CORD-19_Custom_license_subset  

CORD-19:075418efdb961154d99d8d1b4670ef2439a0cca4 JSONTXT 9 Projects

Annnotations TAB TSV DIC JSON TextAE

Id Subject Object Predicate Lexical cue
T1 0-60 Sentence denotes Diagnosis and Treatment of Group A Streptococcal Pharyngitis
T2 62-70 Sentence denotes Abstract
T3 73-116 Sentence denotes the late winter or early spring (Table 3) .
T4 117-197 Sentence denotes Headache, malaise, abdominal pain, nausea, and vomiting are commonly associated.
T5 198-290 Sentence denotes Cough, rhinorrhea, stridor, hoarseness, conjunctivitis, and diarrhea are distinctly unusual.
T6 291-370 Sentence denotes Pharyngeal erythema, sometimes with palatal petechiae, is found on examination.
T7 371-440 Sentence denotes Tonsils are enlarged and red, with patchy exudates on their surfaces.
T8 441-604 Sentence denotes The papillae of the tongue may be red and swollen, leading to the designation, "strawberry tongue." Tender, enlarged anterior cervical lymph nodes often are found.
T9 605-800 Sentence denotes Combinations of these signs assist in diagnosis; tonsillar exudates in association with palatal petechiae and tender anterior cervical adenitis strongly suggest group A streptococcal pharyngitis.
T10 801-912 Sentence denotes Very often, some or all of these classic characteristics are absent in patients with streptococcal pharyngitis.
T11 913-1069 Sentence denotes Younger children may have coryza with crusting below the nares, more generalized adenopathy, and a more chronic course, a syndrome known as streptococcosis.
T12 1070-1188 Sentence denotes Scarlet fever, so-called because of its fine, diffuse red rash, usually indicates infection with group A streptococci.
T13 1189-1254 Sentence denotes It rarely" is seen in children younger than 3 years or in adults.
T14 1255-1457 Sentence denotes The rash of scarlet fever is caused by infection with a group A strain that contains a bacteriophage encoding for the production of an erythrogenic toxin, usually erythrogenic (or pyrogenic) exotoxin A.
T15 1458-1554 Sentence denotes The scarlet fever rash has a texture that feels similar to sandpaper and blanches with pressure.
T16 1555-1616 Sentence denotes Beginning on the face, it becomes generalized after 24 hours.
T17 1617-1748 Sentence denotes The area around the mouth often appears pale in comparison to the extremely red cheeks, giving the appearance of circumoral pallor.
T18 1749-1876 Sentence denotes Accentuation of erythema occurs in flexor skin creases, especially in the antecubital fossae (Pastia's sign or Pastia's lines).
T19 1877-2073 Sentence denotes The erythema begins to fade within a few days, and within a week of onset desquamation occurs, first on the face, progressing downward, and often resembling that seen subsequent to a mild sunburn.
T20 2074-2232 Sentence denotes Occasionally, sheetlike desquamation occurs around the free margins of the finger nails, usually more coarse than the desquamation seen with Kawasaki disease.
T21 2233-2361 Sentence denotes Differential diagnosis of scarlet fever includes Kawasaki disease, measles, and staphylococcal toxic shock syndrome ( Table 2) .
T22 2362-2488 Sentence denotes Recent publicity has highlighted invasive toxin-producing group A streptococcal infection that includes necrotizing fasciiris.
T23 2489-2732 Sentence denotes Although many patients with the so-called "streptococcal toxic shock syndrome" also are infected with streptococci that produce erythrogenic toxin A, most infections caused by such group A streptococci are not associated with unusual severity.
T24 2733-2884 Sentence denotes Streptococcal toxic shock syndrome is associated more commonly with a primary cutaneous focus of infection rather than a pharyngeal focus of infection.
T25 2885-3012 Sentence denotes 3 Scarlet fever can still be explained in simple terms to patients and their families as streptococcal pharyngitis with a rash.
T26 3014-3162 Sentence denotes Streptococcal pharyngitis was identified mainly in well-defined epidemics before World War II, but has been endemic in the United States since then.
T27 3163-3220 Sentence denotes Cases generally peak in the late winter and early spring.
T28 3221-3469 Sentence denotes Children from 5 to 11 years old have the highest rates of streptococcal pharyngitis, but infection occurs at all ages; an outbreak has been documented in a day care center) Spread of group A streptococci in classrooms and within families is common.
T29 3470-3672 Sentence denotes Crowded living conditions increase spread; military units have been common sites for streptococcal research because of frequent epidemics and their devastating effect on troop training and availability.
T30 3673-3799 Sentence denotes 5 Transmission occurs primarily by inhalation of organisms in large droplets or by direct contact with respiratory secretions.
T31 3800-3872 Sentence denotes Pets do not seem to be a 'significant reservoir of group A streptococci.
T32 3873-4026 Sentence denotes Untreated streptococcal pharyngitis is particularly contagious early in the acute illness and for the first 2 weeks after the organism has been acquired.
T33 4027-4164 Sentence denotes Appropriate antibiotic therapy eliminates contagiousness within 24 hours after institution of therapy, and children can return to school.
T34 4165-4166 Sentence denotes 6
T35 4167-4351 Sentence denotes Many patients with bona fide group A streptococcal pharyngitis do not have classic signs and symptoms, and their symptoms overlap substantially with pharyngitis caused by other agents.
