Nelsons Pediatric Symptom-Based Diagnosis 2018 Latest Edition Ebook PDF

Nelsons Pediatric Symptom-Based  Diagnosis 2018 Latest Edition Ebook PDF

Nelsons Pediatric Symptom-Based Diagnosis 2018 Latest Edition Ebook PDFΒ Β Most causes of sore throat are nonbacterial and neither require nor are
alleviated by antibiotic therapy (Tables 1.1, 1.2, and 1.3). Accurate diagnosis is essential: Acute streptococcal pharyngitis warrants diagnosis and therapy to ensure prevention of serious suppurative andΒ  nonsuppurative complications. Life-threatening infectious complications of oropharyngeal infections, whether streptococcal or nonstreptococcal, may manifest with mouth pain, pharyngitis, parapharyngeal
space infectious extension, and/or airway obstruction (Tables 1.4 and
1.5). In many cases, the history and/or physical exam can help direct
diagnosis and treatment, but the enormous number of potential causes
is too large to address all of them.
VIRAL PHARYNGITIS
Most episodes of pharyngitis are caused by viruses (see Tables 1.2 and
1.3). It is difficult to clinically distinguish between viral and bacterial
pharyngitis with a very high degree of precision, but certain clues may
help the physician. Accompanying symptoms of conjunctivitis, rhini-
tis, cough, discrete ulcerations, croup, or laryngitis are common with
viral infection but rare in bacterial pharyngitis.

Many viral agents can produce pharyngitis (see Tables 1.2 and 1.3).
Some cause distinct clinical syndromes that are readily diagnosed without laboratory testing (Table 1.6; see also Tables 1.1 and 1.4). In pharyngitis caused by parainfluenza and influenza viruses, rhinoviruses, coronaviruses, and respiratory syncytial virus (RSV), the symptoms of coryza and cough often overshadow sore throat, which is generally mild. Influenza virus may cause high fever, cough, headache,
malaise, myalgia, and cervical adenopathy in addition to pharyngitis

.
In young children, croup or bronchiolitis may develop. When influenza is suspected on clinicalandepidemiologic grounds or confirmed by testing (polymerase chain reaction [PCR] is most accurate), specific
antiviral therapy is available for treatment of patients and prophylaxis of family members. RSV is associated with bronchiolitis, pneumonia, and croup in young children. RSV infection in older children is usually indistinguishable from a simple upper respiratory tract infection.
Pharyngitis is not a prominent finding of RSV infection in any age group.

Parainfluenza viruses are associated with croup and bronchiolitis; minor sore throat and signs of pharyngitis are common at the outset but rapidly resolve. Infections caused by parainfluenza, influ-
enza, and RSV are often seen in seasonal (winter) epidemics. ManyΒ  agents can be identified using multiplex or targeted PCR testing, but there is rarely reason to test outpatients and infrequent benefit to testing inpatients except to confirm and treat influenza.

Nelsons Pediatric Symptom-Based Diagnosis 2018 Latest Edition Ebook PDF

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