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Angina (acute tonsillitis) - Diagnosis
Medical expert of the article
Last reviewed: 03.07.2025
Physical diagnosis of angina
Changes in the pharynx revealed by mesopharyngoscopy in the first days of the disease are nonspecific and can be similar in many diseases, so the patient should be observed dynamically.
Laboratory diagnostics of angina
Express diagnostic methods for beta-hemolytic streptococcus group A are becoming increasingly widespread, allowing the detection of antigens of this pathogen in smears from the surface of the tonsils or the back wall of the pharynx. Modern diagnostic systems allow obtaining results in 15-20 minutes with high specificity (95-100%), but lower sensitivity than with culture testing (60-95%). Express methods complement, but do not replace, the culture method.
The presence of beta-hemolytic streptococcus is also confirmed by determining anti-O-streptolysin and other antibodies.
A clinical blood test allows for a correct diagnosis of angina, including blood diseases.
In case of catarrhal tonsillitis, the reaction from the blood is insignificant, neutrophilic leukocytosis (7-9x10 9 /l), in the blood formula there is a slight shift to the left for band neutrophils, ESR up to 18-20 mm/h.
In follicular tonsillitis, neutrophilic leukocytes (12-15x10 9 /l) are observed, moderate shift of band nuclei to the left, and an increase in ESR up to 30 mm/h is possible. As a rule, regional lymph nodes are enlarged and painful upon palpation, especially retromandibular ones.
With viral tonsillitis, slight leukocytosis is observed, but more often mild leukopenia, a slight shift in the blood formula to the left.
Instrumental diagnostics of angina
The basis for diagnosing tonsillitis is pharyngoscopy.
In catarrhal tonsillitis, diffuse hyperemia of the tonsils is determined, sometimes spreading to the arches, which are often edematous. The tonsils are moderately (sometimes significantly) edematous, there is no plaque. The soft palate and the mucous membrane of the back wall of the pharynx are not changed, which allows differentiating this form of tonsillitis from pharyngitis.
Pharyngoscopically, follicular tonsillitis is characterized by diffuse hyperemia, infiltration, and swelling of the tonsils, arches, and soft palate. Numerous round, slightly raised yellowish-white dots 1-3 mm in size are visible on the surface of the tonsils. These are suppurating tonsil follicles that show through the mucous membrane and usually open on the 2nd-4th day of the disease, forming a rapidly healing defect (erosion) of the mucous membrane.
In lacunar tonsillitis, small yellowish-white plaques of various shapes are first visible, usually coming from the mouths of the lacunae. Later, these plaque islands merge and form films, sometimes spreading over the entire surface of the tonsil, but not going beyond it. The plaque is relatively easy to remove, leaving no bleeding surface. In any tonsillitis with plaque on the surface of the palatine tonsils, and especially in cases where the plaque extends beyond the tonsils, it is imperative to exclude the possibility of developing diphtheria of the pharynx.
Local manifestations of Simanovsky-Plaut-Vincent's angina come in two forms: rare diphtheroid and much more common ulcerative-membranous. In the diphtheroid form, the tonsil is enlarged, hyperemic and covered with a dirty grayish-white coating, similar to diphtheria, but easily removed. Under the coating, a bleeding erosion is found, quickly covered with a film. In the ulcerative-membranous form, a grayish-yellow coating often appears in the area of the upper pole of the tonsil, easily removed and not tending to spread to the surrounding tissues. Under it, an ulceration with a slightly bleeding surface is found. Necrosis progresses and soon a crater-shaped ulcer with uneven edges covered with a dirty gray coating is visible in the thickness of the tonsil.
During pharyngoscopic diagnostics of viral tonsillitis, small, pinhead-sized, reddish blisters are visible on the soft palate, palatine arches, uvula, and less frequently on the tonsils and back wall of the pharynx. After a few days, the blisters burst, leaving behind superficial, quickly healing erosions, or undergo reverse development without prior 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 medical history indicating contacts with an infectious patient, bacteriological examination of the material from the surface of the tonsils. It is also necessary to take into account the body's reaction and specific signs inherent in a particular infectious disease: rashes, plaque, reaction of regional lymph nodes, etc. Angina can be observed with typhoid and typhus, rubella, chickenpox and smallpox, syphilis and tuberculosis. In some cases, a neoplasm of the tonsil should be excluded.
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