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.