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Faringite estreptocócica

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Apresentação sobre faringite estreptocócica. Atualizada em agosto de 2010.

Publicado en: Salud y medicina
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Faringite estreptocócica

  1. 1. FARINGITE ESTREPTOCÓCICA Mônica de Cássia Firmida Pneumologista Pediátrica HFB Prof a UERJ e UNIGRANRIO
  2. 2. Faringites agudas <ul><li>Dor de garganta é queixa comum. </li></ul><ul><li>Geralmente infecciosas. </li></ul><ul><li>Etiologia predominantemente viral. </li></ul><ul><li>A principal causa bacteriana é o Streptococcus B hemolítico do grupo A ( Streptococcus pyogenes ). </li></ul>
  3. 3. Pediatria (São Paulo) 1998;20:191-210 http://www.pediatriasaopaulo.usp.br/index.php?p=html&id=375
  4. 4. Clin Infect Dis. 2002; 35:113-25
  5. 5. Faringite Estreptocócica <ul><li>Streptococcus B hemolítico do grupo A ( S. pyogenes ). </li></ul><ul><li>Causa 15-30% das faringites agudas nas crianças e 5-10% nos adultos. </li></ul><ul><li>Rara em menores de 3 anos; pico 5 a 15 anos. </li></ul><ul><li>Em 0,3 a 3% dos casos as amigdalites estreptocócicas evoluem para FEBRE REUMÁTICA. </li></ul><ul><li>O tratamento antimicrobiano adequado evita a FR na maioria dos casos. </li></ul>
  6. 6. Diagnóstico Cínico Circulation. 2009;119:1541-51 Dados sugestivos de etiologia estreptocócica Dados sugestivos de etiologia viral Dor de garganta de início súbito Dor a deglutição Febre Rash cutâneo escarlatiforme Cefaléia Náusea, vômito e dor abdominal Eritema tonsilo-faríngeo Exsudato tonsilo-faríngeo Petéquias no palato mole Hiperemia e edema da úvula Adenomegalias cervicais anteriores, dolorosas Paciente entre 5 e 15 anos de idade Apresentação no inverno ou no início da primavera (em países de climas temperados) História de exposição Conjuntivite Coriza Rouquidão Tosse Diarréia Exantema característico Enantema característico
  7. 7. Diagnóstico Clínico Tabela - Freqüência de cada sintoma no grupo de crianças com cultura positiva para EGA e no grupo com cultura negativa para EGA * Diferença estatisticamente significante. Teste do qui-quadrado com correção de Yates resultando em valor de p < 0,001. J Pediatr (Rio J). 2005;81(1):23-8
  8. 10. Diagnóstico Diferencial Alguns agentes manifestam-se sob a forma de síndromes clínicas mais “específicas”. SÍNDROMES ETIOLOGIA Herpangina Síndrome mão-pé-boca Vírus Coxsackie Febre faringo-conjuntival Adenovírus Estomatite Herpes simplex Mononucleose infecciosa Vírus Epstein Barr
  9. 11. Herpangina
  10. 12. Síndrome mão-pé-boca
  11. 13. Febre faringo-conjuntival
  12. 14. Gengivo-estomatite Herpética
  13. 15. Mononucleose
  14. 16. Difteria
  15. 17. <ul><li>A investigação não precisa ser feita em todas as pessoas com faringite. </li></ul><ul><li>Testes de detecção rápida de antígenos. </li></ul><ul><li>Cultura da orofaringe. </li></ul>Diagnóstico laboratorial Circulation. 2009;119:1541-51
  16. 18. <ul><li>Há diferentes métodos. </li></ul><ul><li>Vantagem: rapidez. </li></ul><ul><li>Mais caros que a cultura. </li></ul><ul><li>Especificidade 95%. </li></ul><ul><li>Sensibilidade 80-90% (ou menos) </li></ul>Testes rápidos Circulation. 2009;119:1541-51
  17. 19. <ul><li>Padrão ouro para o diagnóstico. </li></ul><ul><li>Resultado em 1-2 dias. </li></ul><ul><li>Sensibilidade 90-95%. </li></ul>Cultura Circulation. 2009;119:1541-51
  18. 20. Títulos de anticorpos anti-estreptocócicos refletem eventos passados e não presentes e, por isso, não têm valor no diagnóstico da faringite aguda. Circulation. 2009;119:1541-51
  19. 21. Complicações Am Fam Physician. �2009�Mar�1;79(5):383-390 http://www.aafp.org/afp/2009/0301/p383.pdf Supurativas Não Supurativas Bacteremia Febre reumática Adenite cervical Endocardite Mastoidite Meningite Glomerulonefrite pós estreptocócica (GNPE) Otite média Abscesso periamigdaliano /retrofaríngeo Pneumonia
  20. 22. Algoritmo para diagnóstico e tratamento Recomendação do Departamento de Infectologia da Sociedade Brasileira de Pediatria para conduta de crianças e adolescentes com faringoamigdalites agudas. J. Pediatr. (Rio J.) ,  v. 82,  n. 1, Feb.  2006. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572006000100016&lng=en&nrm=iso
  21. 23. <ul><li>Objetivos: erradicar o S.pyogenes da orofaringe e prevenir a FEBRE REUMÁTICA (FR). </li></ul><ul><li>A resolução do quadro é mais rápida quando o paciente recebe antibiótico. </li></ul><ul><li>Previne a FR se iniciado até em 9 dias. </li></ul><ul><li>Deve ser feito com dose certa e por tempo suficiente. </li></ul><ul><li>Na maioria das vezes, não é preciso repetir os testes diagnósticos após o tratamento. </li></ul>Tratamento Circulation. 2009;119:1541-51
  22. 24. <ul><li>Eficácia. </li></ul><ul><li>Segurança. </li></ul><ul><li>Espectro de ação (preferir estreito). </li></ul><ul><li>Esquema posológico. </li></ul><ul><li>Chance de adesão ao tratamento. </li></ul><ul><li>Custo. </li></ul>Escolha do Antibiótico A PENICILINA BENZATINA continua sendo a droga de escolha. Circulation. 2009;119:1541-51
  23. 25. Prevenção Primária da FR Arq Bras Cardiol 2009; 93(3 supl.4): 1-18 http://publicacoes.cardiol.br/consenso/2009/diretriz_febrereumatica_93supl04.pdf
  24. 26. http://circ.ahajournals.org/cgi/reprint/119/11/1541
  25. 27. Arq Bras Cardiol 2009; 93(3 supl.4): 1-18 http://publicacoes.cardiol.br/consenso/2009/diretriz_febrereumatica_93supl04.pdf 2009

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