pathway/febrile-infant-emergent-evaluation-clinical-pathway Last Revised: August 2019 Infectious Diseases Centers for Disease Control and Prevention (CDC) Congenital syphilis – United States, 2003–2008 MMWR Morb Mortal Wkly Rep 2010;59:413–417 Guinto-Ocampo H, Bennett JE, Attia M Predicting pertussis in infants Pediatr Emerg Care 2008;24:16–20 Ralston SL, LIeberthal AS, Meissner HC, et al Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis Pediatrics 2014;134:e1474–e1502 Staat MA, Henrickson K, Elhefni H, et al Prevalence of respiratory syncytial virus-associated lower respiratory infection and apnea in infants presenting to the emergency department Pediatr Infect Dis J 2013;32:911–914 Cardiac Diseases Banka P, Robinson JD, Uppu SC, et al Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study J Cardiovasc Magn Reson 2015;17:96 Canter CE, Simpson KP Diagnosis and treatment of myocarditis in children in the current era Circulation 2014;129:115–128 Eisenberg MA, Green-Hopkins I, Alexander ME, et al Cardiac troponin T as a screening test for myocarditis in children Pediatr Emerg Care 2012;28:1173– 1178 Liberman RF, Getz KD, Lin AE, et al Delayed diagnosis of critical congenital heart defects: trends and associated factors Pediatrics 2014;134:e373–e381 Martinez-Villar M, Gran F, Sabate-Rotes A, et al Acute myocarditis with infarctlike presentation in a pediatric population: role of cardiovascular magnetic resonance Pediatr Cardiol 2018;39:51–56 Endocrine Disorders Speiser PW, Azziz R, Baskin LS, et al Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab 2010;95:4133–4160 Metabolic Disorders Champion MP An approach to the diagnosis of inherited metabolic disease Arch Dis Child Educ Pract Ed 2010;95:40–46 Ficicioglu C, Bearden D Isolated neonatal seizures: when to suspect inborn errors of metabolism Pediatr Neurol 2011;45:283–291 Hematologic Disorders Sgro M, Campbell D, Barozzino T, et al Acute neurological findings in a national cohort of neonates with severe neonatal hyperbilirubinemia J Perinatol 2011;31:392–396 Gastrointestinal Disorders Aboagye J, Godstein SD, Salazar JH, et al Age at presentation of common pediatric surgical conditions: Reexamining dogma J Pediatr Surg 2014;49:995–999 Shalaby MS, Kuti K Walker G Intestinal malrotation and volvulus in infants and children BMJ 2013;347:f6949 Wang KS; Committee on Fetus and Newborn, American Academy of Pediatrics; Section on Surgery, American Academy of Pediatrics Assessment and management of inguinal hernia in infants Pediatrics 2012;130:768–773 Neurologic Diseases Risko W Infant botulism Pediatr Rev 2006;27:36–37 Underwood K, Rubin S, Deakers T, et al Infant botulism: a 30 year experience spanning the introduction of botulism immune globulin intravenous in the intensive care unit at Childrens Hospital Los Angeles Pediatrics 2007;120:e1380–e1385 Wood J, Christian C, Stavas N, et al ED Pathway for Evaluation/Treatment of Children with Physical Abuse Concerns The Children’s Hospital of Philadelphia 2010 Available online at: https://www.chop.edu/clinicalpathway/abuse-physical-clinical-pathway Last revised: September 2018 CHAPTER 74 ■ SORE THROAT CHRISTINA LINDGREN, ANDREW M FINE INTRODUCTION Sore throat refers to any painful sensation localized to the pharynx or the surrounding areas Because young children, particularly those of preschool age, cannot describe their symptoms as precisely as adults, the clinician who evaluates a child with a sore throat must first define the exact nature of the complaint Occasionally, young patients with dysphagia (see Chapter 56 Pain: Dysphagia ), which results from disease in the area of the esophagus or with difficulty swallowing because of a neuromuscular disorder, will verbalize these feelings as a sore throat Careful questioning and examination usually suffices to distinguish between these complaints Although a sore throat is less likely to portend a life-threatening disorder than dysphagia or the inability to swallow, this complaint should not be dismissed without a thorough evaluation Most children with sore throats have self-limiting or easily treated pharyngeal infections, but a few have serious disorders such as retropharyngeal or lateral pharyngeal abscesses Even if the reason for the complaint of sore throat is believed to be an infectious pharyngitis, several different organisms may be responsible Symptomatic therapy, antibiotics, antiinflammatory drugs, or surgical intervention may be appropriate at times Most children experience no adverse consequences from misdiagnosis and inappropriate therapy, but a few may develop local extension of infection or sepsis, chronically debilitating illnesses such as rheumatic fever, or lifethreatening airway obstruction DIFFERENTIAL DIAGNOSIS Infectious Pharyngitis Infection is the most common cause of sore throat and is usually caused by respiratory viruses including adenoviruses, coxsackievirus A (various serotypes), influenza, or parainfluenza virus (see Chapter 94 Infectious Disease Emergencies and Tables 74.1 to 74.3 ) Viruses are the causative agents of infectious pharyngitis in 70% to 85% of patients, especially in adolescents and in children younger than years of age Several of the respiratory viruses produce easily identifiable syndromes, including hand–foot–mouth disease (coxsackievirus) and pharyngoconjunctival fever (adenovirus) These viral infections are closely followed in frequency by bacterial infections caused by group A streptococci (Streptococcus pyogenes ) During streptococcal outbreaks, as many as 30% to 50% of episodes of pharyngitis may be caused by S pyogenes in school-aged children Another common infectious agent in pharyngitis is the Epstein–Barr virus, which causes infectious mononucleosis Although infectious mononucleosis is not often seen in children younger than years ( Fig 74.1 ), it commonly affects the adolescent One additional important consideration in adolescents with an infectious mononucleosis-like syndrome is acute human immunodeficiency virus (HIV) infection, which does not commonly cause significant pharyngeal inflammation Other organisms produce pharyngitis only rarely; these include Neisseria gonorrhoeae, Corynebacterium diphtheriae, Francisella tularensis, Fusobacterium necrophorum, and other bacteria N gonorrhoeae may cause inflammation and exudate but more often remains quiescent, being diagnosed only by culture Diphtheria is a life-threatening but seldom encountered cause of infectious pharyngitis, characterized by a thick membrane and marked cervical adenopathy Oropharyngeal tularemia is rare and should be entertained only in endemic areas among children who have an exudative pharyngitis that cannot be categorized by standard diagnostic testing and/or persists despite antibiotic therapy Although unusual, mixed anaerobic infections should be considered in the ill-appearing adolescent with a severe pharyngitis because these organisms occasionally lead to complications such as infected thrombophlebitis and sepsis (Lemierre syndrome) Arcanobacterium haemolyticum has been isolated from 0.5% to 2.0% of adolescents with pharyngitis, often in association with a maculopapular rash Other pathogens—group C and G streptococci, Mycoplasma pneumoniae, and Chlamydia pneumoniae —have been implicated as agents of pharyngitis in adults, but in childhood, their roles remain unproven and their frequency is unknown Irritative Pharyngitis/Foreign Body Drying of the pharynx may irritate the mucosa, leading to a complaint of sore throat This condition occurs most commonly during the winter months, particularly after sleeping in a house with forced hot-air heating Occasionally, a foreign object such as a fishbone or popcorn shell may become embedded in the pharynx resulting in pain Herpetic Stomatitis ... Fetus and Newborn, American Academy of Pediatrics; Section on Surgery, American Academy of Pediatrics Assessment and management of inguinal hernia in infants Pediatrics 2012;130:768–773 Neurologic... Gastrointestinal Disorders Aboagye J, Godstein SD, Salazar JH, et al Age at presentation of common pediatric surgical conditions: Reexamining dogma J Pediatr Surg 2014;49:995–999 Shalaby MS, Kuti... botulism immune globulin intravenous in the intensive care unit at Childrens Hospital Los Angeles Pediatrics 2007;120:e1380–e1385 Wood J, Christian C, Stavas N, et al ED Pathway for Evaluation/Treatment