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Diagnosis of angina and acute pharyngitis in children
Medical expert of the article
Last reviewed: 23.04.2024
[Laboratory diagnosis of angina and acute pharyngitis in children
In severe acute tonsillitis / tonsillopharyngitis and acute pharyngitis, and in cases of hospitalization, peripheral blood analysis is done, which in uncomplicated cases reveals leukocytosis, neutrophilia and shift of formula to the left with streptococcal etiology of the process and normal leukocytosis or a tendency to leukopenia and lymphocytosis in the viral etiology of the disease.
The analysis of peripheral blood is important for the diagnosis of acute tonsillopharyngitis. Caused by the Epstein-Barr virus. The appearance of mononuclear cells at the 2nd week of the disease is evidence in favor of Epstein-Barr disease.
Etiological diagnosis has a differential diagnostic significance, which allows to identify streptococcal tonsillitis / tonsillopharyngitis and to conduct differential diagnosis with tonsillopharyngitis of another etiology. For this purpose, bacteriological examination of smears from the throat is carried out. The sensitivity and specificity of this test is high (90 and 95%, respectively). The anti-streptolysin O titer is determined, but the sensitivity (70-80%) and specificity (70-90%) of this method are lower.
To identify the mycoplasmal and chlamydial etiology of the disease, the definition in smears from the pharynx of the mycoplasma antigen is determined by the immunofluorescence method and by the PCR method (also in throat swabs).
Identification of viral pathogens of acute tonsillitis / tonsillopharyngitis and acute pharyngitis is carried out only in case of severe illness, in cases of hospitalization of the child. To determine the viral antigens, the immunofluorescence of the fingerprint from the nasal mucosa is used and PCR is used to identify a wide range of respiratory viruses in smears from the mucous membrane of the throat. For the same purpose, PCR diagnostics and detection of elevated titre of antibodies to the Epstein-Barr virus by the method of enzyme immunoassay (ELISA) are carried out.
Instrumental diagnosis of angina and acute pharyngitis in children
Conduct pharyngoscopy.
Differential diagnosis of angina and acute pharyngitis in children
Differential diagnosis of acute tonsillitis / tonsillopharyngitis and pharyngitis is based on the etiological principle.
First of all, they exclude diseases in which the pharynx lesion is one of the clinical manifestations of the common disease: diphtheria, scarlet fever, tularemia, typhoid fever, infectious mononucleosis, HIV infection. At the same time in the differential diagnosis, an important role is played by the epidemiological anamnesis. Clinical features and data of bacteriological, serological and other studies specifying the etiology of the disease.
Then, in cases of severe disease, differential diagnosis is performed between streptococcal and viral lesions. In the differential diagnosis, the main role is played by the epidemiological history, clinical features and data of bacteriological, serological and virological studies that specify the etiology of the disease.