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PubMed2003

[Evaluation of pharyngeal swallowing elicited by fluid infusion using videoendoscopy in dysphagia patients].

The purpose of this study was to investigate the clinical value of assessing pharyngeal swallowing elicited by fluid infusion. Videoendoscopic examinations were performed in 126 patients with dysphagia, after injecting a fluid infusion into the pharyngeal cavity. Blue dye fluid was instilled into the unilateral vallecula through a catheter that was inserted into the biopsy channel of an endoscope. Pharyngeal swallowing elicited by the fluid infusion was classified according to 5 grades: grade 1, normal pharyngeal swallowing; grade IIa, laryngeal penetration before the triggering of pharyngeal swallowing; grade IIb, pharyngeal residue after swallowing; grade IIa + b; and grade III, no the pharyngeal swallowing. The recovery rates for oral intake using several approaches for dysphagia were 98% in grade I patients and 75% in grade IIb patients. However, the oral intake of food was more difficult in grade IIa, grade IIa + b and grade III patients. These results suggest that the classification of dysphagia based on the triggering and output situation of pharyngeal swallowing may be a useful guideline for demonstrating impaired oral food intake. We conclude that videoendoscopic examination using a fluid infusion is a valuable method for evaluating pharyngeal swallowing minus the influence of bolus transport from oral cavity to the pharynx.

Aged↗

PubMedDate not supplied

Respiratory-related activity of the pharyngeal nerves in the rat.

In anesthetized (n = 26) or decerebrate (n = 15) rats, vagotomized, paralyzed and artificially ventilated, we recorded efferent respiratory-related discharges of nerves supplying the pharyngeal muscles, i.e. the glossopharyngeal nerve (IX; n = 30) and the pharyngeal ramus of the vagus nerve (PH.X; n = 33). In both types of preparation, all IX nerves fired during inspiration (I); most PH.X fired either during I (n = 11), expiration (E, n = 12), or both phases (n = 4); some of them were continuously active, without any respiratory modulation (n = 6). We also examined the timing of inspiratory pharyngeal bursts in relation to the phrenic (inspiratory) bursts. We found that the burst onset occurred significantly earlier in pharyngeal nerves than in phrenic ones (pharyngeal-to-phrenic delay). In anesthetized animals, this pharyngeal-to-phrenic delay was long enough to reveal that inspiratory activity appeared first on IX, then on PH.X, and then on phrenic nerves. Since hypoxia did not significantly alter the pharyngeal-to-phrenic delay, we conclude that a reliable organization of the inspiratory drive on pharyngeal and diaphragmatic muscles should exist, in the rat.

Animals↗

PubMed2006

The T-box factor TBX-2 and the SUMO conjugating enzyme UBC-9 are required for ABa-derived pharyngeal muscle in C. elegans.

The C. elegans pharynx is produced from the embryonic blastomeres ABa and MS. Pharyngeal fate in the ABa lineage is specified by the combined activities of GLP-1/Notch-mediated signals and the TBX-37 and TBX-38 T-box transcription factors. Here, we show another T-box factor TBX-2 also functions in ABa-derived pharyngeal development. tbx-2 mutants arrest as L1 larvae lacking most or all ABa-derived pharyngeal muscles. In comparison, tbx-2 mutants retain ABa-derived marginal cells and pharyngeal muscles derived from MS. A tbx-2Colon, two colonsgfp translational fusion is expressed in a dynamic pattern in C. elegans embryos beginning near the 100-cell stage. Early expression is limited to a small number of cells, which likely include the ABa-derived pharyngeal precursors, while later expression is observed in body wall muscles and a subset of pharyngeal neurons. TBX-2 contains 2 consensus sumoylation sites, and it interacts in a yeast two-hybrid assay with the UBC-9 and GEI-17 components of the C. elegans SUMO-conjugating pathway. ubc-9(RNAi) has been previously shown to cause variable embryonic and larval arrest, and we find that, like tbx-2 mutants, ubc-9(RNAi) animals lack ABa-derived pharyngeal muscles. ubc-9(RNAi) also alters the subnuclear distribution of TBX-2::GFP fusion protein, suggesting that UBC-9 and TBX-2 interact in C. elegans. Together, these results indicate that TBX-2 and SUMO-conjugating enzymes are necessary for ABa-derived pharyngeal muscle, and we hypothesize that TBX-2 function requires sumoylation. Sumoylation is increasingly recognized as an important mechanism controlling activity of many nuclear factors, and these results provide the first evidence that T-box factor activity may require sumoylation.

