Differential diagnosis of acute tonsillopharyngitis

Cover Page

Cite item

Full Text

Abstract

Acute tonsillopharyngitis (ATP) is one of the most common diseases that makes patients to search for primary medical care. In clinical practice, the differential diagnosis of streptococcal and viral pharyngitis is based on clinical manifestations along with express diagnostics. In pharyngitis caused by group A р-hemolytic streptococcus, febrile temperature, sore throat, plaque on the tonsils and lymphadenopathy in the anterior part of the neck are most characteristic signs and symptoms, while viral pharyngitis is typically associated with conjunctivitis, rhinitis, cough and diarrhea. In streptococcal pharyngitis, antibacterial therapy is indicated to prevent potential severe complications (including acute rheumatic fever and glomerulonephritis) while in viral pharyngitis -symptomatic treatment and plenty of drinking. In addition, ATP may be a symptom of infectious mononucleosis, acute retroviral syndrome in primary HIV infection and Kawasaki disease, pharyngeal diphtheria and hematological diseases. Purulent infections, including Lemierre's syndrome, Ludwig's angina, paratonsillitis, parapharyngitis, and retropharyngeal abscess, should also be considered in the differential diagnosis of ATP.

About the authors

Aleksandra L. Guseva

Pirogov Russian National Research Medical University

Email: alexandra.guseva@gmail.com
канд. мед. наук, доц. каф. оториноларингологии лечебного фак-та Moscow, Russia