T36 4352-4569 Sentence denotes However, the presence of typical features of viral pharyngitis when there are low rates of streptococcal disease in the community very strongly suggests a nonstreptococcal etiology, and laboratory testing is optional.
T37 4570-4729 Sentence denotes When signs and symptoms suggest acute streptococcal pharyngitis (including patients with scarlet fever), laboratory diagnosis is strongly recommended (Fig 1) .
T38 4730-4978 Sentence denotes Clinical scoring systems for diagnosing acute streptococcal pharyngitis have been developed but have not proved very useful] Using clinical criteria alone, physicians tend to overestimate the likelihood that patients have streptococcal infection, g
T39 4979-5095 Sentence denotes The throat culture has been used in physicians' offices to diagnose streptococcal pharyngitis since the early 1950s.
T40 5096-5340 Sentence denotes 9 Plating a swab of the posterior pharynx and tonsils on sheep blood agar, identifying 13-hemolytic colonies, and testing them for sensitivity to a bacitracin-impregnated disc is the "gold standard" diagnostic test, but requires 24 to 48 hours.
T41 5341-5445 Sentence denotes More recently, a number of rapid diagnostic tests that require less than 30 minutes have been developed.
T42 5446-5624 Sentence denotes When performed by experienced personnel, these rapid diagnostic tests (rapid strep antigen tests) are highly specific (generally > 95%), using the throat culture as the standard.
T43 5625-5743 Sentence denotes Specificity reflects the percentage of positive results that come from patients who truly harbor group A streptococci.
T44 5744-5903 Sentence denotes Unfortunately, the sensitivity (the percentage of true-positives that are identified by group A antigen detection) of most of these rapid tests is problematic.
T45 5904-6085 Sentence denotes Although the sensitivities of these tests are typically 80% to 85%, they can optical immunoassay (OIA) technology has not been evaluated sufficiently to be recommended at this time.
T46 6086-6253 Sentence denotes The inadequate sensitivity of most rapid tests, coupled with their excellent specificity, requires a two-step approach when rapid streptococcal antigen tests are used.
T47 6254-6338 Sentence denotes Two swabs should be obtained from patients with suspected streptococcal pharyngitis.
T48 6339-6373 Sentence denotes One swab is used for a rapid test.
T49 6374-6538 Sentence denotes When the rapid antigen detection test is positive, it is highly likely that the patient has group A streptococci in the throat, and the extra swab can be discarded.
T50 6539-6692 Sentence denotes When the rapid test is negative, group A streptococci may still be present; thus, the extra swab should then be processed for culture in routine fashion.
T51 6693-6793 Sentence denotes In general, patients with negative rapid tests do not require treatment before culture verification.
T52 6794-7097 Sentence denotes When there is a particularly high index of suspicion that group A streptococci are involved (eg, several of the following: tonsillar exudates, cervical adenopathy, palatal petechiae, scarlet fever, and recent exposure to a person with streptococcal pharyngitis) presumptive treatment may be appropriate.
T53 7098-7240 Sentence denotes Rapid tests are intended for the diagnosis of acute streptococcal pharyngitis and should not be used to evaluate the effectiveness of therapy.
T54 7241-7447 Sentence denotes A positive result in an asymptomatic patient does not distinguish among infection, colonization (carriage), or the presence of nonviable organisms, and a negative result must be confirmed by throat culture.
T55 7448-7557 Sentence denotes Several surveys have examined the actual strategies used by physicians to diagnose streptococcal pharyngitis.
T56 7558-7810 Sentence denotes Cochi et al ~5 surveyed primary care physicians in December 1982 and January 1983, before rapid tests became available, and found that approximately 25% of the respondents always or nearly always obtained throat cultures from patients with sore throat.
T57 7811-7890 Sentence denotes Cultures were never or almost never obtained by 23% of the physicians surveyed.
T58 7891-8021 Sentence denotes This survey also found that pediatricians were more likely than internists or family/general practitioners to use throat cultures.
T59 8022-8134 Sentence denotes In 1993, Schwartz et a116 surveyed pediatricians about their diagnostic approaches to children with pharyngitis.
T60 8135-8327 Sentence denotes An optimal approach, defined as use of culture alone or as a backup to a negative rapid antigen test for at least 80% of patients, was used by 44% of pediatricians who responded to the survey.
T61 8328-8444 Sentence denotes Seventeen percent reported using clinical findings or rapid test without culture for most children with pharyngitis.
T62 8445-8711 Sentence denotes We obtained similar results from a recent national survey of U.S. pediatricians; 64% used rapid tests at least some of the time, 42% used throat cultures whenever the rapid test was negative, 38% used cultures alone, and 20% used strategies that are not recommended.
T63 8712-8831 Sentence denotes 17 Thus, it appears that many physicians do not follow recommended guidelines for diagnosing streptococcal pharyngitis.
T64 8832-9024 Sentence denotes Testing patients for serological evidence of an antibody response to extracellular products of group A streptococci (such as streptolysin O) is not useful during the acute pharyngitis episode.
T65 9025-9174 Sentence denotes Because serum antibody levels require at least 10 to 14 days to increase, streptococcal antibody tests are valid only for determining past infection.
T66 9175-9279 Sentence denotes Antibodies often measured include anti-streptolysin O (ASO), anti-DNase B, and anti-hyaluronidase (AHT).
T67 9280-9435 Sentence denotes When antibody testing is desired to evaluate a possible poststreptococcal illness, more than one of these tests should be performed to improve sensitivity.
