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Diagnosis of sore throat and acute pharyngitis in children
Medical expert of the article
Last reviewed: 03.07.2025
[ Laboratory diagnostics of tonsillitis and acute pharyngitis in children
In severe cases of acute tonsillitis/tonsillopharyngitis and acute pharyngitis and in cases of hospitalization, a peripheral blood test is performed, which in uncomplicated cases reveals leukocytosis, neutrophilia and a shift in the formula to the left in the case of streptococcal etiology of the process and normal leukocytosis or a tendency to leukopenia and lymphocytosis in the case of viral etiology of the disease.
Peripheral blood analysis is important for the diagnosis of acute tonsillopharyngitis caused by the Epstein-Barr virus. The appearance of mononuclear cells in the 2nd week of the disease indicates Epstein-Barr disease.
Etiological diagnostics has differential diagnostic value, allowing to detect streptococcal tonsillitis/tonsillopharyngitis and to conduct differential diagnostics with tonsillopharyngitis of other etiologies. For this purpose, bacteriological examination of throat smears is carried out. The sensitivity and specificity of this test are high (90 and 95%, respectively). The titer of antistreptolysin O is determined, but the sensitivity (70-80%) and specificity (70-90%) of this method are lower.
To identify the mycoplasma and chlamydial etiology of the disease, the determination of mycoplasma antigen in throat smears is carried out using the immunofluorescence method and the PCR method (also in throat smears).
Identification of viral pathogens of acute tonsillitis/tonsillopharyngitis and acute pharyngitis is carried out only in severe cases of the disease, in cases of hospitalization of the child. To determine viral antigens, the reaction of immunofluorescence of prints 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 pharynx. For the same purpose, PCR diagnostics and detection of an increased titer of antibodies to the Epstein-Barr virus by enzyme-linked immunosorbent assay (ELISA) are carried out.
Instrumental diagnostics of tonsillitis and acute pharyngitis in children
A pharyngoscopy is performed.
Differential diagnostics of tonsillitis and acute pharyngitis in children
Differential diagnosis of acute tonsillitis/tonsillopharyngitis and pharyngitis is based on the etiological principle.
First of all, diseases are excluded in which pharyngeal lesions are one of the clinical manifestations of a general disease: diphtheria, scarlet fever, tularemia, typhoid fever, infectious mononucleosis, HIV infection. In this case, epidemiological anamnesis, clinical features and data from bacteriological, serological and other studies that clarify the etiology of the disease play a major role in differential diagnostics.
Then, in cases of severe disease, differential diagnostics are carried out between streptococcal and viral lesions. In this case, the main role in differential diagnostics is played by the epidemiological anamnesis, clinical features and data from bacteriological, serological and virological studies, clarifying the etiology of the disease.