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Angina (acute tonsillitis): diagnosis
Last reviewed: 23.04.2024
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Physical diagnosis of angina
Changes in the pharynx revealed during mesopharyngoscopy in the first days of the disease are non-specific and may be similar in many diseases, therefore, the patient should be monitored in dynamics.
Laboratory diagnosis of angina
Increasingly widespread methods of rapid diagnosis of beta-hemolytic streptococcus group A, allowing to detect the antigens of this pathogen in smears from the surface of the tonsils or the posterior pharyngeal wall. Modern diagnostic systems make it possible to obtain a result in 15-20 min with high specificity (95-100%), but lower sensitivity (60-95%) than in culture. Express methods supplement, but do not replace the cultural method.
The presence of beta-hemolytic streptococcus is also confirmed when determining anti-O-streptolysin and other antibodies.
A clinical blood test allows you to shed a proper diagnosis of angina, including with blood diseases.
In catarrhal angina, the reaction from the blood is insignificant, neutrophilic leukocytosis (7-9 × 10 9 / L), in the blood formula a slight stab stem shift left, ESR up to 18-20 mm / h.
In follicular angina, neutrophilic leukocytes (12-15x10 9 / l) are observed , a moderate stab stem shift to the left, an increase in ESR up to 30 mm / h is possible. As a rule, enlarged and painful at palpation of regional lymph nodes, especially retro-mandibular ones.
In viral angina observed a small leukocytosis, but more often light leukopenia, a slight shift of the blood formula to the left.
Instrumental diagnosis of angina
The basis of diagnosis of angina - pharyngoscopy.
With catarrhal sinus, the diffuse hyperemia of the tonsils is determined, sometimes extending to the arches, which are often edematous. The tonsils are mild (sometimes significantly) edematous, there are no plaques. The soft palate and mucous membrane of the posterior pharyngeal wall are not intended, which makes it possible to differentiate this form of sore throat from pharyngitis.
Pharyngoscopy for follicular angina is characterized by diffuse hyperemia, infiltration, swelling of palatine tonsils, arches and soft palate. On the surface of the tonsils there are numerous roundish, slightly yellowish-white dots 1-3 mm above the surface. These are translucent mucous membranes of suppurated tonsillar follicles, which on the 2nd-4th day of the disease are usually opened with the formation of a rapidly healing defect (erosion) of the mucosa.
With lacunar angina, first a variety of forms of yellowish white color are seen, small incrustations, usually emanating from the mouths of lacunae. In the future, these islands of plaque merge and form films, sometimes extending to the entire surface of the amygdala, but not beyond it. The plaque is relatively easy to remove without leaving a bleeding surface. With any angina with raids on the surface of the palatine tonsils. And especially in cases where the raids spread beyond the tonsils, the possibility of developing diphtheria of the pharynx should be excluded without fail.
Local manifestations of angina Simanovsky-Plaut-Vincent are in the form of two forms: rare diphtheria and much more frequent ulcerative-membranous. In the diphtheria form, the amygdala is enlarged, hyperemic and covered with a dirty grayish-white coating, similar to diphtheria, but easily removable. Under the plaque, there is a bleeding erosion quickly covered with a film. With ulcerative form, more often in the upper pole of the amygdala appears a grayish-yellow coating, which is easily removed and does not tend to spread to surrounding tissues. Under it, there is ulceration with a slightly bleeding surface. Necrosis progresses and soon in the amygdala there is a crater-like ulcer with uneven edges covered with a dirty gray coating.
When pharyngoscopic diagnosis of angina viral etiology on the soft palate, palatine arch. Tongue, less often on the tonsils and the back wall of the pharynx, small reddish vesicles, as small as a pinhead, are seen. After a few days, the vesicles burst, leaving behind superficial, rapidly healing erosions, or they undergo reverse development without previous suppuration.
Differential diagnosis of angina
Differential diagnosis of angina, based only on clinical signs, is quite a difficult task, even for an experienced doctor. In the diagnosis of angina, an important role is played by the patient's anamnesis indicating contact with an infectious patient, bacteriological examination of the material from the surface of the tonsils. It is necessary to take into account also the reaction of the body and the specific signs inherent in this or that infectious disease: rashes, plaque, reaction of regional lymph nodes, etc. Angina can be observed with abdominal and typhus, with rubella, chickenpox and smallpox, with syphilis and tuberculosis. In some cases, tumors of the amygdala should be excluded.
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