T68 9436-9678 Sentence denotes However, the Streptozyme test (Wampole Laboratories, Cranbury, NJ), an assay that uses latex particles coated with group A streptococcus broth culture supernates, has been shown to be poorly standardized and therefore cannot be recommended.iS
T69 9679-9780 Sentence denotes The primary goal of therapy for acute streptococcal pharyngitis is to prevent the development of ARF.
T70 9781-9975 Sentence denotes Treatment begun within 9 days after the onset of acute pharyngitis and continued for 10 days is effective in preventing ARF. ~9 Therapy does not seem to affect the risk of poststreptococcal AGN.
T71 9976-10115 Sentence denotes Antibiotic therapy also reduces the suppurative sequelae of streptococcal pharyngitis, such as peritonsillar abscess and cervical adenitis.
T72 10116-10343 Sentence denotes In addition to preventing ARF, signs and symptoms of pharyngitis resolve somewhat more rapidly in patients treated early, a fact documented most recently by studies published in the 1980s 2~ but first noted several decades ago.
T73 10344-10558 Sentence denotes 22,~3 Since antibiotic therapy also terminates contagiousness within 24 hours, institution of appropriate antibiotic therapy generally should be undertaken as soon as the diagnosis is supported by laboratory tests.
T74 10559-10781 Sentence denotes Although some studies have suggested that early treatment may increase the rate of recurrent streptococcal pharyngitis by stunting the immune response, 24,25 the most carefully performed investigation refutes this concept.
T75 10782-11068 Sentence denotes 26 Unnecessarily delaying therapy risks losing the patient to follow-up (a particular problem among patienis without an established source of primary health care), may prolong symptoms leading to loss of additional time from school and/or work, and extends the period of contagiousness.
T76 11069-11279 Sentence denotes Antimicrobial therapy can be started before the results of cultures are available, especially if the rash of scarlet fever is present or other clinical features are highly suggestive of streptococcal infection.
T77 11280-11472 Sentence denotes Therapy should be stopped if group A streptococci are not confirmed by rapid test or throat culture, although many physicians unfortunately continue antibiotic therapy despite negative tests 9
T78 11473-11574 Sentence denotes The drug of choice for treating streptococcal pharyngitis has been penicillin for more than 40 years.
T79 11575-11728 Sentence denotes Despite the widespread use of penicillin to treat streptococcal and other infections, penicillin resistance among group A streptococci has not developed.
T80 11729-12038 Sentence denotes 27 Penicillin usually is given by mouth for 10 days (125 to 250 mg of penicillin V three or four times each day) or intramuscularly as a single injection of benzathine penicillin (600,000 units for patients weighing less than 60 pounds [27 kg], 1.2 million units for those weighing 60 pounds [27 kg] or more).
T81 12039-12125 Sentence denotes In efforts to improve compliance, twice-daily dosing has been tried with some success.
T82 12126-12263 Sentence denotes 2~,29 Shorter courses of therapy also have 9 been tried, but the bacteriologic results of 5 or 7 days of therapy have not been promising.
T83 12264-12380 Sentence denotes 3~ Use of intramuscular benzathine penicillin also alleviates concern about patient compliance but is quite painful.
T84 12381-12524 Sentence denotes A less painful alternative is 900,000 units of benzathine penicillin in combination with 300,000 units of procaine penicillin for all patients.
T85 12525-12635 Sentence denotes Intramuscular procaine penicillin alone is insufficient because adequate levels of penicillin are short-lived.
T86 12636-12773 Sentence denotes Other ~-lactams, including semisynthetic derivatives of penicillin and cephalosporins, have been used to treat streptococcal pharyngitis.
T87 12774-12923 Sentence denotes The decreased frequency of administration of some of these agents may improve patient compliance and makes them attractive in selected circumstances.
T88 12924-13049 Sentence denotes Patients who are allergic to penicillin should receive erythromycin or another non-13-1actam antibiotic, such as clindamycin.
T89 13050-13209 Sentence denotes Resistance of group A streptococci to erythromycin has been reported in countries such as Japan, France, Spain, and Finland, where erythromycin is widely used.
T90 13210-13268 Sentence denotes 32 This has not emerged as a problem in the United States.
T91 13269-13487 Sentence denotes Sulfa drugs, including sulfamethoxasole/trimethoprim, tetracyclines, and chloramphenicol are not effective in eradicating group A streptococci from the pharynx and should not be used for treatment of acute pharyngitis.
T92 13488-13649 Sentence denotes Despite universal susceptibility of group A streptococci to penicillin, treatment fails to eradicate streptococci from the pharynx in as many as 25% of patients.
T93 13650-13768 Sentence denotes 33 Penicillin resistance is not the cause of treatment failure; therefore, treatment failure is a puzzling phenomenon.
T94 13769-14009 Sentence denotes A small proportion of these patients remain symptomatic and are thus characterized as "clinical treatment failures." Reinfection with the same or a different strain of group A streptococcus is possible, as is intercurrent viral pharyngitis.
T95 14010-14172 Sentence denotes Some patients may have been noncompliant with therapy, but apparent treatment failure occurs even among patients treated with intramuscular benzathine penicillin.
T96 14173-14318 Sentence denotes 34,35 Some of these patients are chronic pharyngeal carriers of group A streptococci and suffer from a new superimposed viral infection (Fig 2) .
