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[Association of streptococcal pharyngitis with complicated appendicitis]
P Lê1, A L Zeiter, Y Ramaheriarison
1Service de chirurgie générale, centre hospitalier de l'agglomération montargoise, 658, rue des Bourgoins, BP 725, 45207 Montargis, France. le.pierre@wanadoo.fr
Summary
Pediatric appendicitis can mimic other conditions, presenting a diagnostic challenge. This case highlights how streptococcal pharyngitis can mislead clinicians to suspect mesenteric adenitis over appendicitis.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Diagnostic Imaging
Background:
- Streptococcal pharyngitis commonly presents with throat pain and fever.
- Right lower abdominal quadrant pain in children is often attributed to mesenteric adenitis, especially when pharyngitis is present.
Observation:
- A 6-year-old child presented with acute right lower quadrant abdominal pain and fever.
- Clinical examination revealed pharyngeal erythema and abdominal tenderness; a rapid Strep test was positive.
- Abdominal ultrasound indicated signs consistent with appendicitis.
Findings:
- The child underwent surgery for complicated appendicitis, despite initial suspicion of mesenteric adenitis due to concurrent pharyngitis.
- This case underscores the potential for misdiagnosis when pharyngitis symptoms overlap with appendiceal pain.
Implications:
- Clinicians must maintain a high index of suspicion for appendicitis in children with right lower quadrant pain, even with concurrent pharyngitis.
- Diagnostic imaging, such as ultrasound, is crucial in differentiating appendicitis from mesenteric adenitis in such cases.
- Recognizing this misleading association can prevent delayed diagnosis and treatment of pediatric appendicitis.
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01:27Streptococcal Pharyngitis
Streptococcal pharyngitis, commonly known as “strep throat,” is an acute infection of the oropharyngeal tissues caused by the Gram‑positive Group A Streptococcus (Streptococcus pyogenes). Transmission occurs primarily through respiratory droplets expelled during coughing, sneezing, or talking.Mechanisms of Host Entry and Immune EvasionUpon entering the host, S. pyogenes adheres to the mucosal epithelial cells of the pharynx via surface proteins, notably lipoteichoic acid and the antiphagocytic...
01:19Appendicitis
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The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
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Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
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