The Pharyngitis (GAS) Or Acute Pharyngitis?

Acute bronchitis is one of the most common diagnoses encountered in a primary care setting. It affects millions of individuals resulting in significant impact on health of patients and health care industry. Studies have shown that 90% of times acute bronchitis is caused by a virus, yet health care providers are failing to treat or manage these patients with appropriate therapies (Knutson & Braun, 2002). The focus of this paper is to review the guidelines for treatment of acute bronchitis after differentiating acute bronchitis from other common respiratory disease in terms of epidemiology, pathophysiology, clinical features, diagnosis, differential diagnosis, complications and patient education. Understanding the evaluation and treatment guidelines, nurse practitioners can provide evidence-based practice for patients with acute bronchitis.

Ms. T is an eight year old African American female that presents to Dr. Bill’s Kids today with complaints of her tonsils bothering her again. She has been to this office three times in the past three months with complaints of swollen tonsils and painful swallowing. Each time, she has tested positive for Group A Streptococcus also known as GAS. Her mother is with her today and reports that she had strep throat in the past multiple times about two or three times a year, but it is becoming much more frequent. She began complaining of scratchy throat in the morning and at night, but the symptoms quickly progressed to painful swallowing of solids and liquids. Popsicles are the only thing she will even consider eating at this time because they alleviate the pain.

When CAP occurs, it is determined if the need for hospitalisation is necessary as it depends on the seriousness of the infection. Gram- positive organisms such as S. pneumoniae, naturally occur in the upper respiratory tract, is one cause of lower respiratory infections such as pneumonia, but is also a culprit in causing upper respiratory infections like otitis media. H. influenzae is just one of many bacterial infections that can result in CAP, it therefore can be subacute and present with a low-grade fever and a persistent cough for a few weeks before a patient has a diagnosis. Adults that have very little or no immunity are an easier target for certain viruses such as that of the Cytomegalovirus, which is a viral pathogen that is commonly contracted within the community, other common virus are adenovirus and herpes simplex. When a virus starts to become acute, it starts an infection within the ciliated cells within the airway. When pneumonia occurs from this viral infection, the inflammatory action starts to seep into the alveolar areas and leads to the problem of excess exudation and oedema within the respiratory tract. It is sometimes often difficult to differentiate symptoms of a viral pneumonia from that of bacterial pneumonia (Smeltzer &

Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).

Initial diagnosis of Streptococcal pharyngitis is determined by a point system awarding 1 point for each of the following; temperature greater than 38 C, absence of cough, tender anterior cervical lymph nodes, tonsillar swelling, age younger than 15, subtracting a point for age older than 45. If these symptoms are met, a rapid strep test will be performed before antibiotics are given, a precaution taken to prevent super-bugs from developing.

Streptococcus pharyngitis is a bacterial infection of the throat caused by Streptococcus pyogenes, also known as group A Streptococcus. It can causes throat pain, difficulty with swallowing, red and swollen tonsils which can be accompanied with white patches or streaks of pus, red spots on the palate, swollen lymph glands in the neck, fever, headache, rash, stomach ache, and fatigue. It can lead to more serious conditions such as scarlet fever, inflammation of the kidneys, and rheumatic fever. When Streptococcus pharyngitis is suspected, usually a rapid antigen test is run but a throat culture also needs to be done. Treatment is usually Penicillin and Amoxicillin for children. Nursing intervention for Streptococcus pharyngitis is to make sure the patient gets plenty of rest and also to push fluids to keep the back of the throat lubricated and to prevent dehydration (http://www.mayoclinic.org/diseases-conditions/strep-throat/basics/definition/con-20022811).

Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013). A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013). Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to inflammation noted at the back of the throat and associated with complaints of pain when swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the rhino or coronavirus which lasts between 5-7 days and presents with associated symptoms like cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in children and adolescents. Often individuals present with symptoms including throat pain, fever, chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal (Ruppert & Fay, 2015). This infectious process in younger children may also present with gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by cough or nasal

Strep throat is an infection of the tonsils and/or throat caused by the bacteria streptococcus pyogenes (group A strep), and streptococcal bacteria are highly contagious. Symptoms include sore throat, fever, and trouble swallowing. Children may also experience stomachache, vomiting, and headache. Signs of strep throat are white dots on the tonsils, and/or redness in the throat. How is strep throat spread? It can be spread through the air when someone with strep throat coughs, sneezes, or breathes.