T97 14319-14485 Sentence denotes Most patients with bacteriologic treatment failure are asymptomatic and are identified when follow-up cultures are obtained, a practice that generally is unnecessary.
T98 14486-14554 Sentence denotes Patients who are compliant with therapy are at minimal risk for ARF.
T99 14555-14715 Sentence denotes 36 There is some evidence that bacteriologic failure rates may be somewhat lower when antibiotics other than penicillin are used, especially the cephalosporins.
T100 14716-15012 Sentence denotes 3739 Although numerous studies of various cephalosporins have been published, few studies have been large enough or have been performed rigorously enough to prove that this class of antimicrobials is superior to penicillin; all of the antibiotics have treatment failure associated with their use.
T101 15013-15096 Sentence denotes Published metanalyses suffer from the poor quality of many of the included studies.
T102 15097-15276 Sentence denotes 39 Semisynthetic derivatives of penicillin (such as dicloxicillin), rifampin given with oral penicillin, amoxicillin-clavulanate, clindamycin, and other drugs also have been used.
T103 15277-15575 Sentence denotes At this time, it is fair to say that these antimicrobials are at least as effective as penicillin for treating streptococcal pharyngitis but that their broader spectrum, their much greater cost, and the lack of formal data concerning prevention of ARF currently relegate them to second-line status.
T104 15576-15621 Sentence denotes Routine use of these agents is not warranted.
T105 15622-15701 Sentence denotes Several theories have been advanced to explain bacteriologic treatment failure.
T106 15702-15980 Sentence denotes These include protection of group A streptococci by [3-1actamase-producing oral flora, 4~ tolerance of group A streptococci to penicillin, 43 streptococci "hiding" in tonsils, 44 and the absence of oral ttora (particularly alpha streptococci) inhibitory to group A streptococci.
T107 15981-16055 Sentence denotes 45-46 None of these theories has been proven, but several deserve mention.
T108 16056-16212 Sentence denotes Numerous reports on efficacy of [3-1actamase-resistant antibiotics suggest a possible role for [3-1actamase-producing flora in penicillin treatment failure.
T109 16213-16349 Sentence denotes 37,47-49 However, the patient populations studied, the bacteriologic methods used, and the follow-up differ greatly among these studies.
T110 16350-16520 Sentence denotes Few of these studies actually isolated [3-1actamase-producing bacteria from the pharynx and tried to correlate their presence with the bacteriologic outcome of treatment.
T111 16521-16687 Sentence denotes Our study that evaluated thepresence of [3-1actamas'e producers with outcome of treatment of acute streptococcal pharyngitis does not support the [3-1actamase theory.
T112 16688-16844 Sentence denotes 5~ Tolerance to penicillin (inhibition of bacterial growth without killing) has been discussed widely but does not seem to play a role in treatment failure.
T113 16845-17182 Sentence denotes 49,51 Perhaps the best explanation for asymptomatic persistence ofgroupA streptococci after appropriate treatment is that these patients are chronically colonized with group A streptococci and develop symptoms because of an intercurrent viral pharyngitis (ie, in retrospect, they did not have bonafide acute streptococcal pharyngitis).33
T114 17183-17276 Sentence denotes Patients who are colonized chronically with group A streptococci are called chronic carriers.
T115 17277-17438 Sentence denotes Chronic carriers do not seem to be at risk for ARF or for development of suppurative complications, and they rarely spread group A streptococci in the community.
T116 17439-17521 Sentence denotes 36 There is no reason to exclude chronic carriers from school or other activities.
T117 17522-17627 Sentence denotes Careful, controlled studies of the causes of chronic pharyngeal carriage of group A streptococci are few.
T118 17628-17787 Sentence denotes At present, the precise mechanisms that lead to this phenomenon remain obscure, but theories include those advanced to explain bacteriologic treatment failure.
T119 17788-17976 Sentence denotes Chronic streptococcal carriage is fairly common; in one study, 8.3% of children 5 to 7 years old who presented for well child care had asymptomatic colonization with group A strepto-cocci.
T120 17977-18035 Sentence denotes 52 Even higher rates of carriage are sometimes documented.
T121 18036-18200 Sentence denotes Carriage poses problems for the clinician because there is no easy way to identify chronic carriers prospectively among patients with symptoms of acute pharyngitis.
T122 18201-18349 Sentence denotes Streptococcal antibody titers often are elevated in carriers, hut neither these elevated titers nor quantitative throat cultures have proved useful.
T123 18350-18548 Sentence denotes 36 The clinician should consider the possibility of chronic streptococcal carriage when a patient has multiple culturepositive episodes of pharyngitis, especially when symptoms are mild or atypical.
T124 18549-18797 Sentence denotes A culture obtained when the suspected carrier is symptom-free or is receiving treatment with penicillin (intramuscular benzathine penicillin is recommended to eliminate the possibility of noncompliance) usually is positive for group A streptococci.
T125 18798-18923 Sentence denotes Chronic carriers sometimes receive multiple unsuccessful courses of antibiotic therapy in attempts to eliminate streptococci.
T126 18924-19021 Sentence denotes Physician and patient anxiety is common and can develop into "streptophobia" on the part of both.
T127 19022-19099 Sentence denotes Unproven and generally untested therapies for carriers often are encountered.
T128 19100-19250 Sentence denotes These include tonsillectomy, prolonged administration of antibiotics, use of [3-1actamase-resistant antibiotics, and culture and/or treatment of pets.
