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differential diagnosis of angina

Differential diagnosis of angina should be carried out with diseases that occur with tonsillitis syndrome:

a) localized forms of diphtheria (insular and membranous) - differ from angina by the gradual onset of the disease, specific manifestations of general intoxication in the form of pallor of the face, moderate adynamia and lethargy (chills, body aches, muscle and joint pains, characteristic only for tonsillitis), a mismatch between the objective and subjective manifestations of the disease (slight sore throat when swallowing in the presence of pronounced inflammatory changes in the tonsils), the characteristics of the inflammatory process in the oropharynx, characterize egosya stagnant-bluish color pronounced hyperemia and edema of tonsils with the presence on their surfaces hard membranous removes plaque, leaving behind a tissue defect. With an atypical course of diphtheria, which is observed in half of adult patients, plaque is removed easily, without leaving a tissue defect. However, in these cases, the remaining signs characteristic of diphtheria of the pharynx are preserved.

b) angina of Simanovsky-Vincent (fusospirochetosis) - characterized by slightly pronounced general manifestations (short-term subfebrile body temperature, lack of general weakness, headache, etc.), damage to only one tonsil in the form of an ulcer 5-10 mm in size, covered with easily removable yellowish white or whitish-gray plaque, the presence in the preparations from the separated ulcer, stained according to Romanovsky-Giemsa, spindle-shaped sticks and spirochetes. Regional lymphadenitis is not expressed.

c) scarlet fever - it differs from a sore throat by the appearance on the first day of the disease throughout the body, except for the nasolabial triangle, an abundant point rash, located on a hyperemic background, thickening on the neck, side surfaces of the chest and in the Simon triangle and especially pronounced in the natural folds of the skin (symptom Pastia), as well as the characteristic manifestations of tonsillitis in the form of a bright red color of hyperemia of the tonsils, palatine arches, tongue and soft palate ("flaming pharynx").

d) infectious mononucleosis - characteristic, in addition to tonsillitis (purulent-necrotic or fibrinous), polyadenitis, enlargement of the liver and spleen, lymphomonocytosis with the simultaneous appearance of atypical mononuclear cells and plasma cells, as well as a positive CD / PBB reaction.

e) anginal form of tularemia - differs from angina in the relatively late appearance (on day 3-5) of one-sided catarrhal or necrotic tonsillitis, a marked increase in the regional lymph nodes to the affected tonsil, which continue to increase even after the disappearance of tonsillitis (tularemia bubo )

e) for leukemia and agranulocytosis, typically relatively late (on the 3-6th day of the disease) the appearance of necrotic tonsillitis with the spread of necrotic changes in the mucous membrane of the palatine arches, tongue, cheeks; the presence of septic fever, hepatolienal syndrome and characteristic changes in the hemogram (hiatus leucemicus with leukemia and a sharp decrease in the number of neutrophils with agranulocytosis).

g) herpangin - along with fever and intoxication, local changes are observed in the form of hyperemia of the mucous membrane of the oropharynx and the presence on the palatine arches, tongue, soft palate, and sometimes on the tonsils and tongue of individual papules 2-4 mm in diameter, quickly turning into white-gray bubbles and then erosion.

h) oropharyngeal candidiasis - occurs with normal or subfebrile body temperature, well-being of patients, the presence on the surface of the tonsils, tongue, palatine arches, and sometimes on the back wall of the pharynx of a crumbly white plaque in the form of easily removable islands 2-3 mm in diameter .
There is a history of more or less prolonged use of broad-spectrum antibiotics, or combinations thereof.

i) exacerbation of chronic tonsillitis - differs from repeated sore throat with a gradual onset, sluggish and relatively prolonged course of the disease with unstable subfebrile body temperature, lack of severe intoxication, moderate pain and unpleasant sensations in the throat when swallowing, the stagnant nature of hyperemia of scarring and welded with palatine by the arches of the tonsils, the presence of caseous contents in the gaps, an increase in the carbon-maxillary lymph nodes, characterized by a dense texture and moderate pain eznennostyu, normal values ​​in the number of blood neutrophils or slightly pronounced neutrophilic leukocytosis.
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differential diagnosis of angina

  1. Differential diagnosis of angina Comparative signs of various forms of angina

  2. differential diagnosis of pharyngeal diphtheria (infectious mononucleosis, tonsillitis)
    For angina, the following differences are characteristic: acute onset (with chills, aches in the body and joints) of the disease, intoxication (severe general weakness, headache, agitation), as well as the purulent nature of tonsillitis. 2. For infectious mononucleosis, the following differences are characteristic: polyadenitis, hepatolienal syndrome, membranous with crumbling, and not a dense coating on tonsils tonsils,
  3. Klyucharyov A.A. et al. Diagnosis and differential diagnosis of liver diseases in children (Manual for Practitioners), 2001

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