Differential diagnoses Viral infection the symptoms are usually milder and often related to the common cold Coxsackie virus, small blisters develop on the tonsils and the roof of the mouth. The blisters erupt in a few days and are followed by a scab, which may be very painful. Infectious mononucleosis (glandular fever) Patients are quite unwell with very large and purulent tonsils and a long-lasting lethargy over 10/7. An enlarged spleen is – classically described and infrequently found mostly in teenagers. Herpes simplex virus (HSV) infection, especially in adolescents and young adults. Streptococcal infection - sore, swollen throat with coated tonsils, high temperature, and halitosis. The differences are variable and it is impossible to tell on inspection if the infection is viral or bacterial. Check that the patient is not taking a drug that may cause agranulocytosis. Epiglottitis requires immediate admission. Unusual bacteria may be involved including gonococcal infection. Unilateral enlargement of the tonsils, especially in the elderly, may indicate malignancy. It is not uncommon for HIV infection to present with ENT symptoms, especially in children. The most common presentations are cervical lymphadenopathy, candidiasis and otitis media. Diagnostic criteria Culture of Group A beta-haemolytic streptococcus (GABS) is inefficient as a diagnostic criterion, as it is too slow and it fails to differentiate between infection and carriage. There are four Centor Criteria that may be used. of fever •History exudates •Tonsillar •No cough anterior cervical lymphadenopathy •Tender Patients with one or none of these criteria are unlikely to have GABS. Consideration of antibiotic prescription should be limited to patients with three or four criteria. If the patient does not fit the criteria the practitioner will advise on conservative management. Another option if there is a possibility of symptoms increasing the practitioner may decide to give a delayed prescription taking in to account the individuals patients circumstances and including the rationale within their documentation.
Differential diagnoses Viral infection the symptoms are usually milder and often related to the common cold Coxsackie virus, small blisters develop on the tonsils and the roof of the mouth. The blisters erupt in a few days and are followed by a scab, which may be very painful. Infectious mononucleosis (glandular fever) Patients are quite unwell with very large and purulent tonsils and a long-lasting lethargy – over 10/7. An enlarged spleen is classically described and infrequently found mostly in teenagers. Herpes simplex virus (HSV) infection, especially in adolescents and young adults. Streptococcal infection - sore, swollen throat with coated tonsils, high temperature, and halitosis. The differences are variable and it is impossible to tell on inspection if the infection is viral or bacterial. Check that the patient is not taking a drug that may cause agranulocytosis. Epiglottitis requires immediate admission. Unusual bacteria may be involved including gonococcal infection. Unilateral enlargement of the tonsils, especially in the elderly, may indicate malignancy. It is not uncommon for HIV infection to present with ENT symptoms, especially in children. The most common presentations are cervical lymphadenopathy, candidiasis and otitis media. Diagnostic criteria Culture of Group A beta-haemolytic streptococcus (GABS) is inefficient as a diagnostic criterion, as it is too slow and it fails to differentiate between infection and carriage. There are four Centor Criteria that may be used. •History of fever •Tonsillar exudates •No cough •Tender anterior cervical lymphadenopathy Patients with one or none of these criteria are unlikely to have GABS. Consideration of antibiotic prescription should be limited to patients with three or four criteria. If the patient does not fit the criteria the practitioner will advise on conservative management. Another option if there is a possibility of symptoms increasing the practitioner may decide to give a delayed prescription taking in to account the individuals patients circumstances and including the rationale within their documentation.