T129 19251-19360 Sentence denotes None of these approaches can be justified at this time for treating chronic carriers of group A streptococci.
T130 19361-20022 Sentence denotes Several treatment options are available for the physician faced with a chronic streptococcal carrier: (1) Ignore the problem and stop obtaining throat cultures, even for new symptomatic attacks of pharyngitis; (2) obtain a rapid test and/or throat culture each time the patient has symptoms and signs suggestive of streptococcal pharyngitis, and avoid obtaining throat cultures when patients have symptoms more typical of viral illnesses (cough, rhinorrhea, stridor, hoarseness, conjunctivitis, diarrhea), and treat with penicillin each time a test is positive; or (3) treat with one of the regimens established to be effective for terminating chronic carriage.
T131 20023-20205 Sentence denotes 34,53 Of these three options, the first is the most risky because a patient could become infected with a new strain of group A streptococcus and be at risk for ARF if left untreated.
T132 20206-20292 Sentence denotes The second option is simple, as safe as penicillin, and appropriate for many patients.
T133 20293-20655 Sentence denotes The third option should be reserved for particularly anxious patients and families, individuals with a history of ARF or living with someone who had ARF, or those living or working in nursing homes, chronic care facilities, and hospitals, and in families exhibiting "ping-pong" spread, ie, streptococcal pharyngitis bouncing among family members for a long time.
T134 20656-21013 Sentence denotes The two treatment regimens that have been demonstrated to be effective are: (1) intramuscular benzathine penicillin plus oral rifampin (10 mg/kg/dose up to 300 mg, administered twice daily for 4 days beginning on the day of the penicillin injection)34; and (2) oral clindamycin given for 10 days (20 mg/kg/ day up to 450 mg, divided into three equal doses).
T135 21014-21161 Sentence denotes 53 We currently prefer clindamycin because it is easier to use than intramuscular penicillin plus oral rifampin and may be somewhat more effective.
T136 21162-21310 Sentence denotes No other antibiotic regimens have been demonstrated in controlled, comparative trials to reliably terminate the chronic streptococcal carrier state.
T137 21311-21506 Sentence denotes Successful eradication of the carrier state makes evaluation of subsequent episodes of pharyngitis much easier, although we have seen chronic carriage recur on reexposure to group A streptococci.
T138 21507-21578 Sentence denotes Some patients seem remarkably susceptible to streptococcal pharyngitis.
T139 21579-21699 Sentence denotes Appropriate antibiotic treatment of each episode results in resolution of symptoms and eradication of the microorganism.
T140 21700-21876 Sentence denotes Follow-up throat culture may be needed to distinguish recurrent acute streptococcal pharyngitis from frequent nonstreptococcal pharyngitis in patients who are chronic carriers.
T141 21877-22139 Sentence denotes The reasons for frequent episodes ofbonafide acute streptococcal pharyngitis are obscure, but lack of flora, especially alpha streptococci, capable of inhibiting group A streptococci, or unusual mucosal adherence to group A streptococci, are intriguing concepts.
T142 22140-22249 Sentence denotes Studies of nasal spraying of alpha streptococci to prevent recurrent acute pharyngitis are ongoing in Sweden.
T143 22250-22374 Sentence denotes 54 The role of tonsillectomy in managing patients with multiple episodes of streptococcal pharyngitis remains controversial.
T144 22375-22578 Sentence denotes Paradise et a155 demonstrated fewer episodes of sore throat among children treated with tonsillectomy (compared to patients treated without surgery) but only during the first 2 years after the operation.
T145 22579-22784 Sentence denotes The patients enrolled in that study had experienced numerous episodes of pharyngitis, but not all episodes of sore throat were caused by group A streptococci (a fact often missed when this study is dited).
T146 22785-22952 Sentence denotes Of particular concern are the reported tonsillectomy complication rate of 14% and the improvement over time noted among the patients who did not undergo tonsillectomy.
T147 22953-23058 Sentence denotes Finally, it is clear that the presence of tonsils is not necessary for streptococci to infect the throat.
T148 23059-23138 Sentence denotes Tonsillectomy cannot be recommended at present except in unusual circumstances.
T149 23139-23190 Sentence denotes Most episodes of pharyngitis are caused by viruses.
T150 23191-23335 Sentence denotes Distinguishing between viral and streptococcal pharyngitis on clinical grounds alone can be difficult, but certain clues may help the physician.
T151 23336-23500 Sentence denotes Accompanying symptoms of rhinifis, croup, laryngitis, hoarseness, conjunctivitis, or diarrhea are common with viral infection hut rare in streptococcal pharyngitis.
T152 23501-23554 Sentence denotes Many viral agents can produce pharyngitis (Table 1) .
T153 23555-23651 Sentence denotes Some viruses cause distinct clinical syndromes that can be diagnosed without laboratory testing.
T154 23652-23824 Sentence denotes Parainfluenza and influenza viruses, rhinoviruses, coronaviruses and respiratory syncytial virus typically produce sYmptoms of coryza and cough as well as mild pharyngitis.
T155 23825-23957 Sentence denotes Influenza virus infections may cause fever, cough, headache, malaise, myalgias, and cervical adenopathy, in addition to pharyngitis.
T156 23958-24093 Sentence denotes Adenoviruses can cause fever, cervical lymph node enlargement, pharyngeal erythema, follicular hyperplasia of the tonsils, and exudate.
