Sandbox:Differentiating tonsillits from other diseases
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
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.
Differentiating Tonsillitis from other Diseases
- There are two diseases that are distinguished to present similarly to tonsillitis; they are Scarlet fever and Epstein Barr Virus.
| Disease | Findings |
|---|---|
| Psoriasis | Presents with erythema and formation of silvery scales on the epidermis, resulting in itching and pain.[1] Differentiates from Erythrasma in that it is usually located throughout the entire body; Erythrasma usually manifests in skin folds of the armpit, groin, and perianal regions.[2]Psoriasis is an autoimmune disorder and is not caused by Corynebacteria; therapeutic options include topical corticosteroids, systemic anti-inflammatory therapies (such as methotrexate and cyclosporine), and UVA/UVB phototherapy.[2] Psoriasis is a chronic, recurrent condition; Erythrasma will usually resolve with sufficient treatment. |
| Dermatophytosis | Presents with lesions that vary based on the location of the mycosis, but usually displays in a circular shape with erythema, scaling, and itching at the point of infiltration .[3] Differentiated by its mycotic cause. Visually distinct from Erythrasma by consistently forming circular-shaped "ring" lesions. Treatment involves topical antifungal medication, including miconazole, clotrimazole, ketoconazole, terbinafine, naftifine, and butenafine.[4] |
| Skin Candidiasis | Presents with rash that displays erythema and itching, as well as folliculitis.[5] Differentiated from Erythrasma in that it is caused by Candida fungal infection. While Erythrasma usually manifests in moist locations, such as skin folds, skin candidiasis is usually found in wet or dry regions of the body. Treatment includes antifungal therapy, including fluconazole, caspofungin, micafungin, anidulafungin, and additional topical and systemic options.[6] |
| Intertrigo | An inflammatory condition of the epidermis caused by repeated friction between adjacent skin folds.[7]. Presents with erythema, itching, and scaling in primarily moist regions of the body. Differentiates from Erythrasma in that it can progress to discharge and pain if untreated.[8] Can be caused by bacterial or mycotic infection, as well as a non-infectious inflammatory response to moisture and friction. Treatment varies based on the cause; it is important to differentiate Erythrasma from Intertrigo due to the former's singular cause as Corynebacterium minitissium to determine appropriate therapy. |
| Contact dermatitis | An inflammatory condition of the epidermis resulting from direct contact with an allergen or irritant. Contact dermatitis is similar to Erythrasma due to the usual presentation of erythema and itching. It differentiates from Erythrasma by manifesting with blisters, pain, and discharge. Differentiated from Erythrasma by its cause: an allergic response by contact to a specific surface or entity. There is no indication of bacterial infection. Common causes include chemicals from cosmetic and hygienic products, fabrics, metals, and animal hair or skin. Therapy involves avoiding the original cause and application of topical or oral corticosteroids and analgesics.[9] |
| Seborrheic dermatitis | Presents with erythema and white-yellow scaling skin that sheds, accompanied by pruritus and flaking. Is primarily found in the face, upper chest, and retro-auricular area. Similarly to erythrasma, it can affect skin folds, including the axillae and the genitals.[10] It is differentiated from erythrasma by its varied causes; seborrheic dermatitis causes are not fully known and are speculated to be autoimmunal, neurological, or from nutrition deficiency.[11] Therapy focuses on treating the inflammation, including corticosteroids, or topical antifungal medication if a mycotic causes is determined.[12] |
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
- ↑ "Psoriasis: MedlinePlus".
- ↑ 2.0 2.1 Di Meglio P, Villanova F, Nestle FO (2014). "Psoriasis". Cold Spring Harb Perspect Med. 4 (8). doi:10.1101/cshperspect.a015354. PMC 4109580. PMID 25085957.
- ↑ Ely JW, Rosenfeld S, Seabury Stone M (2014). "Diagnosis and management of tinea infections". Am Fam Physician. 90 (10): 702–10. PMID 25403034.
- ↑ Kyle AA, Dahl MV (2004). "Topical therapy for fungal infections". Am J Clin Dermatol. 5 (6): 443–51. PMID 15663341.
- ↑ "Genital / vulvovaginal candidiasis (VVC) | Fungal Diseases | CDC".
- ↑ Pappas, Peter G.; Kauffman, Carol A.; Andes, David; Benjamin, Jr., Daniel K.; Calandra, Thierry F.; Edwards, Jr., John E.; Filler, Scott G.; Fisher, John F.; Kullberg, Bart‐Jan; Ostrosky‐Zeichner, Luis; Reboli, Annette C.; Rex, John H.; Walsh, Thomas J.; Sobel, Jack D. (2009). "Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 48 (5): 503–535. doi:10.1086/596757. ISSN 1058-4838.
- ↑ Janniger CK, Schwartz RA, Szepietowski JC, Reich A (2005). "Intertrigo and common secondary skin infections". Am Fam Physician. 72 (5): 833–8. PMID 16156342.
- ↑ Mistiaen P, van Halm-Walters M (2010). "Prevention and treatment of intertrigo in large skin folds of adults: a systematic review". BMC Nurs. 9: 12. doi:10.1186/1472-6955-9-12. PMC 2918610. PMID 20626853.
- ↑ "Contact dermatitis: MedlinePlus Medical Encyclopedia".
- ↑ Borda LJ, Wikramanayake TC (2015). "Seborrheic Dermatitis and Dandruff: A Comprehensive Review". J Clin Investig Dermatol. 3 (2). doi:10.13188/2373-1044.1000019. PMC 4852869. PMID 27148560.
- ↑ "Seborrheic dermatitis: MedlinePlus Medical Encyclopedia".
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin. Infect. Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.