Animals↗

PubMedDate not supplied

Forward movement of posterior pharyngeal wall on phonation.

Forward movement of the posterior pharyngeal wall on phonation is divided into 2 types. One is movement of Passavant's ridge, which is a crescent-shaped or shelf-like posterior pharyngeal structure, and the other is generalized forward movement, which is not sharply outlined, of the posterior pharyngeal wall. Although nasopharyngoscopic and multiview videofluoroscopic findings on their movement show that they are markedly different, there are few reports about differentiation between them. In this study, multiple cross-sectional observations with rapid magnetic resonance imaging were performed to elucidate the forward movement of the posterior pharyngeal wall on phonation. I used rapid MRI to examine 4 subjects (3 females and 1 male) who had forward movement of the posterior pharyngeal wall with or without Passavant's ridge. Judging from the findings and local morphology, Passavant's ridge consisted of pharyngeal mucous and/or pharyngeal superficial muscles. On the other hand, it was revealed that generalized forward movement of the posterior pharyngeal wall was caused by contraction of the longus capitis muscle. The longus capitis muscle is well known as a flexor muscle of the head. The findings of the present study are significant and useful in speech rehabilitation for patients with velopharyngeal insufficiency.

Adult↗

PubMed2001

Principles of appropriate antibiotic use for acute pharyngitis in adults: background.

The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus. 1. Group A beta-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis. The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed. 2. Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection. All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care. 3. Limit antibiotic prescriptions to patients who are most likely to have GABHS infection. Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis). Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection. For patients with two or more criteria the following strategies are appropriate: (a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; (b) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or (c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria. 4. Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80%. Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered. 5. The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient.

Acute Disease↗

PubMed1999

Detection of group A streptococci in children under 3 years of age with pharyngitis.

OBJECTIVE: To determine the frequency of group A streptococcal pharyngitis in young preschool children presenting to the emergency department with upper respiratory tract infection. METHODS: A prospective, observational study performed between September 1995 and September 1997. Throat swabs were obtained on young children less than 3 years old with pharyngeal erythema as well as age- and time-matched controls without pharyngeal erythema or exudate. Signs and symptoms that were recorded included: age, temperature, pharyngeal erythema, tonsillar exudate, cervical adenopathy, scarlatini-form rash, rhinorrhea, school-aged child in the home, day care attendance. Swabs were inoculated on 5% sheep blood agar and incubated for 48 hours. Beta-hemolytic colonies were sero-grouped by latex agglutination. RESULTS: Seventy-eight children with pharyngeal erythema, and 152 controls had pharyngeal specimens obtained and signs or symptoms recorded. Under 2 years of age, the detection of group A streptococci was similar to controls. Detection of group A streptococci was significantly different from controls in children over 2 years of age. Ten (29%) of 35 children over 2 years were positive for group A streptococci compared to 2 (7%) of 29 controls of the same age group (P = 0.03, odds ratio 5, 95% CI: 1.2-24). Findings on clinical examination in children with pharyngeal erythema did not distinguish those that would be culture-positive for group A streptococci. CONCLUSION: In our emergency department, group A streptococci caused 30% of pharyngitis seen in children between 2 and 3 years of age. Diagnostic testing is recommended because physical examination may not accurately distinguish etiology in this age group.