T157 24094-24223 Sentence denotes When conjuctivitis occurs in association with adenoviral pharyngitis the resulting syndrome is called pharyngoconjunctival fever.
T158 24224-24324 Sentence denotes The enteroviruses (Coxsackie viruses and echovirus) can cause sore throat, especially in the summer.
T159 24325-24415 Sentence denotes The throat may be slightly red, but tonsillar exudate and cervical adenopathy are unusual.
T160 24416-24451 Sentence denotes Symptoms resolve within a few days.
T161 24452-24523 Sentence denotes Enteroviruses cause two specific syndromes that involve the oropharynx.
T162 24524-24712 Sentence denotes Herpangina caused by Coxsackie viruses A and B or echovirus is characterized by distinctive discrete, painful, gray-white papulovesicular lesions distributed over the posterior oropharypx.
T163 24713-24818 Sentence denotes The vesicles are 1 to 2 mm in diameter and are surrounded initially by a halo of erythema, then ulcerate.
T164 24819-24892 Sentence denotes Fever may reach 39.5~ Coxsackie virus A16 causes hand-foot-mouth disease.
T165 24893-24964 Sentence denotes Painful vesicles that may ulcerate can occur throughout the oropharynx.
T166 24965-25052 Sentence denotes Vesicles also develop on the palms and soles and sometimes on the trunk or extremities.
T167 25053-25121 Sentence denotes Fever is present in most cases, but many children do not appear ill.
T168 25122-25241 Sentence denotes Primary infection with herpes simplex virus usually produces high fever with acute gingivostomatitis in young children.
T169 25242-25383 Sentence denotes Vesicles (which become ulcers) develop throughout the anterior portion of the mouth, including the lips, but the posterior pharynx is spared.
T170 25384-25494 Sentence denotes High fever is common and pain is intense; intake of oral fluids often is impaired and may lead to dehydration.
T171 25495-25545 Sentence denotes Herpetic gingivostomatitis may last up to 2 weeks.
T172 25546-25670 Sentence denotes Experience with infants and toddlers during a measles epidemic in Chicago highlighted the prominence of early oral findings.
T173 25671-25831 Sentence denotes In addition to high fever, cough, coryza, and conjunctivitis, the pharynx may be intensely and diffusely erythematous, without tonsillar enlargement or exudate.
T174 25832-26025 Sentence denotes The presence of Koplik's spots, the pathognomonic white or blue-white enanthem of measles, on the buccal mucosa near the mandibular molars provides evidence of measles before the rash develops.
T175 26026-26160 Sentence denotes Acute exudative pharyngitis often occurs with infectious mononucleosis (IM) caused by primary infection with Epstein-Barr virus (EBV).
T176 26161-26277 Sentence denotes IM usually is associated with hepatosplenomegaly, generalized lymphadenopathy, and pharyngitis of variable severity.
T177 26278-26440 Sentence denotes The latter may be quite severe, with significant tonsillar hypertrophy, erythema, and impressive tonsillar exudates, closely resembling streptococcal pharyngitis.
T178 26441-26502 Sentence denotes Regional lymph nodes may be particularly enlarged and tender.
T179 26503-26626 Sentence denotes IM occurs most prominently in adolescents and young adults and is frequently milder or is subclinical among preadolescents.
T180 26627-26843 Sentence denotes After a 2-to 4-week incubation period, patients typically experience abrupt onset of malaise, fatigue, fever, and headache, followed closely by pharyngitis with enlarged tonsils with exudates and cervical adenopathy.
T181 26844-26919 Sentence denotes More generalized adenopathy with hepatosplenomegaly often follows quickly'.
T182 26920-27044 Sentence denotes Fever and pharyngitis typically last 1 to 3 weeks, whereas lymphadenopathy and hepatosplenomegaly subside over 3 to 6 weeks.
T183 27045-27151 Sentence denotes Malaise and lethargy can persist for up to several months, leading to impaired school or work performance.
T184 27152-27276 Sentence denotes Acute exudative pharyngitis associated with hepatomegaly, splenomegaly, and generalized lymphadenopathy strongly suggest IM.
T185 27277-27404 Sentence denotes Early in the disease, IM may be difficult to distinguish from other causes of pharyngitis, including streptococcal pharyngitis.
T186 27405-27682 Sentence denotes Laboratory findings include atypical lymphocytosis, heterophile antibodies that react with bovine erythrocytes (most often detected by the monospot test), and specific antibody against EBV viral capsid antigen (VCA), early antigen (EA), and Epstein-Barr nuclear antigen (EBNA).
T187 27683-27774 Sentence denotes Acute IM usually is associated with a positive heterophile test and antibody to VCA and EA.
T188 27775-27942 Sentence denotes Serological evidence of IM should be sought when splenomegaly or other features are present or if symptoms persist beyond 7 days, regardless of throat culture results.
T189 27943-28030 Sentence denotes Several bacteria other than group A streptococci have been associated with pharyngitis.
T190 28031-28115 Sentence denotes States and other developed countries because of immunization with diphtheria toxoid.
T191 28116-28266 Sentence denotes The handful oi" diphtheria cases recognized annually in the United States usually occur in unimmunized individuals, and the fatality rate is about 5%.
T192 28267-28435 Sentence denotes A recent large outbreak of diphtheria in Russia, with infection documented in several travelers to Western Europe, emphasizes the need to support immunization programs.
T193 28436-28556 Sentence denotes 57,5~ Acute tonsillar and pharyngeal diphtheria is characterized by anorexia, malaise, low-grade fever, and sore throat.
