Differentiating tonsillitis 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 must be differentiated from other diseases that present with edema and erythema of the tonsils and nasopharynx, lymphadenopathy, fever, dysphonia, and dysphagia.
Differentiating Tonsillitis from other Diseases
Tonsillitis must be differentiated from other diseases that present with edema and erythema of the tonsils and nasopharynx, lymphadenopathy, fever, dysphonia, and dysphagia.
- Mononucleosis
- Retropharyngeal abscess
- Epstein Barr virus
- Herpes simplex virus pharyngitis
- Epiglottitis
- Croup
- Peritonsillar abscess
- Diphtheria
- HIV
The table below outlines the differences between tonsillitis and other respiratory tract infections.
| Disease/Variable | Presentation | Causes | Physical exams findings | Age commonly affected | Imaging finding | Treatment |
|---|---|---|---|---|---|---|
| Peritonsillar abscess | Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[1] | Aerobic and anaerobic | Contralateral deflection of the uvula,
the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema. |
The highest occurrence is in adults between 20 to 40 years of age.[1] | On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[6][7][8][9][6][7] | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid |
| Croup | Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Parainfluenza virus | Suprasternal and intercostal indrawing,[10] Inspiratory stridor[11], expiratory wheezing,[11] Sternal wall retractions[12] | Mainly 6 months and 3 years old
rarely, adolescents and adults[13] |
Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine |
| Epiglottitis | Stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | H. influenza type b, | Cyanosis, Cervical lymphadenopathy, Inflamed epiglottis | Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[14] with a mean age of 44.94 years |
Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] |
| Pharyngitis | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Group A beta-hemolytic | Inflamed pharynx with or without exudate | Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years.[17] |
_ | Antimicrobial therapy mainly penicillin-based and analgesics. |
| Tonsilitis | Sore throat, pain on swallowing, fever, headache, and cough | Most common cause is
viral including adenovirus, coronavirus, and Second most common causes are bacterial; |
Fever, especially 100°F or higher.[19][20]Erythema, edema and exudate of the tonsils,[21] cervical lymphadenopathy, and Dysphonia.[22] | Primarily affects children
between 5 and 15 years old.[23] |
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[24][25][26] | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. |
| Retropharyngeal abscess | Neck pain, stiff neck, torticollis, fever, malaise, stridor, and barking cough | Polymicrobial infection.
Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, |
Child may be unable to open the mouth widely. May have enlarged cervical lymph nodes and neck mass. | Mostly between 2-4 years, but can occur in other age groups.[32][33] | On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[34][35] | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. |