Pharyngitis: diagnosis

Laboratory research

In order to diagnose the streptococcal nature of pharyngitis, a culture method, an express determination of streptococcal antigen, and immunological studies are used.

Instrumental research

With pharyngoscopy in a patient with acute pharyngitis and exacerbation of chronic inflammation, the mucous membrane of the pharynx is hyperemic, edematous.

The process can spread to the palatine arches, tonsils: the palatine curtain and the tongue can be swollen, enlarged in volume. Often, on the posterior and lateral walls of the pharynx, separate lymphadenoid follicles are visible in the form of bright red rounded elevations (granules) - granulose pharyngitis.

Sometimes on the side walls, just behind the palatine arch, you can observe enlarged, infiltrated lymphadenoid ridges (lateral pharyngitis). However, persistent hypertrophy of granules and lateral ridges should often be considered as a manifestation of an acute exacerbation of chronic pharyngitis. Local complications of acute pharyngitis can be associated with the spread of inflammation to the auditory tubes, nasal cavity, larynx, and common with the emergence or exacerbation of common diseases, such as rheumatism, arthritis, nephritis, etc.

In the catarrhal form of chronic pharyngitis, moderately pronounced congestive flushing, some swelling and thickening of the mucous membrane are noted; in some places the surface of the posterior pharyngeal wall is covered with viscous mucus. Hypertrophic pharyngitis, in addition to the features described above, is often characterized by mucopurulent discharge, flowing down the back wall of the pharynx. Granulose pharyngitis is characterized by the presence on the posterior wall of the pharynx of granules - semicircular elevations of the size of millet grains of dark red color, located on the background of hyperemic mucosa, superficial branching veins. The lateral pharyngitis is revealed in the form of strands of various thickness, located behind the posterior palatines. For the atrophic process is characterized by a thin, dry mucous membrane, a pale pink cyst with a dull tint, covered in places with crusts, viscous mucus. In the shiny surface of the mucous membrane, injected vessels can be seen.

With exacerbation of chronic pharyngitis, these changes are accompanied by hyperemia and edema of the mucous membrane, but the scarcity of objective data often does not correspond to the severity of symptoms disturbing the patient.

Differential diagnosis of pharyngitis

Characteristic complaints, anamnesis, a typical pharyngoscopic pattern facilitate the diagnosis of pharyngitis.

Acute pharyngitis should be differentiated from catarrhal sinus, lesions of the pharynx in acute infectious diseases (measles, scarlet fever). The diagnosis is facilitated by the appearance of a characteristic rash on the mucous membranes, on the skin of a sick child.

In acute respiratory infection, including the flu, other parts of the respiratory system are affected besides the pharynx. The inflammatory process is descending, the general reaction of the organism is more pronounced, regional lymphadenitis is observed. In a number of cases, acute nonspecific rhinopharyngitis has to be differentiated with the diphtheria process, in which there are difficult to remove filmy raids on the surface of the mucosa.

In addition, if suspicion of diphtheria is made, the diagnosis of the diphtheria test is helpful. Sometimes acute pharyngitis is combined with catarrhal angina.

In children, in rare cases, acute pharyngitis must be differentiated from gonorrheic rhinopharyngitis. It should be borne in mind that gonococcal infection causes a specific eye damage already in the period of newborn. A pronounced hyperemia of the pharyngeal mucosa can be observed with syphilis. In children, congenital syphilitic damage is determined in the second month of life - syphilis on the buttocks and around the anus, enlargement of the liver and spleen. Anamnesis and a corresponding bacteriological study help to establish the correct diagnosis.

Rhinopharyngitis can accompany diseases of the sphenoid sinus and posterior cells of the trellis labyrinth. In this case, differential diagnosis is performed by endoscopy and X-ray examination.

Hyperthrophic forms of pharyngitis may include hyperkeratosis of the pharynx (leptotrichosis), in which pyramid-like spikelets of the cornified epithelium of about 2-3 mm are formed on the surface of lymphoid formations (including the palatine tonsils). Most often, yellowish-white dense formations protrude on the cleft palate of the palatine tonsils. Papillae of the tongue and differ from the lacunar plugs in hardness and strong adhesion to the epithelium (they are hardly torn off by forceps); morphologically characterized by the proliferation of epithelium with keratinization. At microscopic examination, filamentous bacteria of B. Lepotrix are found in these formations, which makes it possible to consider this pathogen as an etiological factor in the onset of the disease. The process proceeds chronically and remains for a long time not detected due to the absence of inflammation of the tissues and clinical manifestations. Diagnosis is established by examination and histological examination of epithelial outgrowths.

In case of persistent, morbid sensations in the throat that are not amenable to conventional therapy, in some cases, differential diagnosis is required with syndromes developing in a number of systemic diseases and diseases of the nervous system. Thus, Sjogren's syndrome is a chronic systemic disease accompanied by a pronounced dryness of the mucous membranes of the respiratory and gastrointestinal tract, dysfunction and diffuse enlargement of salivary glands, conjunctivitis, keratitis, impaired calcification of teeth and bones. Often polyarthritis.

Persistent unilateral pain in the throat can be caused by the elongation of the styloid process, which is located on the lower surface of the temporal bone and can be palpated above the upper pole of the palatine tonsil.

Neuralgia of the glossopharyngeal or vagus nerves can also cause sore throats, especially in the elderly.

Indications for consultations of other specialists

To clarify the diagnosis may require consultation infektsionista, therapist, gastroenterologist, neurologist.

[1], [2], [3], [4], [5], [6], [7], [8], [9]