Age Distribution↗

PubMed2006

Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis.

OBJECTIVE: The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A beta-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies. STUDY DESIGN/METHODS: The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A beta-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months. RESULTS: Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9-4.9; P < .001) more likely to develop a subsequent group A beta-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A beta-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A beta-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A beta-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years). CONCLUSIONS: Tonsillectomy is associated with a decrease in the number of group A beta-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A beta-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis.

Adolescent↗

PubMed1992

Adherence of Streptococcus pyogenes M type 5 to pharyngeal and buccal cells of patients with rheumatic fever and rheumatic heart disease during a one-year follow-up.

In vitro adherence of Streptococcus pyogenes M type 5 to isolated pharyngeal and buccal epithelial cells was studied in patients with acute recurrent rheumatic fever (n = 21), chronic rheumatic heart disease (n = 33), streptococcal pharyngitis (n = 12), and in normal controls. Patients were investigated at admission and one, six and 12 months later. Streptococci adhered significantly more to the pharyngeal cells of patients with rheumatic fever and rheumatic heart disease than to the pharyngeal cells of controls. Adherence of streptococci to pharyngeal cells of patients with pharyngitis was not different from age-matched controls. The adherence of streptococci to the pharyngeal cells of patients with acute rheumatic fever fell during follow-up but even after one year remained significantly higher than in the control group. These findings suggest that host factor(s) controlling streptococcal adhesion and colonization at the pharyngeal mucosa may be important in the pathogenesis of acute rheumatic fever.

Acute Disease↗

PubMed1995

Value of screening for oro-pharyngeal Chlamydia trachomatis infection.

AIMS: To determine whether oro-pharyngeal colonisation by Chlamydia trachomatis occurs in patients at risk of genital chlamydia infection; to determine whether screening pharyngeal specimens by polymerase chain reaction (PCR) increases detection of C trachomatis compared with isolation and the immune dot blot test; and to correlate the detection of C trachomatis and Neisseria gonorrhoeae in the pharynx with a history of oro-genital contact. METHODS: Thirteen homosexuals and 11 heterosexuals were included in the study. Urogenital and pharyngeal specimens were tested for C trachomatis and N gonorrhoeae using standard clinical diagnostic procedures. Two different PCR methodologies were also used to detect C trachomatis in the pharyngeal specimens. Results were correlated with the mode of sexual practice. RESULTS: Oro-genital sexual contact was practised by 64.9% (72/111) of heterosexuals in addition to penetrative penovaginal intercourse. Additionally, 62.1% (77/124) of all patients did not use any form of barrier protection. Of those who admitted to oro-genital sexual contact, 17.6% of patients with a genital chlamydial infection and 36.4% of those with genital gonorrhoea also had asymptomatic pharyngeal colonisation. C trachomatis was detected in three of 124 (2.4%) pharyngeal specimens by PCR which were reported as negative by chlamydial culture; one was positive by the immune dot blot test. CONCLUSION: The majority of patients practised unprotected oro-genital contact and significant pharyngeal colonisation by C trachomatis and N gonorrhoeae occurred if genital infection was present. Despite the use of PCR in a population at high risk of sexually transmitted disease, the prevalence of chlamydia in the pharynx was very low. This indicates that transmission of C trachomatis to the oro-pharynx does not pose a serious health risk and that screening of patients for oro-pharyngeal C trachomatis is not worthwhile.

Adolescent↗

PubMed1997

PCR for detection of Chlamydia trachomatis in endocervical, urethral, rectal, and pharyngeal swab samples obtained from patients attending an STD clinic.