T194 28557-28692 Sentence denotes The classic grayish membrane forms within 1 to 2 days over the tonsils and pharyngeal walls and may extend into the larynx and trachea.
T195 28693-28850 Sentence denotes Cervical adenopathy may be associated with the appearance of a "bull neck." In mild cases, the membrane sloughs after 7 to 10 days, and the patient recovers.
T196 28851-28953 Sentence denotes In severe cases, the disease may progress to prostration, stupor, coma, and death within 6 to 10 days.
T197 28954-29072 Sentence denotes Toxin-mediated palatal paralysig, laryngeal paralysis, ocular palsies, diaphragmatic palsy, and myocarditis may occur.
T198 29073-29241 Sentence denotes Accurate diagnosis requires isolation of C diphtheriae on culture of material from beneath the membrane, with confirmation of toxin production by the organism isolated.
T199 29242-29388 Sentence denotes Acute symptomatic pharyngitis caused by N gonorrhoeae occurs occasionally in sexually active individuals as a consequence of oral-genital contact.
T200 29389-29433 Sentence denotes In children, sexual abuse must be suspected.
T201 29434-29562 Sentence denotes The infection usually presents as an ulcerative exudative tonsillopharyngitis but may be asymptomatic and resolve spontaneously.
T202 29563-29698 Sentence denotes Gonococcal phar3alg~tis occurs in homosexdal men and heterosexual women after fellatio, and is less readily acquired after cunnilingus.
T203 29699-29822 Sentence denotes Gonorrhea rarely is transmitted from the phat~/nx to a sex partner, but pharyngitis can serve as a source for gonococcemia.
T204 29823-29901 Sentence denotes Diagnosis requires culture on appropriate selective media (eg, Thayer-Martin).
T205 29902-30064 Sentence denotes Chlamydia trachomatis has been implicated serologically in as many as 20% of adults with pharyngitis, but isolation of the organism from the pharynx is difficult.
T206 30065-30163 Sentence denotes Recently Chlamydia pneumoniae (formerly named TWAR) also was identified as a cause of pharyngitis.
T207 30164-30308 Sentence denotes Diagnosis of chlamydial pharyngitis is difficult, whether by culture or serologically, and neither method is readily available to the clinician.
T208 30309-30349 Sentence denotes Mpneumoniae probably causes pharyngitis.
T209 30350-30416 Sentence denotes Serological or culture methods can be used to identify this agent.
T210 30417-30532 Sentence denotes 59,6~ Chlamydial or mycoplasmal pharyngitis are diagnosed only in research studies of nonstreptococcal pharyngitis.
T211 30533-30639 Sentence denotes The efficacy of antibiotic treatment for these illnesses is not known, but both appear to be self-limited.
T212 30640-30734 Sentence denotes Certain [3-hemolytic streptococci other than group A are capable of causing acute pharyngitis.
T213 30735-30855 Sentence denotes Well-documented epidemics of foodborne group C and group G streptococcal pharyngitis have been reported in young adults.
T214 30856-31002 Sentence denotes 61,62 The role of these non-group A streptococcal organisms as etiologic agents of endemic acute pharyngitis has been more difficult to establish.
T215 31003-31142 Sentence denotes There are data suggesting group C and group G [3-hemolytic streptococci are responsible for acute pharyngitis, particularly in adolescents.
T216 31143-31240 Sentence denotes Gerber et al63 reported an outbreak of group G streptococcal pharyngitis among suburban children.
T217 31241-31370 Sentence denotes However, the exact role of these agents, which can be carried asymptomatically in the pharynx, remains to be fully characterized.
T218 31371-31520 Sentence denotes When implicated as agents of acute pharyngitis, group C or G organisms do not appear to require treatment because they cause self-limited infections.
T219 31521-31698 Sentence denotes Acute rheumatic fever is not a sequel to these infections, although poststreptococcal nephritis has occurred rarely after epidemic group C and group G streptococcal pharyngitis.
T220 31699-31868 Sentence denotes Antibiotic therapy has greatly reduced the suppurative complications of acute group A streptococcal pharyngitis caused by spread from the pharynx to adjacent structures.
T221 31869-32098 Sentence denotes Peritonsillar abscess ("quinsy") presents with fever, severe throat pain, dysphagia, "hot potato voice," pain referred to the ear, and bulging of the peritonsillar area with asymmetry of the tonsils and displacement of the uvula.
T222 32099-32176 Sentence denotes Occasionally, peritonsillar cellulitis without a well-defined abscess occurs.
T223 32177-32301 Sentence denotes When an abscess is found clinically or by an imaging study such as computed tomography scan, surgical drainage is indicated.
T224 32302-32485 Sentence denotes Retropharyngeal abscess represents extension of infection from the pharynx or peritonsillar region into the retropharyngeal (prevertebral) space, which is rich in lymphoid structures.
T225 32486-32603 Sentence denotes Fever, dysphagia, drooling, stridor, extension of the neck, and a mass in the posterior pharyngeal wall may be noted.
T226 32604-32668 Sentence denotes Surgical drainage is required if frank suppuration has occurred.
T227 32669-32788 Sentence denotes Spread of streptococci via pharyngeal lymphatics to regional nodes can cause cervical lymphadenitis that can suppurate.
T228 32789-32901 Sentence denotes Otitis media, mastoiditis, and sinusitis also may occur as complications of streptococcalpharyngitis (Table 4 ).
