Features of the diagnosis of acute tonsillopharyngitis
Acute tonsillopharyngitis is the most common infection and the most common pathology of childhood. As a rule, it has both a viral (in most cases) and a bacterial nature. Viral agents are mainly respiratory viruses, enteroviruses, Epstein-Barr virus. As a microbial agent is mainly called beta-hemolytic streptococcus group A, which is the cause of about 20-30% of all cases of acute inflammation of the pharynx and tonsils in children (5-15% in adults). Other bacterial pathogens are anaerobes, Streptococcus pneumoniae, Mycoplasma pneumoniae and many others.
The principles of treatment of this disease depend on the etiologic factor. In the case of the viral nature of tonsillitis, no specific therapy is required. In the case of bacterial non-streptococcal flora, the need for antibiotic therapy is questioned because of the inability of these microorganisms to participate in the development of complications of acute tonsillopharyngitis, as well as the inability to differentiate the simple carrier of this flora from its clinical manifestation. Therefore, the only indication for the prescription of etiotropic antimicrobial therapy is the streptococcal etiology of this pathology (exceptions are diphtheria and gonococcal tonsillitis).
On the basis of etiologic signs in ICD-10 (International Classification of Diseases of the 10th revision), all tonsillitis is divided into:
In order to avoid the occurrence of complications in the case of hypodiagnosis of streptococcus, the method of its detection should have the highest sensitivity and specificity. Therefore, the only diagnostic criterion (the so-called gold standard for diagnosis) is a smear from the tonsils and its subsequent sowing on growth medium. If all the conditions of technology are observed by this method, streptococcus is diagnosed in 100% of cases. However, in reality, this method is limited for everyday and routine use because of its high cost, the relative complexity of the execution (the necessity of having media for transportation) and the duration of the result (in 1-3 days). Also in practice, the collection of material is usually done late, when the patient has already begun antibiotic therapy. Because of these minuses, the study is performed only in 2% of cases. And as a result of the impossibility of excluding streptococcal etiology of tonsillitis, in order to reduce the risk of complications, antibiotics are prescribed, which is often unnecessary.
All the disadvantages of culture research required the search for new technologies that allow rapid and effective detection of streptococci in the oropharynx. As a result, rapid tests were developed, which make it possible to detect this microbe almost instantaneously. Currently, there are 3 generations of tests, which differ in the methods used for diagnosis and performance. The fastest express test of generation 2, which is based on the definition of antigen in a smear of tonsils, is a highly sensitive and specific method (about 95%).