Pharyngitis, croup, and epiglottitis

The exact diagnosis of pharyngitis remains a problem despite the advent of rapid streptococcal screening. An apparent resurgence of rheumatic fever outbreaks makes it more important to attempt to accurately diagnose pharyngitis. Positive identification of streptococci should be followed by treatment with penicillin, or erythromycin in the patient with penicillin allergy. The patient without positive identification of streptococci will need either observation or further evaluation depending on the degree of illness. Classic croup or laryngotracheobronchitis is a clinical entity that can be diagnosed with reasonable confidence. The few patients that require hospitalization can be treated with humidity, racemic epinephrine, corticosteroids, parental and child support, or any combination of these with good results. Continued observation of all patients with croup is necessary to recognize the uncommon complication of bacterial tracheitis when it occurs. Epiglottitis has a varied clinical appearance and management according to age groups. Infants show a mixed clinical picture similar to croup, but with more obstruction. The classic epiglottitis with acute airway obstruction is seen in the 3-8-year-old age group. Adults have a less fulminant form of supraglottitis. Infants and children will need artificial airway management in most cases, whereas many adults can be treated simply with observation.