Differential diagnosis of angina pectoris
Acute tonsillitis (lat. acute tonsillitis) can be caused by a wide range of agents. It occurs most often in children and young adults.
The etiology is mainly determined by the intensity, extent, involvement of the neck, soft palate, and the presence of exudation, blisters, petechiae or enanthema. Among the bacteria, the most common causative agent is Streptococcus pyogenes. In children under three years of age, it is usually of viral origin.
Clinical picture[edit | edit source]
Locally, with tonsillitis, the tonsils become red and swollen, they may be covered with coatings - studs. A sore throat accompanied by difficulty in swallowing (odynophagia) develops quickly. The submandibular nodes are swollen and painful. In addition to the local manifestations, a general feeling of illness is added - malaise, fatigue, fever, malaise.
|Diagnosis||Clinical Picture (CP), and Diagnosis (DG)|
|Acute tonsillitis||CP: redness and edema of palatine tonsils, purulent plugs, fibrin coatings, necrosis ( angina catarrhalis, follicularis, lacunaris, pseudomembranacea )|
|Infectious mononucleosis||CP: angina pectoris with marked lymphadenopathy (generalized), Holzel's sign, Bass' sign
CP+diff: leukocytosis (initially leukopenia) monocytosis, atypical leukocytes,
|Herpangina||CP: picture of vesicular angina, vesicular efflorescence on palatal arches,
|Streptococcal angina||CP: picture most often of lacunar angina,
CP+diff: neutrophilia with shift to the left,
DG: culture, ASLO
|Scarlet fever||CP: fever, picture most often of lacunar angina, raspberry tongue, burning skin exanthema, Filatov's and Šrámek's signs,
DG: CP, FW, cultivation, ASLO
|Angina in the oropharyngeal form of tularemia||CP: picture of necrotizing angina, often unilateral, significant regional lymphadenopathy,
DG: CP, FW, serology
|Diphtheria||CP: dirty gray coating beyond the edges of the tonsils, tightly adherent, foetor,
DG: slide smear, bacteriology
|Ulceromembranous tonsillitis||CP: necrotizing angina with a tendency to ulceration, dirty coatings, immunologically compromised individuals, severe general condition, unilateral finding, rare occurrence|
|Angina in agranulocytosis
(in acute leukemia)
|CP: bilateral necrotizing angina, ulceration of the pharyngeal mucosa, lymphadenopathy is not evident, while hepatosplenomegaly is usually present, tonsillitis may be the first manifestation of a general underlying disease
DG: CP, FW
(stage II syphilis)
|CP: plaques mucous,
Clinical units[edit | edit source]
Streptococcal tonsillopharyngitis[edit | edit source]
Diphtheria[edit | edit source]
Plaut-Vincent's angina[edit | edit source]
- Rare, caused by a mixed flora of anaerobes and spirochetes;
- The disability is one-sided - typical is the disgusting feator ex ore;
- Lemierre's disease/Lemierre syndrome – rare but fatal, infection fusobacterium necrophorum spreads to the mediastinum.
Infectious mononucleosis[edit | edit source]
- Considerable swelling of the tonsils, humming;
- Holtzel's sign – small petechiae on the soft palate;
- Bass's sign - swelling of the eyelids.
Herpangina[edit | edit source]
- Coxsackie viruses, mostly in children,
- Fever, headache,
- Redness of the oropharynx with small blisters (2–10), they do not merge,
- On arches, pain when swallowing,
- Within 2-4 days the fever subsides and the boils heal,
- Diff.dg. – herpetic stomatitis – ulcers in the front of the oral cavity.
- Other forms
- From the clinical picture;
- Laboratory examination – viral – normal sedimentation, rather leukopenia, predominance of mononuclear cells;
- IM – atypical lymphocytes.
- Viral - only symptomatically;
- Streptococcal – penicillin (erythromycin), cephalosporins I.g., abscess – lincosamides;
- Gonococcus, lues – also penicillin;
- Ccorynebacterium diphtheriae – also penicillin;
- On the contrary, aminopenicillins are completely unsuitable for MI!
Links[edit | edit source]
Source[edit | edit source]
- BENEŠ, Jiří. Studying materials [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.
References[edit | edit source]
- KLOZAR, Jan. Special otorhinolaryngology. 1. edition. Galén, 2005. pp. 224. ISBN 80-7262-346-X.
- HAVLÍK, Jiří. Infectology. 2. edition. Avicenum, 1990. ISBN 80-201-0062-8.
- LOBOVSKÁ, Alena. Infectious diseases. 1. edition. Karolinum, 2001. pp. 263. ISBN 80-246-0116-8.