Epistemic_Statements  

CORD-19:075418efdb961154d99d8d1b4670ef2439a0cca4 JSONTXT 9 Projects

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Id Subject Object Predicate Lexical cue
T1 441-540 Epistemic_statement denotes The papillae of the tongue may be red and swollen, leading to the designation, "strawberry tongue."
T2 605-800 Epistemic_statement 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.
T3 913-1069 Epistemic_statement denotes Younger children may have coryza with crusting below the nares, more generalized adenopathy, and a more chronic course, a syndrome known as streptococcosis.
T4 1189-1254 Epistemic_statement denotes It rarely" is seen in children younger than 3 years or in adults.
T5 1617-1748 Epistemic_statement denotes The area around the mouth often appears pale in comparison to the extremely red cheeks, giving the appearance of circumoral pallor.
T6 2489-2732 Epistemic_statement 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.
T7 2733-2884 Epistemic_statement denotes Streptococcal toxic shock syndrome is associated more commonly with a primary cutaneous focus of infection rather than a pharyngeal focus of infection.
T8 2885-3012 Epistemic_statement denotes 3 Scarlet fever can still be explained in simple terms to patients and their families as streptococcal pharyngitis with a rash.
T9 3014-3162 Epistemic_statement denotes Streptococcal pharyngitis was identified mainly in well-defined epidemics before World War II, but has been endemic in the United States since then.
T10 3221-3469 Epistemic_statement 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.
T11 3800-3872 Epistemic_statement denotes Pets do not seem to be a 'significant reservoir of group A streptococci.
T12 4027-4164 Epistemic_statement denotes Appropriate antibiotic therapy eliminates contagiousness within 24 hours after institution of therapy, and children can return to school.
T13 4352-4569 Epistemic_statement 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.
T14 4570-4729 Epistemic_statement denotes When signs and symptoms suggest acute streptococcal pharyngitis (including patients with scarlet fever), laboratory diagnosis is strongly recommended (Fig 1) .
T15 4730-4978 Epistemic_statement 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
T16 4979-5095 Epistemic_statement denotes The throat culture has been used in physicians' offices to diagnose streptococcal pharyngitis since the early 1950s.
T17 5744-5903 Epistemic_statement 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.
T18 5904-6085 Epistemic_statement 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.
T19 6254-6338 Epistemic_statement denotes Two swabs should be obtained from patients with suspected streptococcal pharyngitis.
T20 6374-6538 Epistemic_statement 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.
T21 6539-6692 Epistemic_statement 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.
T22 6794-7097 Epistemic_statement 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.
T23 7098-7240 Epistemic_statement denotes Rapid tests are intended for the diagnosis of acute streptococcal pharyngitis and should not be used to evaluate the effectiveness of therapy.
T24 7891-8021 Epistemic_statement denotes This survey also found that pediatricians were more likely than internists or family/general practitioners to use throat cultures.
T25 8445-8711 Epistemic_statement 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.
T26 8712-8831 Epistemic_statement denotes 17 Thus, it appears that many physicians do not follow recommended guidelines for diagnosing streptococcal pharyngitis.
T27 9280-9435 Epistemic_statement denotes When antibody testing is desired to evaluate a possible poststreptococcal illness, more than one of these tests should be performed to improve sensitivity.
T28 9436-9678 Epistemic_statement 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
T29 9679-9780 Epistemic_statement denotes The primary goal of therapy for acute streptococcal pharyngitis is to prevent the development of ARF.
T30 9906-9975 Epistemic_statement denotes ~9 Therapy does not seem to affect the risk of poststreptococcal AGN.
T31 10344-10558 Epistemic_statement 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.
T32 10559-10781 Epistemic_statement 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.
T33 10782-11068 Epistemic_statement 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.
T34 11069-11279 Epistemic_statement 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.
T35 11280-11472 Epistemic_statement 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
T36 11473-11574 Epistemic_statement denotes The drug of choice for treating streptococcal pharyngitis has been penicillin for more than 40 years.