OBJECTIVE: To investigate, by use of the Amplicor PCR in a routine setting, the recovery rate of Chlamydia trachomatis in ano-rectal and pharyngeal swab samples obtained from males and females attending an STD clinic in relation to sexual practices, symptoms, and signs. DESIGN: Data regarding sexual practices, and symptoms and signs related to the rectum and pharynx, were obtained from 196 females and 208 males, including 31 homosexuals and eight bisexuals. Swab samples were obtained from the urethra, rectum, and pharynx from all the patients. An additional endocervical swab sample was obtained from the females. METHODS: All samples were analysed by the Amplicor PCR (Roche). SETTING: Rudolph Bergh's Hospital, a clinic for sexually transmitted diseases situated in the centre of Copenhagen, Denmark. RESULTS: The overall prevalence of urogenital C trachomatis infection was 9.2% (37/404). The specificity of the Amplicor PCR was 100% for both ano-rectal and pharyngeal swab samples. In females three (13%) of the 23 infections were detected only by testing an ano-rectal or throat swab sample. In homosexual males two (67%) of three infections were detected only by the anorectal swab sample. Ano-rectal intercourse without use of condom was reported by 44% of females and by 52% of homosexual males. Fellatio without condom use was reported by 91% of females, and 80% of heterosexual males practised cunnilingus. Pharyngeal infection, however, occurred only in females, and the presence of pharyngeal symptoms or signs seemed predictive for pharyngeal C trachomatis infection, for which the time of incubation or colonisation exceeded 3 months. The presence of ano-rectal signs or symptoms was not predictive for an ano-rectal C trachomatis infection. CONCLUSION: The Amplicor PCR can be used on ano-rectal and pharyngeal swab samples. Ano-rectal swab samples should be obtained in females and homosexual males at high risk of being infected. Pharyngeal samples should be taken in females at high risk of being infected, especially when pharyngeal signs or symptoms are present.

Adolescent↗

PubMed1987

Changes in pharyngeal cross-sectional area with posture and application of continuous positive airway pressure in patients with obstructive sleep apnea.

In an attempt to elucidate whether changes in posture (from sitting to supine) result in reduction in pharyngeal area, thus promoting pharyngeal occlusion during sleep in so predisposed persons, we studied 12 snoring apneic patients and 6 snoring nonapneic control subjects. in all subjects, we employed acoustic reflection technique to measure pharyngeal area at FRC sitting and supine. We also examined changes in pharyngeal area resulting from the application of positive intrapharyngeal pressure in sitting and supine posture. We found that (1) pharyngeal cross-sectional area at FRC was similar in both groups, (2) decrease in pharyngeal area with assumption of supine posture was also similar in both groups (21 +/- 11% in patients with OSA versus 15 +/- 13% in nonapneic control subjects), and (3) pharyngeal distensibility was significantly higher in apneic snorers than in nonapneic control subjects (0.090 +/- 0.039 cm H2O-1 in apneic snorers versus 0.032 +/- 0.027 cm H2O-1 in nonapneic control subjects; p less than 0.005). We conclude that changes in posture alone are not sufficient to convert a snorer into a patient with OSA; however, when physiologic abnormalities ("floppy" pharynx) are superimposed on postural reduction in pharyngeal area, airway occlusion results.

Humans↗

PubMed2006

Clinicians' management of children and adolescents with acute pharyngitis.

OBJECTIVE: Sore throat is a common complaint in children and adolescents. With increasing antimicrobial resistance because of antimicrobial overuse, accurate diagnosis is imperative. Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures. We surveyed pediatricians and family physicians to evaluate their management strategies for children and adolescents with acute pharyngitis and to assess the availability and use of diagnostic tests in office practice. METHODS: In 2004, surveys were mailed to a random sample of 1000 pediatrician members of the American Academy of Pediatrics and 1000 family physician members of the American Academy of Family Physicians. We assessed factors associated with physicians using an appropriate management strategy for treating acute pharyngitis. RESULTS: Of 948 eligible responses, 42% of physicians would start antimicrobials before knowing diagnostic test results and continue them despite negative results, with 27% doing this often or always. When presented with clinical scenarios of patients with acute pharyngitis, < or =23% chose an empirical approach, 32% used an inappropriate strategy for a child with pharyngitis suggestive of group A Streptococcus, and 81% used an inappropriate strategy for a child with findings consistent with viral pharyngitis. Plating cultures in the office was associated with an appropriate management strategy, although not statistically significant. Solo/2-person practice and rural location were both independent factors predicting inappropriate strategies. CONCLUSIONS: There is much room for improvement in the management of acute pharyngitis in children and adolescents. Most physicians use appropriate management strategies; however, a substantial number uses inappropriate ones, particularly for children with likely viral pharyngitis. Efforts to help physicians improve practices will need to be multifaceted and should include health policy and educational approaches.