The client’s secondary diagnosis is community-acquired pneumonia. Typically, immune defense mechanisms, such as the secretion of alveolar macrophages and immunoglobulins A and G, protect the lower airway from infection. Streptococcus pneumoniae, the most common causative agent of community-acquired pneumonia, invades the lungs. The organism triggers an inflammatory response, resulting in increased blood flow and vascular permeability. Neutrophil activation occurs, to surround the kill the invading organism. A combination of the offending organism, neutrophils and fluid from the surrounding blood vessels flood the alveoli, inhibiting normal oxygen transportation. This filling of the alveoli may lead to tachypnea, tachycardia and dyspnea. Further obstruction of airflow and an increased impairment of gas exchange occur as mucous production increases. When

Pneumonia is an inflammation of the lung which results into an excess of fluid or pus accumulating into the alveoli of the lung. Pneumonia impairs gas exchange which leads to hypoxemia and is acquire by inhaling a contagious organism or an irritating agent. (Ignatavicius & Workman, 2013). Fungal, bacteria and viruses are the most common organisms that can be inhale. Pneumonia could be community-acquired or health care associated. Community –acquired pneumonia (CAP) occurs out of a healthcare facility while health care associated pneumonia (HAP) is acquired in a healthcare facility. HAP are more resistant to antibiotic and patients on ventilators and those receiving kidney dialysis have a higher risk factor. Infants, children and the elderly also have a higher risk of acquiring pneumonia due to their immune system inability to fight the virus. Pneumonia can also be classified as aspiration pneumonia if it arises by inhaling saliva, vomit, food or drink into the lungs. Patients with abnormal gag reflex, dysphagia, brain injury, and are abusing drug or alcohol have a higher risk of aspiration pneumonia (Mayo Clinic, 2013). In the case of patient E.O., this patient had rhonchi in the lower lobe and the upper lobe sound was coarse and diminished. Signs and symptoms of pneumonia include difficulty breathing, chest pain, wheezing, fever, headache, chills, cough, confusion, pain in muscle or

Tonsillitis can be described as the inflammation of the non-encapsulated lymphoid structures, lingual and palatine tonsils. These lymphoid tissues are part of the immune system and are the first line of defence against pathogens in the oral cavity. The palatine and lingual tonsils are located underneath the stratified squamous epithelial mucosa of the tongue and oropharynx. The tonsils’ response to bacterial or viral infections of the epithelial mucosa, e.g. streptococci and the Epstein-Barr virus (EBV), is inflammation and enlargement of the tonsils and antibody responses, largely IgA. Symptoms of tonsillitis include Sore throat and fever.

Strep throat is a common, contagious infection caused by group A streptococcus, bacteria that presents as a sore throat. The bacteria that causes strep throat tend to

For some reason my sister also gets strep a lot, they told us it was due to eating a lot of ice. My sister also has never had tonsillitis. While doing research I found that Strep and tonsillitis both are an infection causing the throat to become sore. The only real difference is with strep the patient will experience sever soreness to their throat. With tonsillitis the tonsils are inflamed and strep it‘s a specific bacteria that also inflame the throat. I’ve attached a great article on the difference between the two

Streptococcus pneumoniae is found worldwide. The common host is the human body, in which it often does not cause disease but at other times it can cause diseses in particular, pneumonia. It also causes otitis media, bacteremia, meningitis, peritonitis, and sinusitis. The route by which this organism is spread is from human to human in the form of aerosol droplets. When inside the host the organism’s primary site of pneumococcal colonization is the nasopharynx. From this site it can aspire to the lungs, eventually spread to the blood and traverse the blood-brain barrier to the meninges, once inside the blood it can cause infections throughout the body. Symptoms of the disease include sudden

The clinical manifestations of pneumonia will be different according to the causative organism and the patient’s underlying conditions and/or comorbidities (Smeltzer, et al). Some of the manifestations are