The diagnosis is made on the basis of the clinical appearance. Typical symptoms such as redness and swelling of the tonsils, enlargement of the lymph nodes, and difficulty swallowing usually allow an easy diagnosis.
Necessary examinations are
- ENT status – inspection of tonsils, assessment of location, appearance, swelling, discharge, etc.
- Palpation (palpation) of cervical and nuchal (“belonging to the neck and throat”) lymph nodes.
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- Small blood count
- Differential blood count
- Inflammatory parameter – CRP (C-reactive protein) [> 35 mg/l: GABHS detection (= group A beta-hemolytic streptococci) likely (2)]
- Urine status (rapid test for: pH, leukocytes, nitrite, protein, blood), sediment if necessary.
- Bacteriology (cultural): tonsil smear for pathogen and resistance or rapid test for Group A beta-hemolytic streptococci (GABHS) and resistogram (determination of which antibiotics are suitable for therapy), if positive score ≥ 3 (diagnostic scoring system, usually modified Centor Score/McIsaac Score; see below “Physical examination“)Rapid test: The sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e., a positive test result occurs) and specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy in the test) of rapid test methods for GABHS detection vary between 65.6% and 96.4% and 68.7% and 99.3%, respectively. Specimen collection: press down on the tongue with a spatula and pass the swab “rubbing-turning” over both tonsils or the lymphatic side strands and the posterior pharyngeal wall under visual control. Note: After acute streptococcal tonsillitis, routine progress controls of the throat swab should not be done.After acute streptococcal tonsillitis, routine blood and urine tests or cardiological diagnostics (ECG) is not required.
- Note: Blood tests are of much lower sensitivity and specificity than clinical scoring systems and pathogen detection in the diagnosis of β-hemolytic streptococcal tonsillopharyngitis.
- Antibodies to coxsackie viruses (group: A2, A4, A5, A6, A8, A10, B4) – due toVD on angina herpetica (infectious inflammation of pharyngeal lymphatic ring), DD: stomatitis aphthosa of child (herpes simplex virus).
- Pathogen detection or pathogen-specific serology – in suspected Epstein-Barr virus (EBV) infection ( infectious mononucleosis) in high-risk patients (eg, children with immunodeficiency).
- Multiplex polymerase chain reaction (multiplex PCR) – molecular genetic detection of viral (tonsillitis) pathogens.