Acute Disease↗

PubMed2006

Pharyngitis in low-resources settings: a pragmatic clinical approach to reduce unnecessary antibiotic use.

OBJECTIVE: Existing scoring systems for the diagnosis of group A streptococcus pharyngitis are insensitive or inapplicable in low-resources settings. Bacterial cultures and rapid tests can allow for antibiotic prescription abstention in high-income regions. These techniques are not feasible in many low-resources settings, and antibiotics often are prescribed for any pharyngitis episode. However, judicious antibiotics prescription in the community also is of concern in low-income countries. The objective of this study was to develop a clinical decision rule that allows for the reduction of empirical antibiotic therapy for children with pharyngitis in low-resources settings by identifying non-group A streptococcus pharyngitis. PATIENTS AND METHODS: We prospectively included children with pharyngitis in 3 public hospitals of Brazil during 9 months in 2004. We filled out clinical questionnaires and performed throat swabs. Bilateral chi2 (2-tailed test) and multivariate analysis were used to determine score categories. The outcome measures were sensitivity, specificity, positive likelihood ratio, and posttest probability of non-group A streptococcus infection with the clinical approach as compared with throat culture. RESULTS: A total of 163 of the 220 children had non-group A streptococcus pharyngitis (negative culture). We established a 3-questions decision rule (age and viral and bacterial signs) with 3 possible answers. The use of this score would prevent 41% to 55% of unnecessary antimicrobial prescriptions. The specificity of the score for non-group A streptococcus pharyngitis was >84%. CONCLUSION: Such a clinical decision rule could be helpful to reduce significantly unnecessary antibiotic prescriptions for pharyngitis in children in low-resources settings.

Anti-Bacterial Agents↗

PubMed2001

Principles of appropriate antibiotic use for acute pharyngitis in adults: background.

The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus.1. Group A beta-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis. The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed.2. Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection. All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care.3. Limit antibiotic prescriptions to patients who are most likely to have GABHS infection. Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis). Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection. For patients with two or more criteria the following strategies are appropriate: a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; b) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria. 4. Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80%. Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered.5. The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient.

Acute Disease↗

PubMedDate not supplied

Accuracy of rapid strep testing in patients who have had recent streptococcal pharyngitis.

BACKGROUND: Some clinicians have questioned the accuracy of rapid diagnosis of group A streptococcal pharyngitis by commercial immunochemical antigen test kits in the setting of recent streptococcal pharyngitis, believing that the false-positive rate was increased because of presumed antigen persistence. METHODS: We studied 443 patients--211 cases--who had clinical pharyngitis diagnosed as group A beta-hemolytic streptococcus infection in the past 28 days and compared them with 232 control patients who had symptoms of pharyngitis but no recent diagnosis of streptococcal pharyngitis. Our aim was narrowly focused to compare the rapid strep test with the culture method we used in our clinical practice. RESULTS: We found that the rapid strep test in this setting showed no difference in specificity (0.96 vs 0.98); hence, the assertion that rapid antigen testing had higher false-positive rates in those with recent infection was not confirmed. We also found that in patients who had recent streptococcal pharyngitis, the rapid strep test appears to be more reliable (0.91 vs 0.70, P < .001) than in those patients who had not had recent streptococcal pharyngitis. CONCLUSIONS: The findings of this study indicate that the rapid strep test is both sensitive and specific in the setting of recent group A beta-hemolytic streptococcal pharyngitis, and its use might allow earlier treatment in this subgroup of patients.

