ear, nose, and throat disorders
Tonsillopharyngitis
Diagnosis of Tonsillopharyngitis
Clinical evaluation Group A beta-hemolytic streptococcus (GABHS) ruled out by rapid antigen test, culture, or both, routinely or selectively Pharyngitis itself is easily recognized clinically. However, its cause is not. Rhinorrhea and cough usually indicate a viral cause. Infectious Mononucleosis is suggested by posterior cervical or generalized adenopathy, hepatosplenomegaly, fatigue, and malaise for Because GABHS requires antibiotics, it must be diagnosed early. Criteria for testing are controversial. Many authorities recommend testing with a rapid antigen test or culture for all children. Rapid antigen tests are specific but not sensitive and may need to be followed by a culture, which is about 90% specific and 90% sensitive. In adults, many authorities recommend using the following 4 criteria of the modified Centor score ( Diagnosis reference ): History of fever Tonsillar exudates Absence of cough Tender anterior cervical lymphadenopathy Patients who meet 1 or no criteria are unlikely to have GABHS and should not be tested. Patients who meet 2 criteria can be tested. Patients who meet 3 or 4 criteria can be tested or treated empirically for GABHS. 1.Fine AM, Nizet V, Mandl KD: Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis.Arch Intern Med172(11):847-852, 2012. doi: 10.1001/archinternmed.2012.950 