General Pediatrics, the University of Chicago

Yingshan Shi, M.D. (773) 702-6169 03/2003

Sore Throat

Diseases	Cause	S & S	Dx & Tx
Streptococcus
Infectious Monoucleosis	Viral infection	Pharyngitis and posterior cervical lymphadenopathy	Dx: made clinically and confirmed by the presence of atypical lymphocytosis and a positive spot test (heterophil antibodies)
Peritonsillar Abscess		Fever, dysphagia, odynophagia, and hoarseness PE: trismus, unilateral swelling - tonsillar region, deviation of the uvula to the opposite side
Ludwig Angina	Usually resulting from an infected lower molar	Rapidly spreading cellulitis of the sublingual and submandibular spaces Acutely ill and rapidly develops brawny edema of the sublingual region, which pushes the tongue upward May cause glottic edema and airway obstruction
Lemierre Syndrome	Fusobacterium necrophorum, a gram negative anaerobic bacillus	Previously healthy adolescents Initially-oropharyngeal infection Rapidly progresses to suppurative thrombophlebitis of the internal jugular vein followed by metastatic foci of infection, most commonly involving the lungs	Dx Clinical presentation High white count Blood cultures: Gram(-) anaerobic rods CXR CT scan of the neck with IV contrast- thrombosis of internal jugular vein Tx: IV 2 wks: penicillin, metronidazole, or clindamycin Surgical intervention

Current Indications for tonsillectomy and adenodectomy

Adenotonsilllar hypertrophy with symptoms of URAS, OSAS

Prevent infection: recurrent tonsillitis 7 episode/year; 5/yr x 2 years, 3/yr x 3years

Recurrent peritonsillar abscesses (2-3 episodes)

Episodes of rheumatic fever

Chronic tonsillitis lasting 3 months

Tonsillar asymmetry

Suspicion of tonsillar tumor/malignancy