Differentiating tonsillits from other diseases

Jump to navigation Jump to search

Tonsillitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tonsillitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

USG

CT Scan

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating tonsillits from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating tonsillits from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating tonsillits from other diseases

CDC on Differentiating tonsillits from other diseases

Differentiating tonsillits from other diseases in the news

Blogs on Differentiating tonsillits from other diseases

Directions to Hospitals Treating Tonsillitis

Risk calculators and risk factors for Differentiating tonsillits from other diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:

Overview

Tonsillitis is a bacterial or viral infection that causes inflammation and swelling of the tonsils. Most often, this infection is characterized by two distinct traits; sore throat and difficulty swallowing. However, other infections such as Scarlet fever and Epstein-Barr virus may present in a similar fashion. Thus prior to any treatment of the infection, it is important to perform diagnostic testing to identify the correct infection.

Differentiating Tonsillitis from other Diseases

  • There are two diseases that are distinguished to present similarly to tonsillitis; they are Scarlet fever and Epstein Barr Virus.
Disease Definition
Scarlet Fever
  • Streptococcus pyogenes (group A strep) is responsible for scarlet fever. It can also cause simple angina, erysipelas and serious toxin-mediated syndromes like necrotizing fasciitis and the so-called streptococal toxic shock-like syndrome. The virulence of group A strep seems to be increasing lately. The exanthem of scarlatina is thought to be due to erythrogenic toxin production by specific streptococcal strains in a nonimmune patient. Along with erythrogenic toxins, the Group A strep produces several toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an hemolytic, thermolabile and immunogenic toxin, is the base of an assay for scarlatina and erysipelas - the anti-streptolysin O titer.
  • Early symptoms indicating the onset of scarlet fever can include:

[1] [2]

Rash

  • Characteristic rash, which:
  • is fine, red, and rough-textured; it blanches upon pressure
  • Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone
  • The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month."[2] Peeling also occurs in axilla, groin, and tips of the fingers and toes.[1]
Epstein-Barr Virus

EBV is named after Michael Epstein and Yvonne Barr, who together with Bert Achong, discovered the virus in 1964.[3]

  • Epstein-Barr virus is ubiquitous across the globe and the strongest causative agent for the manifestation of infectious mononucleosis. Commonly, a person is first exposed to the virus during or after adolescence. Though once deemed "The Kissing Disease", recent research has shown that transmission of mononucleosis not only occurs from intimate contact with infected saliva, but also from contact with the airborne virus.
  • Symptoms of infectious mononucleosis are:
  • Sometimes, a splenomegaly or hepatomegaly may develop. Heart problems or involvement of the central nervous system occurs only rarely, and infectious mononucleosis is almost never fatal. There are no known associations between active EBV infection and problems during pregnancy, such as miscarriages or birth defects. Although the symptoms of infectious mononucleosis usually resolve in 1 or 2 months, EBV remains dormant or latent in a few cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and is commonly found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness.

Differentiating between Common Misdiagnosis

Scarlet Fever

  • Scarlet fever may be ruled out in testing for specific bacteria that produce the erythrogenic toxin.
  • This toxin is ultimately the underlying cause of Scarlet fever.
  • In its absence, Scarlet fever would only present as purulent tonsillitis.

Epstein-Barr

  • Differentiated based on clinical manifestations.
  • May be responsible for prolonged fatigue.
  • Tonsillectomy may lead to further complications including an increased risk of hemorrhaging.

References

  1. 1.0 1.1 Balentine J and Kessler D (March 7, 2006). "Scarlet Fever". eMedicine. emerg/518.
  2. 2.0 2.1 Dyne P and McCartan K (October 19, 2005). "Pediatrics, Scarlet Fever". eMedicine. emerg/402.
  3. Epstein MA, Achong BG, Barr YM (1964). "Virus particles in cultured lymphblasts from Burkitt's Lymphoma". Lancet. 1: 702–3. PMID 14107961.

Template:WH Template:WS