Angina, or acute tonsillitis, is an infectious disease that affects the tissue of the lymphadenoid pharyngeal ring. Most often, with angina, the palatine tonsils become inflamed. The causative agents of this disease can be bacteria - staphylococci, streptococci, etc., as well as viruses and fungi. Recently, more and more researchers are inclined to believe that acute tonsillitis in children in most cases is caused by a viral infection. Bacterial infection is often a complication, but not the root cause of sore throat.
How do you know if you or your child has a sore throat? First of all, attention should be paid to the external symptoms of this disease. If they confirm your concerns, you need to contact an otolaryngologist. To make a diagnosis, a pharyngoscopic examination of the throat is necessary. Often, the diagnosis is limited to pharyngoscopy, and the doctor prescribes treatment based on the clinical picture.
Ideally, each case of tonsillitis requires more in-depth diagnosis. This approach prevents the unjustified use of antibiotics for viral angina, shortens the course of treatment, and reduces the risk of developing antibiotic resistance in microflora. Tests for angina can accurately determine the causative agent of the disease, as well as its sensitivity to certain drugs.
What tests are taken for angina? First of all, this is a clinical blood test and bacteriological culture of a throat swab. To clarify the diagnosis, biochemical blood tests and serologic tests may be required.
Sore throat symptoms
Many people prefer not to be tested for angina (especially with an illness in adults), but begin treatment immediately, focusing on the external symptoms of this disease. Indeed, angina is characterized by a typical clinical picture:
- acute onset of the disease - high body temperature, headache and other symptoms appear simultaneously and unexpectedly;
- sore throat, usually severe but may be mild
- when swallowing, the pain increases;
- the voice is usually not hoarse (hoarseness is a sign of laryngitis);
- enlargement and redness of the tonsils, the appearance of plaque on their surface - mucous, loose or purulent;
- general intoxication - headache, fatigue, sweating, etc.;
- heart palpitations, aching joints - characteristic signs of streptococcal sore throat;
- enlargement and soreness of the lymph nodes (they can be felt under the lower jaw).
Despite the presence of characteristic symptoms, clinical data alone are not enough to make a diagnosis. Similar manifestations can be observed with diphtheria of the oropharynx, infectious mononucleosis, the initial stages of scarlet fever.
Pharyngoscopy
Pharyngoscopy is an examination of the pharynx, one of the main methods for diagnosing tonsillitis, as well as pharyngitis and other acute respiratory infections. Analyzes for angina in children and adults are prescribed only after a pharyngoscopic examination by an otolaryngologist.
With inflammation of the tonsils in the pharynx, the following changes are observed:
- swelling of the tonsils and the visible part of the pharynx;
- vasodilation, redness, sometimes - punctate hemorrhages;
- the presence of a loose yellow or white plaque on the tonsils, which is easily and painlessly removed with a spatula (with a lacunar form of the disease);
- the absence of plaque on the edematous reddened tonsils (indicates a catarrhal form of sore throat);
- the presence of plaque on the surface of the tonsils in the form of raised points (a symptom of the follicular form of tonsillitis).
Examination of the pharynx gives an idea of the severity of the disease and, to some extent, about the causative agents of tonsillitis. To clarify the diagnosis, blood and pharyngeal microflora tests may be required.
Clinical blood test
A general clinical blood test for angina is a study that allows one to judge the causative agents of the disease, the degree of development of inflammation, and the activity of the immune response. It is not for nothing that this analysis is one of the most universal, and it is prescribed for a variety of pathological processes.
When giving a blood test for angina in a child, it should be borne in mind that the forms indicate the norms for adults, and some indicators in childhood may differ from them.
This is especially true for infants - for them, the norms of blood counts shift almost every month. The pediatrician will help you to correctly evaluate the results of the child's blood test.
