What are the differential diagnoses for suppurative tonsillitis?

Acute suppurative tonsillitis is an acute nonspecific inflammation of the palatine tonsils, characterized by a sudden onset and often presenting with severe sore throat and high fever. The differential diagnosis of suppurative tonsillitis typically includes acute pharyngitis, peritonsillar abscess, infectious mononucleosis, pharyngeal diphtheria, and herpangina.

1. Acute pharyngitis: Acute pharyngitis can also cause throat pain and fever, but it usually does not present with tonsillar enlargement or purulent discharge. Examination of the tonsils for swelling or presence of purulent exudate can help differentiate between acute pharyngitis and suppurative tonsillitis.

2. Peritonsillar abscess: A peritonsillar abscess presents with severe throat pain and difficulty swallowing, but typically without systemic fever. Suppurative tonsillitis is often accompanied by systemic fever, tonsillar enlargement, and purulent discharge, whereas peritonsillar abscess is mainly localized around the tonsils and does not present with systemic fever.

3. Infectious mononucleosis: This condition may present with sore throat and fever, but often accompanied by lymphadenopathy and splenomegaly. Complete blood count analysis shows that infectious mononucleosis typically presents with lymphocytosis, while C-reactive protein (CRP) levels are normal or only mildly elevated. In contrast, suppurative tonsillitis typically presents with significantly elevated white blood cell count and neutrophil levels.

4. Pharyngeal diphtheria: Sore throat in pharyngeal diphtheria is mild. Physical examination reveals a grayish-white pseudomembrane that often extends beyond the tonsils and is firm and adherent. In suppurative tonsillitis, the pseudomembrane is usually confined to the tonsils and can be easily wiped away, whereas in pharyngeal diphtheria, the pseudomembrane extends beyond the tonsils and is difficult to remove.

5. Herpangina: When herpes lesions appear on the tonsils, misdiagnosis may occur. However, in addition to the tonsils, herpangina typically presents with small white vesicles resembling grains of rice in the posterior pharyngeal wall, soft palate, and other areas, surrounded by a red halo. A thorough examination of the posterior pharyngeal wall, soft palate, and other areas for vesicles can help differentiate herpangina from suppurative tonsillitis.

If symptoms of suppurative tonsillitis occur, prompt medical attention should be sought, and diagnosis should be confirmed through appropriate diagnostic tests. During treatment, a bland diet is recommended to facilitate recovery.