2025 – PAGE 301 – INFECTIOUS DISEASES

PERITONSILLAR ABSCESS

A peritonsillar abscess presents with a deviated uvula due to unilateral tonsillar swelling, difficulty with opening mouth (trismus) and speaking (“hot-potato voice”) and drooling because of pain with swallowing (odynophagia). This is usually due to Group A Streptococcus (GAS). Also cover for anaerobes with IV antibiotics such as clindamycin or ampicillin-sulbactam. Once the lesion has been drained and the patient can swallow, you can treat with oral amoxicillin-clavulanate.

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RETROPHARYNGEAL ABSCESS

A retropharyngeal abscess will present with a young child (< 6 years old) with fever, lymphadenopathy, pain and difficulty with swallowing, drooling, and HYPEREXTENSION of the neck. The child may also have refused to eat. This is usually due to Group A Streptococcus (GAS) and can be diagnosed with a lateral X-ray of the neck showing widening of the retropharyngeal space in which the pus resides.

PEARL: Don’t confuse hyperextension of the neck in a drooling child with the LEANING forward posture and drooling of a child with epiglottitis.

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SCARLET FEVER

Scarlet fever is also due to Group A Strep (GAS). Look for a rash in areas with CREASES (axilla and groin). There is initially a “sandpaper” rash. It then becomes more erythematous and less sandpaper-like. There can also be pink or red lines in/near the creases called Pastia’s lines. Other symptoms may include perioral pallor and a strawberry, or white, tongue. Though many GAS infectious hurt, this rash does NOT.

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OCCULT BACTEREMIA

Streptococcus pneumoniae (pneumococcus) is the most common etiology of occult bacteremia (no obvious source). For Streptococcal bacteremia found incidentally, if there are NO symptoms, then you do NOT need to treat!