T229 32902-33040 Sentence denotes These complications include acute rheumatic fever, acute poststreptococcal glomerulonephritis, and probably reactive arthritis/ synovitis.
T230 33041-33170 Sentence denotes As noted above, preventing ARF and subsequent rheumatic heart disease is the principle reason to treat streptococcal pharyngitis.
T231 33171-33306 Sentence denotes Therapy with an appropriate antibiotic begun within 9 days after onset of symptoms is highly effective in preventing this complication.
T232 33307-33395 Sentence denotes 19 Acute rheumatic fever is diagnosed using the clinical criteria first formulated by T.
T233 33396-33418 Sentence denotes Duckett Jones in 1944.
T234 33419-33482 Sentence denotes The latest (1992) revised Jones Criteria are found in Table 5 .
T235 33483-33644 Sentence denotes In addition to evidence of antecedent infection with group A streptococci, the diagnosis of ARF requires one major plus two minor criteria or two major criteria.
T236 33645-33805 Sentence denotes Proof of infection is a positive throat culture or rapid test, or an elevated antibody titer to at least one extracellular product of the group A streptococcus.
T237 33806-33991 Sentence denotes Long-term, chronic therapy with penicillin or sulfa (perhaps for life) is recommended for patients with a hi'story of ARF or rheumatic heart disease to prevent recurrent attacks of ARF.
T238 33992-34128 Sentence denotes Poststreptococcal reactive arthritis analogous to other postinfectious reactive syndromes without other features of ARF probably occurs.
T239 34129-34179 Sentence denotes The relationship of this entity to ARF is unclear.
T240 34180-34318 Sentence denotes Those patients who fulfill the Jones criteria should be considered to have ARF after other diagnoses are excluded and managed accordingly.
T241 34319-34439 Sentence denotes The incidence and severity of ARF in the United States and many developed countries began to decline in the early 1900s.
T242 34440-34537 Sentence denotes Advances in living conditions, sanitation, and nutrition probably account for this early decline.
T243 34538-34679 Sentence denotes Since the 1950s, greater access to medical care, presumably leading to prompt diagnosis and treatment, contributed to further decline in ARF.
T244 34680-34818 Sentence denotes 64 Since the late 1980s, unexpected local and regional clusters of ARF have been reported, beginning with an outbreak near Salt Lake City.
T245 34819-35013 Sentence denotes 65,6~ Many of the patients in these outbreaks have been suburban, middle-class children with only mild symptoms of antecedent pharyngitis, and the incidence of carditis among them has been high.
T246 35014-35183 Sentence denotes There is evidence that group A streptococcus strains that are heavily encapsulated and produce mucoidappearing colonies on blood agar are associated with some outbreaks.
T247 35184-35352 Sentence denotes 67 Although it was once thought that all group A streptococci had equal potential to cause acute rheumatic fever, certain strains now appear particularly rheumatogenic.
T248 35353-35526 Sentence denotes The reasons for the local resurgences of ARF remain to be fully Elevated acute phase reactants Erythrocyte sedimentation rate C-reactive protein Prolonged P-R interval NOTE.
T249 35527-35877 Sentence denotes Jones criteria, revised 1992; two major or one major and two minor criteria suffice for diagnosis if supported by evidence of antecedent infection with GAS (positive throat culture or rapid strep test or elevated or rising antibody titer). elucidated but may be related to local presence of these highly rheumatogenic strains of group A streptococci.
T250 35878-35962 Sentence denotes Poststreptococcal AGN is the other major sequela of group A streptococcal infection.
T251 35963-36081 Sentence denotes In contrast to ARF, AGN does not appear to be prevented by prompt treatment of the antecedent streptococcal infection.
T252 36082-36186 Sentence denotes Pharyngitis caused by a nephritogenic strain of group A streptococci precedes symptoms by about 10 days.
T253 36187-36271 Sentence denotes Unlike ARF, which only occurs after pharyngitis, AGN also can follow skin infection.
T254 36272-36370 Sentence denotes AGN is characterized by sudden onset of edema, oliguria, hematuria, proteinuria, and hypertension.
T255 36371-36514 Sentence denotes Diagnosis of poststreptococcal AGN requires evidence of prior infection with group A streptococci by culture, rapid test, or serological means.
T256 36515-36583 Sentence denotes Hypocomplementemia, especially decreased C3, supports the diagnosis.
T257 36584-36714 Sentence denotes Pharyngitis caused by the group A streptococcus requires accurate diagnosis and timely treatment to prevent acute rheumatic fever.
T258 36715-36859 Sentence denotes Clinical signs and symptoms often do not distinguish pharyngitis caused by group A streptococci from pharyngitis caused by other microorganisms.
T259 36860-36983 Sentence denotes Rapid antigen detection or throat culture are recommended for diagnosis except when viral signs and symptoms are prominent.
T260 36984-37146 Sentence denotes Therapy with penicillin, the drug of choice, is associated with prevention of rheumatic fever, more rapid clinical improvement, and prompt loss of contagiousness.
T261 37147-37254 Sentence denotes Bacteriologic treatment failure occurs despite universal sensitivity of group A streptococci to penicillin.
T262 37255-37337 Sentence denotes The causes of treatment failure (and of chronic carriage) remain to be determined.
T263 37338-37464 Sentence denotes Newer, more expensive antibiotics do not substantially enhance treatment success and need not be prescribed for most patients.