Table 1 shows the comparative characteristics of the indicators of the clinical blood test in normal conditions, with viral and bacterial tonsillitis.
| Index | Viral tonsillitis | Bacterial tonsillitis | Norm |
| Leukocytes, g / l | 4,0-9,0 | 25-30 and more | 4.0-9.0 (for children, a slightly higher level is allowed) |
| Erythrocyte sedimentation rate (ESR) in mm / hour | Increased, up to 15-30 mm / hour | Increased, 18-30 mm / hour | F-2-15 M- 1-10 Children - 2-10 |
| Stab neutrophils,% | Up to 5% | Increases significantly, 7-15% | 1-6% |
| Segmented neutrophils,% | Below 47% | Above 50% | 47-72% |
| Lymphocytes,% | From 40% and above | Less than 19% | 19-37% |
| Monocytes,% | The level is elevated or normal; with a significant increase, you should be tested for mononucleosis. | The level is elevated or normal. A reduced level (less than 1%) indicates an extremely severe course of infection, sepsis. | 3-11% |
Table 1 Changes in indicators of general clinical analysis in viral and bacterial infections (for example, tonsillitis).
When considering the results of a blood test, special attention is paid to indicators such as ESR, leukocyte count and percentage of lymphocytes.
The erythrocyte sedimentation rate is a non-specific indicator that allows one to judge the presence of an inflammatory process in the body. As can be seen from the table, in both viral and bacterial infections, the ESR rate increases. This indicator is always considered in conjunction with the level of leukocytes and the percentage of lymphocytes.
The number of leukocytes increases significantly with a bacterial infection. This is primarily due to an increase in the number of neutrophils, in particular, immature (stab). White blood cells are immune cells that absorb and digest bacteria.
With a viral infection, the number of leukocytes usually does not change. There may be a slight shift in their number to the left or right. A characteristic sign of a viral infection is an increase in the number of lymphocytes. So, with ARVI, the level of lymphocytes usually exceeds 40%.
When diagnosing angina, special attention should be paid to the level of monocytes. This indicator changes relatively rarely.
If the percentage of monocytes is significantly higher than normal and there are symptoms of acute tonsillitis, the possibility of developing infectious mononucleosis in the patient should be considered.
Infectious mononucleosis is caused by the Epstein-Barr virus. For its diagnosis, PCR analysis of a throat smear and the determination of antibodies to this virus in blood serum are widely used.
What other blood tests may I need?
In most cases, a complete blood count is sufficient for the correct prescription of treatment. However, you may be assigned follow-up tests:
- ASLO - the titer of antibodies to antistreptolysin-O in the blood serum is used to determine streptococcal infection;
- streptokinase also detects antibodies to streptococcus;
- C-reactive protein is a non-specific indicator of an infectious process in the body;
- a biochemical analysis of the level of urea, as well as the determination of creatinine, is prescribed to diagnose complications of angina on the kidneys;
- an immunogram is prescribed for frequent tonsillitis, as well as for the chronic form of this disease in order to assess the functional state of the immune system.
How to prepare and donate blood correctly for tests with angina:
- blood is always given on an empty stomach (at least 6 hours after eating), in the first half of the day;
- exclude alcohol consumption 2 days before donating blood;
- it is not recommended to smoke for at least an hour before taking blood;
- keep in mind that some tests require venous blood, others use capillary (finger) blood.
Bacteriological diagnostics
Bacteriological diagnostics is one of the most informative tests for acute respiratory infections, including angina. The sensitivity of this method is quite high (about 90%). Bacteriological analysis for sore throat involves sowing a throat swab on a special nutrient medium. At the same time, cultures of microorganisms that inhabit the patient's throat grow in the Petri dish. By sowing these cultures into media with various antibiotics, the microbiologist determines to which antibacterial drug the strain of microorganisms found in the patient is most sensitive. This allows you to prescribe the most effective antibiotic in this case.
If pathogenic microorganisms are not found in the cell culture, they refuse to prescribe an antibiotic. Treatment is carried out with antiviral drugs, throat antiseptics, etc.
If a chronic form of angina is suspected, bacteriological analysis should be repeated after the end of the acute period of the disease. The absence of a pathogenic strain in the crop indicates a complete recovery.
