Differential diagnosis of tonsillitis

Acute tonsillitis
It can be caused by a diverse range of agents. It most often occurs in children and young adults. The etiology can be guessed by clinical presentation: intensity, extent, involvement of the neck and soft palate, the presence of exudation, blisters, and the presence of petechiae or enanthema. Out of all the bacterial etiologies, Streptococcus pyogenes is the most common cause of tonsillitis. In children under the age of three, it is usually of viral origin.

Clinical picture
Locally, in tonsillitis there is redness and swelling of the tonsils, they may be covered with pins. Sore throat, accompanied by difficulty swallowing (odynophagia), develops rapidly. The submandibular nodes are swollen and painful. To the local manifestations is worsened by a general feeling of illness - malaise, fatigue, fever, and lethargy.

According to the clinical picture, it is usually not possible to identify the causative agent.

Plaut-Vincent angina

 * rare, caused by a mixed flora of anaerobes and spirochetes
 * the disability is one-sided - a disgusting odor (feator ex ore) is typical
 * Lemierre's syndrome - a rare but fatal, infection by fusobacterium necrophorum, which spreads to the mediastinum.

Infectious mononucleosis

 * significant swelling of the tonsils with thickening
 * Holtzel's sign - small petechias on the soft palate
 * Bass symptom - swelling of the eyelids

Herpangina
Other forms
 * coxsackie viruses, mostly in children
 * fever, headache
 * redness of the oropharynx with small blisters (2-10) that do not coalesce
 * pain during swallowing
 * within 2-4 days the fever subsides and the ulcers heal
 * dif. dg. - herpetic stomatitis - anterior ulcers in the oral cavity
 * less common
 * gonococcal pharyngitis, secondary syphilis


 * Diagnosis
 * from the clinical picture
 * laboratory examination - viral - normal sedimentation, leukopenia, predominance of mononuclear cells
 * Infectious mononucleosis (IM)- atypical lymphocytes
 * Therapy
 * viral - only symptomatic
 * streptococcal - penicillin (erythromycin), cephalosporins I.g., abscess - lincosamides;
 * gonococcus, syphilis - also penicillin
 * corynebacterium diphtheriae - also penicillin
 * In IM, on the other hand, aminopenicillins are completely inappropriate!

Source

 * BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. .

Used literature

 * KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. vydání. Praha : Galén, 2005. 224 s.  ISBN 80-7262-346-X.


 * HAVLÍK, Jiří, et al. Infektologie. 2. vydání. Praha : Avicenum, 1990. 393 s.  ISBN 80-201-0062-8.


 * LOBOVSKÁ, Alena. Infekční nemoci. 1. vydání. Praha : Karolinum, 2001. 263 s.  ISBN 80-246-0116-8.