Luliia V. Levina

Pirogov Russian National Research Medical University

канд. мед. наук, доц. каф. оториноларингологии лечебного фак-та Moscow, Russia

Mariia L. Derbeneva

Pirogov City Clinical Hospital №1

канд. мед. наук, врач-оториноларинголог Moscow, Russia

References

  1. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report 2010; 26: 1-31.
  2. Ebell MH, Smith MA, Barry HC et al. The rational clinical examination. Does this patient have strep throat? JAMA 2000; 284 (22): 2912-8. doi: 10.1001/jama.284.22.2912
  3. Hildreth AF, Takhar S, Clark MA, Hatten B. Evidence-Based Evaluation And Management Of Patients With Pharyngitis In The Emergency Department. Emerg Med Pract 2015; 17 (9): 1-16; quiz 16-7.
  4. Поляков Д.П., Карнеева О.В., Рязанцев С.В. и др. Острый тонзиллофарингит. Клинические рекомендации Национальной ассоциации оториноларингологов, 2016.
  5. Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med 2011; 364 (7): 648-55. doi: 10.1056/NEJMcp1009126
  6. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, Galeone C et al. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 (Suppl. 1): 1-28. doi: 10.1111/j.1469-0691.2012.03766.x
  7. Barnett ML, Linder JA. Antibiotic prescribing to adults with sore throat in the United States, 19972010. JAMA Intern Med 2014; 174 (1): 138-40. doi: 10.1001/jamainternmed.2013.11673
  8. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010; 126 (3): e557-64. doi: 10.1542/peds.2009-2648
  9. Pfoh E, Wessels MR, Goldmann D, Lee GM. Burden and economic cost of group A streptococcal pharyngitis. Pediatrics 2008; 121 (2): 229-34. doi: 10.1542/peds.2007-0484
  10. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009; 79 (5): 383-90.
  11. Bisno AL. Acute pharyngitis. N Engl J Med 2001; 344 (3): 205-11. doi: 10.1056/NEJM200101183440308
  12. Крюков А.И., Кунельская Н.Л., Туровский А.Б. Стрептококковые заболевания глотки. РМЖ. 2006; 14 (27): 5-9.
  13. Centor RM, Witherspoon JM, Dalton HP et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981; 1 (3): 239-46. doi: 10.1177/0272989X8100100304
  14. Mclsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998; 158 (1): 75-83.
  15. Mclsaac WJ, Kellner JD, Aufricht P et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291 (13): 1587-95. doi: 10.1001/jama.291.13.1587
  16. Shulman ST, Bisno AL, Clegg HW et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55 (10): e86-102. doi: 10.1093/cid/cis629
  17. Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine; Centers for Disease Control. Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med 2001; 134 (6): 506-8. doi: 10.7326/0003-4819-134-6-200103200-00018
  18. Tanz RR, Gerber MA, Rippe J et al. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics 2009; 123 (2): 437-44. doi: 10.1542/peds.2008-0488
  19. Cohen JF, Chalumeau M, Levy C et al. Effect of clinical spectrum, inoculum size and physician characteristics on sensitivity of a rapid antigen detection test for group A streptococcal pharyngitis. Eur J Clin Microbiol Infect Dis 2013; 32 (6): 787-93. doi: 10.1007/s10096-012-1809-1
  20. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, Galeone C et al. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 (Suppl. 1): 1-28. doi: 10.1111/j.1469-0691.2012.03766.X
  21. Отвагин И.В., Соколов Н.С. Диагностика инфекций, вызванных стрептококками группы А. Клиническая микробиология и антимикробная химиотерапия. 2011; 3 (13): 223-30.
  22. Chapin KC, Blake P, Wilson CD. Performance characteristics and utilization of rapid antigen test, DNA probe, and culture for detection of group a streptococci in an acute care clinic. J Clin Microbiol 2002; 40 (11): 4207-10. doi: 10.1128/jcm.40.11.4207-4210.2002
  23. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2006; 4: CD000023. doi: 10.1002/14651858.CD000023.pub3
  24. Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med 2018; 54 (5): 619-29. doi: 10.1016/j.jemermed.2018.01.031
  25. Schachtel BP, Fillingim JM, Thoden WR et al. Sore throat pain in the evaluation of mild analgesics. Clin Pharmacol Ther 1988; 44 (6): 704-11. doi: 10.1038/clpt.1988.215
  26. Chrubasik S, Beime B, Magora F Efficacy of a benzocaine lozenge in the treatment of uncomplicated sore throat. Eur Arch Otorhinolaryngol 2012; 269 (2): 571-7. doi: 10.1007/s00405-011-1802-9
  27. Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ 2017; 358: j3887. doi: 10.1136/bmj.j3887
  28. Sato S, Kuratomi Y, Inokuchi A. Pathological characteristics of the epiglottis relevant to acute epiglottitis. Auris Nasus Larynx 2012; 39 (5): 507-11. doi: 10.1016/j.anl.2011.10.015
