteric lymphadenitis, 11 and a Type 3 of these agents has been isolated from a stool of an infant with a disease resembling roseola infantum. 12 While in general the diseases induced appear to be relatively mild, adenoviruses have been isolated from the lungs of two fatal cases