T37 11575-11728 Epistemic_statement denotes Despite the widespread use of penicillin to treat streptococcal and other infections, penicillin resistance among group A streptococci has not developed.
T38 12126-12263 Epistemic_statement 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.
T39 12264-12380 Epistemic_statement denotes 3~ Use of intramuscular benzathine penicillin also alleviates concern about patient compliance but is quite painful.
T40 12774-12923 Epistemic_statement denotes The decreased frequency of administration of some of these agents may improve patient compliance and makes them attractive in selected circumstances.
T41 12924-13049 Epistemic_statement denotes Patients who are allergic to penicillin should receive erythromycin or another non-13-1actam antibiotic, such as clindamycin.
T42 13210-13268 Epistemic_statement denotes 32 This has not emerged as a problem in the United States.
T43 13269-13487 Epistemic_statement 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.
T44 13488-13649 Epistemic_statement 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.
T45 13886-14009 Epistemic_statement denotes Reinfection with the same or a different strain of group A streptococcus is possible, as is intercurrent viral pharyngitis.
T46 14010-14172 Epistemic_statement denotes Some patients may have been noncompliant with therapy, but apparent treatment failure occurs even among patients treated with intramuscular benzathine penicillin.
T47 14555-14715 Epistemic_statement denotes 36 There is some evidence that bacteriologic failure rates may be somewhat lower when antibiotics other than penicillin are used, especially the cephalosporins.
T48 14716-15012 Epistemic_statement 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.
T49 15097-15276 Epistemic_statement denotes 39 Semisynthetic derivatives of penicillin (such as dicloxicillin), rifampin given with oral penicillin, amoxicillin-clavulanate, clindamycin, and other drugs also have been used.
T50 15576-15621 Epistemic_statement denotes Routine use of these agents is not warranted.
T51 15622-15701 Epistemic_statement denotes Several theories have been advanced to explain bacteriologic treatment failure.
T52 15981-16055 Epistemic_statement denotes 45-46 None of these theories has been proven, but several deserve mention.
T53 16056-16212 Epistemic_statement denotes Numerous reports on efficacy of [3-1actamase-resistant antibiotics suggest a possible role for [3-1actamase-producing flora in penicillin treatment failure.
T54 16350-16520 Epistemic_statement 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.
T55 16688-16844 Epistemic_statement 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.
T56 17277-17438 Epistemic_statement 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.
T57 17628-17787 Epistemic_statement denotes At present, the precise mechanisms that lead to this phenomenon remain obscure, but theories include those advanced to explain bacteriologic treatment failure.
T58 18350-18548 Epistemic_statement 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.
T59 18549-18797 Epistemic_statement 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.
T60 18924-19021 Epistemic_statement denotes Physician and patient anxiety is common and can develop into "streptophobia" on the part of both.
T61 19251-19360 Epistemic_statement denotes None of these approaches can be justified at this time for treating chronic carriers of group A streptococci.
T62 19361-20022 Epistemic_statement 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.
T63 20023-20205 Epistemic_statement 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.
T64 20293-20655 Epistemic_statement 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.
T65 21014-21161 Epistemic_statement denotes 53 We currently prefer clindamycin because it is easier to use than intramuscular penicillin plus oral rifampin and may be somewhat more effective.
T66 21311-21506 Epistemic_statement 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.
T67 21507-21578 Epistemic_statement denotes Some patients seem remarkably susceptible to streptococcal pharyngitis.
T68 21700-21876 Epistemic_statement denotes Follow-up throat culture may be needed to distinguish recurrent acute streptococcal pharyngitis from frequent nonstreptococcal pharyngitis in patients who are chronic carriers.
T69 22250-22374 Epistemic_statement denotes 54 The role of tonsillectomy in managing patients with multiple episodes of streptococcal pharyngitis remains controversial.
T70 22785-22952 Epistemic_statement 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.
T71 22953-23058 Epistemic_statement denotes Finally, it is clear that the presence of tonsils is not necessary for streptococci to infect the throat.
T72 23059-23138 Epistemic_statement denotes Tonsillectomy cannot be recommended at present except in unusual circumstances.
