Pathogenesis and clinical presentation
Transmission occurs predominantly via airborne droplets, less commonly via the enteral route. Decreased body reactivity (hypothermia, overfatigue) provokes inflammation accompanied by edema, hyperemia, and lymphostasis in the tonsils. With prolonged carriage of pathogens, the process can become chronic with the development of adhesions in the lacunae and immune suppression.
Symptoms of the acute form:
- Fever (37.5–39 °C).
- Sore throat, worsening upon swallowing (young children may refuse to eat).
- During pharyngoscopy: edema and hyperemia of the palatine tonsils, posterior pharyngeal wall; plaque and enanthema may be present.
- Regional lymphadenopathy (enlarged, firm, and tender cervical lymph nodes).
Compensated form (local changes only) and decompensated form, occurring with chronic tonsillogenic intoxication, are distinguished.
Differential diagnosis and Centor-McIsaac score
The physician's primary task is to determine the nature of the inflammation. Viral infections are more often accompanied by catarrhal syndrome and milder intoxication, whereas GAS is characterized by prominent local symptoms.
To assess the risk of streptococcal infection, the Centor-McIsaac score is used:
- Fever > 38.0 °C (+1 point).
- Absence of cough (+1 point).
- Tenderness and enlargement of cervical lymph nodes (+1 point).
- Tonsillar edema and exudate (+1 point).
- Age: 3–14 years (+1 point), 15–44 years (0 points), $\ge$ 45 years (–1 point).
With a score of 2 points or higher, performing a microbiological test (throat swab or rapid antigen test) is advisable.
Principles of treatment
Management tactics depend on the etiology:
- Viral tonsillopharyngitis: Symptomatic treatment similar to ARVI therapy (ample hydration, gentle diet, local antiseptics, antipyretics).
- GAS infection: Absolute indication for antibacterial therapy. The goal is eradication of the pathogen and prevention of purulent (abscesses) and non-purulent (acute rheumatic fever, glomerulonephritis) complications.
The drugs of choice are $\beta$-lactam antibiotics. In case of intolerance, macrolides are used. Evaluation of the effectiveness of antibiotic therapy is carried out after 48 hours.
Class and exam questions
When are antibiotics prescribed for a sore throat?
Antibacterial therapy is indicated only for confirmed (or highly probable according to the McIsaac score ≥ 4 points) streptococcal etiology (group A Streptococcus).
What is a strep test used for?
This is a point-of-care rapid diagnostic method that allows verification of GAS infection within minutes and justifies the prescription of antibiotics.
What else to study on this topic
- Clinical picture of infectious mononucleosis
- Differential diagnosis with diphtheria
- Features of herpetic and fungal tonsillitis
- Criteria for chronic tonsillitis
- Dispanserization (follow-up) after streptococcal infection
Master the entire topic in the Pediatrics course
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