Antigens, Bacterial↗

PubMedDate not supplied

[Physiology of pharyngeal muscles after surgical restoration of the velopharyngeal sphincter].

INTRODUCTION: Speech velopharyngeal sphincter restoration is generally performed by pharyngeal flap or sphincter pharyngoplasty. OBJECTIVE: Evaluate pharyngeal muscle physiology after pharyngeal flap or sphincter pharyngoplasty using simultaneous electromyography and videonasopharyngoscopy. MATERIAL AND METHODS: Forty patients were studied. Twenty patients were operated on with an upper base pharyngeal flap. Twenty patients were operated on with sphincter pharyngoplasty. The following muscles were studied: superior constrictor pharyngeus, palatopharyngeus, and levator veli palatini. RESULTS: None of the patients studied showed electromyographic activity in the lateral flaps of tile pharyngoplasties. None showed electromyographic activity of the upper base pharyngeal flaps. All patients demonstrated strong electromyographic activity on the superior constrictor pharyngeus and the levator veli palatini. CONCLUSIONS: Lateral pharyngeal flaps in cases of sphincter pharyngoplasties and the central pharyngeal flap in cases of pharyngeal flaps, do not create new sphincters for velopharyngeal closure. The participation of these structures is passive, increasing tissue volume in specific areas, whereas their movements are caused by the contraction of the superior constrictor pharyngeus and the levator veli palatini.

Adolescent↗

PubMed1979

Prospective study on streptococcal pharyngitis among a town population.

A one-year-round study on pharyngitis incidence among the general population of a town (24,300 inhabitants) was carried out. All patients, with pharyngitis who visited health centres were examined clinically and mcirobiologically. The overall pharyngitis incidence rate and the streptococcal pharyngitis incidence rate were, respectively, 8.3 and 3.9 cases per 100 population. Age-related incidence was highest in the group of 5-10 years, seasonal incidence was highest in autumn. Clinical diagnoses made preliminary to bacteriological examination were correct in only a half of the streptococcal pharyngitis cases. The accuracy of clinical diagnosis of streptococcal pharyngitis could, at best, be raised to 80% if fever of less than or equal to 38.0 degrees C and presence of exudate on tonsils should be considered significant criteria. A great majority of the streptococcal pharyngitis cases were caused by group A streptococci; the prevailing M types were 12, 1 and 3. Emphasis is laid on the necessity of performing microbiological examination of all pharyngitis cases in order to ensure etiological diagnosis and causal therapy. 15)

Adolescent↗

PubMed1993

Inferior wall myocardial infarction preceded by acute exudative pharyngitis in young males.

We conducted a comparative study in an intensive coronary care unit to elucidate the role of acute exudative pharyngitis in the setting of acute myocardial infarction (AMI). The subjects were 42 young male patients with AMI that was preceded by pharyngitis in 7 of them. Results showed that the site of the infarction was inferior in all those with preceding pharyngitis while only 33% of the other group had an inferior infarction. In patients with preceding exudative pharyngitis the coronary event was the first and only confrontation with the disease. Their prognosis was good, with normal exercise tests and absent coronary risk factors except for smoking in two patients and family history in one. Patients without pharyngitis had multiple coronary risk factors, with positive exercise stress tests in 46% and recurrent infarctions in 26%. Coronary arteriography was performed in four patients with pharyngitis and was normal, while multi-vessel disease was the rule in those without pharyngitis. We conclude that exudative pharyngitis may be followed by acute inferior myocardial infarction in young males and the diagnosis of infarction should be ruled out when such patients present with chest pains.

Acute Disease↗