T73 23191-23335 Epistemic_statement denotes Distinguishing between viral and streptococcal pharyngitis on clinical grounds alone can be difficult, but certain clues may help the physician.
T74 23336-23500 Epistemic_statement denotes Accompanying symptoms of rhinifis, croup, laryngitis, hoarseness, conjunctivitis, or diarrhea are common with viral infection hut rare in streptococcal pharyngitis.
T75 23501-23554 Epistemic_statement denotes Many viral agents can produce pharyngitis (Table 1) .
T76 23555-23651 Epistemic_statement denotes Some viruses cause distinct clinical syndromes that can be diagnosed without laboratory testing.
T77 23825-23957 Epistemic_statement denotes Influenza virus infections may cause fever, cough, headache, malaise, myalgias, and cervical adenopathy, in addition to pharyngitis.
T78 23958-24093 Epistemic_statement denotes Adenoviruses can cause fever, cervical lymph node enlargement, pharyngeal erythema, follicular hyperplasia of the tonsils, and exudate.
T79 24094-24223 Epistemic_statement denotes When conjuctivitis occurs in association with adenoviral pharyngitis the resulting syndrome is called pharyngoconjunctival fever.
T80 24224-24324 Epistemic_statement denotes The enteroviruses (Coxsackie viruses and echovirus) can cause sore throat, especially in the summer.
T81 24325-24415 Epistemic_statement denotes The throat may be slightly red, but tonsillar exudate and cervical adenopathy are unusual.
T82 24819-24892 Epistemic_statement denotes Fever may reach 39.5~ Coxsackie virus A16 causes hand-foot-mouth disease.
T83 24893-24964 Epistemic_statement denotes Painful vesicles that may ulcerate can occur throughout the oropharynx.
T84 25053-25241 Epistemic_statement denotes Fever is present in most cases, but many children do not appear ill. Primary infection with herpes simplex virus usually produces high fever with acute gingivostomatitis in young children.
T85 25384-25494 Epistemic_statement denotes High fever is common and pain is intense; intake of oral fluids often is impaired and may lead to dehydration.
T86 25495-25545 Epistemic_statement denotes Herpetic gingivostomatitis may last up to 2 weeks.
T87 25671-25831 Epistemic_statement denotes In addition to high fever, cough, coryza, and conjunctivitis, the pharynx may be intensely and diffusely erythematous, without tonsillar enlargement or exudate.
T88 26161-26277 Epistemic_statement denotes IM usually is associated with hepatosplenomegaly, generalized lymphadenopathy, and pharyngitis of variable severity.
T89 26278-26440 Epistemic_statement denotes The latter may be quite severe, with significant tonsillar hypertrophy, erythema, and impressive tonsillar exudates, closely resembling streptococcal pharyngitis.
T90 26441-26502 Epistemic_statement denotes Regional lymph nodes may be particularly enlarged and tender.
T91 27045-27151 Epistemic_statement denotes Malaise and lethargy can persist for up to several months, leading to impaired school or work performance.
T92 27152-27276 Epistemic_statement denotes Acute exudative pharyngitis associated with hepatomegaly, splenomegaly, and generalized lymphadenopathy strongly suggest IM.
T93 27277-27404 Epistemic_statement denotes Early in the disease, IM may be difficult to distinguish from other causes of pharyngitis, including streptococcal pharyngitis.
T94 27683-27774 Epistemic_statement denotes Acute IM usually is associated with a positive heterophile test and antibody to VCA and EA.
T95 27775-27942 Epistemic_statement 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.
T96 27943-28030 Epistemic_statement denotes Several bacteria other than group A streptococci have been associated with pharyngitis.
T97 28557-28692 Epistemic_statement 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.
T98 28693-28768 Epistemic_statement denotes Cervical adenopathy may be associated with the appearance of a "bull neck."
T99 28851-28953 Epistemic_statement denotes In severe cases, the disease may progress to prostration, stupor, coma, and death within 6 to 10 days.
T100 28954-29072 Epistemic_statement denotes Toxin-mediated palatal paralysig, laryngeal paralysis, ocular palsies, diaphragmatic palsy, and myocarditis may occur.