  29. Савенкова М., Балясинская Г., Бычков В. и др. Острый эпиглоттит у детей (этиопатогенез, диагностика, лечение). Вопросы современной педиатрии. 2008; 7 (5): 91-7.
  30. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2008; 122 (8): 818-23. doi: 10.1017/S0022215107000473
  31. Cherry JD. Epiglottitis (supraglottitis). In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases, 6th. Philadelphia: Saunders, 2009; р. 244.
  32. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am 2008; 41 (3): 551-66, ix. doi: 10.1016/j.otc.2008.01.012
  33. Ноговицына Е.Б. Современные подходы к диагностике и лечению инфекционного мононуклеоза Эпштейна-Барр-вирусной этиологии. Дальневосточный мед. журн. 2016; 3: 40-5.
  34. Ebell MH, Call M, Shinholser J, Gardner J. Does This Patient Have Infectious Mononucleosis? The Rational Clinical Examination Systematic Review. JAMA 2016; 315 (14): 1502-9. doi: 10.1001/jama.2016.2111
  35. Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010; 362 (21): 1993-2000. doi: 10.1056/NEJMcp1001116 ИНФОРМАЦИЯ ОБ АВТОРАХ / INFORMATION ABOUT THE AUTHORS
  36. Bartlett A, Williams R, Hilton M. Splenic rupture in infectious mononucleosis: A systematic review of published case reports. Injury 2016; 47 (3): 531-8. doi: 10.1016/j.injury.2015.10.071
  37. Львов Н.Д., Мельниченко А.В., Панюкова Е.М., Шестакова И.В. Инфекционный мононуклеоз. Клинические рекомендации. Национальное научное общество инфекционистов, 2014.
  38. Schwartzkopf J. Infectious mononucleosis. JAAPA 2018; 31 (11): 52-3. doi: 10.1097/01. JAA.0000546488.73851.dd
  39. Thompson SK, Doerr TD, Hengerer AS. Infectious mononucleosis and corticosteroids: management practices and outcomes. Arch Otolaryngol Head Neck Surg 2005; 131 (10): 900-4. doi: 10.1001/archotol.131.10.900
  40. Seve P Lega JC. Maladie de Kawasaki de l'adulte [Kawasaki disease in adult patients]. Rev Med Interne 2011; 32 (1): 17-25. doi: 10.1016/j.revmed.2010.04.006
  41. Singh S, Jindal AK, Pilania RK. Diagnosis of Kawasaki disease. Int J Rheum Dis 2018; 21 (1): 3644. doi: 10.1111/1756-185X.1322
  42. Волгина С.Я. Синдром Кавасаки у детей (лекция). Вестн. современной клинической медицины. 2013; 6 (3): 86-91.
  43. Gutteridge DL, Egan DJ. The HIV-Infected Adult Patient In The Emergency Department, The Changing Landscape Of Disease. Emerg Med Pract 2016; 18 (2): 1-16.
  44. Прянишникова Г.А. Дебютные маски ВИЧ-инфекции. Современная терапия в психиатрии и неврологии.2016; 2:24-8.
  45. Johannesen KM, Bodtger U. Lemierre's syndrome: current perspectives on diagnosis and management. Infect Drug Resist 2016; 9: 221-7. doi: 10.2147/IDR.S95050
  46. Михайлов Ю.Х., Михайлова И.В. Синдром Лемьера. Российская оториноларингология. 2015; 6 (79): 103-5.
  47. Pak S, Cha D, Meyer C et al. Ludwig's Angina. Cureus 2017; 9 (8): e1588. doi: 10.7759/cureus.158
  48. Parker E, Mortimore G. Ludwig's angina: a multidisciplinary concern. Br J Nurs 2019; 28 (9): 54751. doi: 10.12968/bjon.2019.28.9.547
  49. Пальчун В.Т., Гуров А.В., Аксенова А.В., Гусева О.А. Дифференциальная диагностика хронического тонзиллита по степени выраженности тонзиллогенной интоксикации организма. Вестн. оториноларингологии. 2015; 80 (5): 8-13. doi: 10.17116/otorino20158058-13
  50. Klug TE. Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess. Dan Med J 2017; 64 (3): B5333.
  51. Kosko J, Casey J. Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure. Ear Nose Throat J 2017; 96 (1): E12-E15.
  52. Забиров Р.А., Резниченко А.В., Багаутдинов А.А. Заглоточные абсцессы у взрослых и их хирургическое лечение. Рос. оториноларингология. 2013; 4 (65): 152-4.
  53. Свистушкин В.М., Мустафаев Д.М. Парафарингит, тонзиллогенный сепсис: особенности патогенеза, клиническая картина и современные представления о лечении. Вестн. оториноларингологии. 2013; 78 (3): 29-34.
  54. Ruppert SD, Fay VP. Pharyngitis: soothing the sore throat. Nurse Pract 2015; 40 (7): 18-26. doi: 10.1097/01.NPR.0000466498.57296.60
  55. Дербенева М.Л., Гусева А.Л. Острые респираторные вирусные заболевания: современные подходы к диагностике и лечению. Мед. совет. 2019; 20: 32-7. doi: 10.21518/2079-701X-2019-20-32-37
  56. Ляшенко Ю.И. Руководство по инфекционным болезням. СПб.: Фолиант, 2003.
  57. Финогееев Ю.П., Павлович Д.А., Захаренко С.М., Крумгльц В.Ф. Острые тонзиллиты у инфекционных больных. Журнал инфектологии. 2011; 4 (3): 84-91.

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies