Pediatric emergency medicine trisk 1478 1478

Pharyngitis in the Immunosuppressed Host Immunosuppressed hosts may develop pharyngitis from any of the previously discussed causes In addition, these patients exhibit a particular susceptibility to infections with fungal organisms such as Candida albicans EVALUATION AND DECISION The history and physical examination should focus on systemic illnesses causing pharyngitis and the appearance of the oral cavity A careful medical history of an immunosuppressive disorder or incomplete immunizations should raise the specter of unusual infections A sudden onset is most characteristic of epiglottitis Fever, either historical or measured, points to an infection or, less commonly, Kawasaki disease Toxicity and/or respiratory distress occur with infections leading to respiratory obstruction, such as peritonsillar, retropharyngeal, and lateral pharyngeal abscesses; epiglottitis; diphtheria; and infectious mononucleosis with severe tonsillar hypertrophy Conjunctivitis suggests pharyngoconjunctival fever (adenovirus), Kawasaki disease, or Stevens–Johnson syndrome; generalized adenopathy occurs with infectious mononucleosis and HIV A rash is seen with scarlet fever (group A streptococci), Kawasaki disease, infectious mononucleosis, particularly after the administration of amoxicillin, and rarely with Arcanobacterium hemolyticum in adolescents