T101 29434-29562 Epistemic_statement denotes The infection usually presents as an ulcerative exudative tonsillopharyngitis but may be asymptomatic and resolve spontaneously.
T102 29699-29822 Epistemic_statement denotes Gonorrhea rarely is transmitted from the phat~/nx to a sex partner, but pharyngitis can serve as a source for gonococcemia.
T103 29902-30064 Epistemic_statement 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.
T104 30164-30308 Epistemic_statement denotes Diagnosis of chlamydial pharyngitis is difficult, whether by culture or serologically, and neither method is readily available to the clinician.
T105 30309-30349 Epistemic_statement denotes Mpneumoniae probably causes pharyngitis.
T106 30350-30416 Epistemic_statement denotes Serological or culture methods can be used to identify this agent.
T107 30533-30639 Epistemic_statement denotes The efficacy of antibiotic treatment for these illnesses is not known, but both appear to be self-limited.
T108 30856-31002 Epistemic_statement 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.
T109 31003-31142 Epistemic_statement denotes There are data suggesting group C and group G [3-hemolytic streptococci are responsible for acute pharyngitis, particularly in adolescents.
T110 31241-31370 Epistemic_statement denotes However, the exact role of these agents, which can be carried asymptomatically in the pharynx, remains to be fully characterized.
T111 31371-31520 Epistemic_statement 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.
T112 32486-32603 Epistemic_statement denotes Fever, dysphagia, drooling, stridor, extension of the neck, and a mass in the posterior pharyngeal wall may be noted.
T113 32669-32788 Epistemic_statement denotes Spread of streptococci via pharyngeal lymphatics to regional nodes can cause cervical lymphadenitis that can suppurate.
T114 32789-32901 Epistemic_statement denotes Otitis media, mastoiditis, and sinusitis also may occur as complications of streptococcalpharyngitis (Table 4 ).
T115 33806-33991 Epistemic_statement 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.
T116 34129-34179 Epistemic_statement denotes The relationship of this entity to ARF is unclear.
T117 34180-34318 Epistemic_statement denotes Those patients who fulfill the Jones criteria should be considered to have ARF after other diagnoses are excluded and managed accordingly.
T118 34538-34679 Epistemic_statement denotes Since the 1950s, greater access to medical care, presumably leading to prompt diagnosis and treatment, contributed to further decline in ARF.
T119 34819-35013 Epistemic_statement 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.
T120 35014-35183 Epistemic_statement 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.
T121 35184-35352 Epistemic_statement 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.
T122 35767-35877 Epistemic_statement denotes elucidated but may be related to local presence of these highly rheumatogenic strains of group A streptococci.
T123 35963-36081 Epistemic_statement denotes In contrast to ARF, AGN does not appear to be prevented by prompt treatment of the antecedent streptococcal infection.
T124 36187-36271 Epistemic_statement denotes Unlike ARF, which only occurs after pharyngitis, AGN also can follow skin infection.
T125 36371-36514 Epistemic_statement denotes Diagnosis of poststreptococcal AGN requires evidence of prior infection with group A streptococci by culture, rapid test, or serological means.
T126 36515-36583 Epistemic_statement denotes Hypocomplementemia, especially decreased C3, supports the diagnosis.
T127 36860-36983 Epistemic_statement denotes Rapid antigen detection or throat culture are recommended for diagnosis except when viral signs and symptoms are prominent.
T128 36984-37146 Epistemic_statement denotes Therapy with penicillin, the drug of choice, is associated with prevention of rheumatic fever, more rapid clinical improvement, and prompt loss of contagiousness.
T129 37147-37254 Epistemic_statement denotes Bacteriologic treatment failure occurs despite universal sensitivity of group A streptococci to penicillin.
T130 37255-37337 Epistemic_statement denotes The causes of treatment failure (and of chronic carriage) remain to be determined.
T131 37338-37464 Epistemic_statement denotes Newer, more expensive antibiotics do not substantially enhance treatment success and need not be prescribed for most patients.