Tonsillitis differential diagnosis: Difference between revisions
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==Overview== | ==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. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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:*is fine, red, and rough-textured; it [[wikt:blanch|blanches]] upon pressure | :*is fine, red, and rough-textured; it [[wikt:blanch|blanches]] upon pressure | ||
:*Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone | :*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."<ref name="Dyne"/> Peeling also occurs in axilla, groin, and tips of the fingers and toes.<ref name="Balentine"/> | *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."<ref name="Dyne" /> Peeling also occurs in axilla, groin, and tips of the fingers and toes.<ref name="Balentine" /> | ||
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*The '''Epstein-Barr Virus''' ('''EBV'''), also called ''Human herpesvirus 4'' (HHV-4), is a [[virus]] of the [[herpesviridae|herpes family]] (which includes ''[[Herpes simplex virus]]'' and ''[[Cytomegalovirus]]''), and is one of the most common viruses in [[human]]s. Most people become infected with EBV, which is often [[asymptomatic]] but commonly causes [[infectious mononucleosis]]. | *The '''Epstein-Barr Virus''' ('''EBV'''), also called ''Human herpesvirus 4'' (HHV-4), is a [[virus]] of the [[herpesviridae|herpes family]] (which includes ''[[Herpes simplex virus]]'' and ''[[Cytomegalovirus]]''), and is one of the most common viruses in [[human]]s. Most people become infected with EBV, which is often [[asymptomatic]] but commonly causes [[infectious mononucleosis]]. | ||
EBV is named after Michael Epstein and [[Yvonne Barr]], who together with Bert Achong, discovered the virus in 1964.<ref name=Epstein1964>{{cite journal |author=Epstein MA, Achong BG, Barr YM |title=Virus particles in cultured lymphblasts from Burkitt's Lymphoma |journal=Lancet |volume=1 |issue= |pages=702-3 |year=1964 |pmid=14107961 |doi=}}</ref> | EBV is named after Michael Epstein and [[Yvonne Barr]], who together with Bert Achong, discovered the virus in 1964.<ref name="Epstein1964">{{cite journal |author=Epstein MA, Achong BG, Barr YM |title=Virus particles in cultured lymphblasts from Burkitt's Lymphoma |journal=Lancet |volume=1 |issue= |pages=702-3 |year=1964 |pmid=14107961 |doi=}}</ref> | ||
*[[EBV|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. | *[[EBV|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. | ||
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*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. | *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. | ||
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Revision as of 13:02, 5 May 2016
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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.
Differential Diagnosis
- There are two diseases that are distinguished to present similarly to Tonsillitis; they are Scarlet fever and Epstein Barr Virus.
| Disease | Definition |
|---|---|
| Scarlet Fever |
Rash
|
| Epstein-Barr Virus |
EBV is named after Michael Epstein and Yvonne Barr, who together with Bert Achong, discovered the virus in 1964.[3]
|
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
- ↑ 1.0 1.1 Balentine J and Kessler D (March 7, 2006). "Scarlet Fever". eMedicine. emerg/518.
- ↑ 2.0 2.1 Dyne P and McCartan K (October 19, 2005). "Pediatrics, Scarlet Fever". eMedicine. emerg/402.
- ↑ Epstein MA, Achong BG, Barr YM (1964). "Virus particles in cultured lymphblasts from Burkitt's Lymphoma". Lancet. 1: 702–3. PMID 14107961.