This document compares tonsillitis to other infections or illnesses that can present similarly. Tonsillitis is inflammation of the palatine tonsils caused mainly by Streptococcus bacteria. It is characterized by fever, sore throat, and painful swallowing. Epstein-Barr virus causes infectious mononucleosis with tonsillar swelling and additional symptoms like lymph node tenderness. Scarlet fever presents with abrupt fever and sore throat followed by a rash. Diphtheria can form a pseudomembrane in the throat. Vincent's infection shows grey membranous spots on the tonsils. Tonsil cancer typically presents as a neck mass but can also cause sore throat and ear pain. Differential diagnosis requires diagnostic tests

1. Differential diagnosis of
Tonsillitis
This is a comparison of Tonsillitis and infections or clinical illnesses that may
present in the same manner
By Fareedah Muheeb, LNMU group 2, 5th year

2. Tonsillitis
 Tonsillitis is inflammation of the palatine tonsils. The
inflammation usually extends to the adenoid and the
lingual tonsils
 Most cases of bacterial tonsillitis are caused by group A
beta-hemolytic Streptococcus pyogenes (GABHS).
 Characterised by Fever, Sore throat, Foul breath,
Dysphagia (difficulty swallowing), Odynophagia
(painful swallowing), Tender cervical lymph nodes

3. Tonsillitis and
epstein Barr virus
(infectious
mononucleosis)
Fig 1:
tonsillitis
Fig2: epstein
Barr(mono)

4.  Consideration should be given to Epstein Barr
infectious mononucleosis if symptoms of Tonsillitis is
accompanied by tender cervical, axillary, and/or
inguinal nodes; splenomegaly; severe lethargy and
malaise; and low-grade fever..
 Differential diagnostic test is done to confirm the
microorganism responsible for the symptoms. Swabs
are taken from the surface of the tonsils, or sputum for
culture isolation and identification

5. Tonsillitisand
Scarletfever
Fig 1:
strawberry
coated tongue
in scarlet fever
Tonsil
appearance+
blanching red
spots in scarlet
fever

6.  The emergence of scarlet fever tends to be abrupt,
usually heralded by sudden onset of fever associated
with sore throat,[16]headache, chills, nausea,
myalgias, and malaise.
 Young children may also present with vomiting,
abdominal pain, and seizure.
 There is the characteristic rash that appears 12-48
hours after the onset of fever, first on the neck and
then extending to the trunk and extremities.
 Also initial a white coated tongue, but progresses into a
strawberry red colored tongue.
 The mucous membranes usually are bright red, and
scattered petechiae and small red papular lesions on
the soft palate are often present.
 Final differentiation should be made by culture
isolation

7. Tonsillitisand
diphtheria
Fig 1: visuals of a diphtheritic throat. Notice
the diphtheric pathes

8.  Symptoms initially are general and nonspecific, often resembling a typical
viral upper respiratory infection (URI).
 Respiratory involvement usually begins with sore throat and mild
pharyngeal inflammation. Development of a localized or coalescing
pseudomembrane can occur in any portion of the respiratory tract.
 The pseudomembrane is characterized by the formation of a dense, gray
debris layer composed of a mixture of dead cells, fibrin, RBCs, WBCs, and
organisms. When scraped reveals bleeding
 The distribution of the membrane varies from local (eg, tonsillar,
pharyngeal) to widely covering the entire tracheobronchial tree.
 The membrane is intensely infectious, and droplet and contact precautions
must be followed when examining or caring for infected patients.
 A combination of cervical adenopathy and swollen mucosa imparts a “bull’s
neck” appearance to many of the infected patients
 PT’s present with Cervical lymphadenopathy and respiratory tract
pseudomembrane formation (about 50%), Serosanguineous or seropurulent
nasal discharge, white nasal membrane, Hoarseness, dysphagia (26-40%),
Dyspnea, respiratory stridor, wheezing, cough

9. Tonsillitisand
Vincent’s
infection
Note multiple
greyish
membranous
spots over tonsil.
Progressed
spots on tonsils
bilaterally

10.  The tooth is grossly decayed, although it may be normal
with cavitated lesions that may have a surrounding
chalky demineralized area and swollen erythematous
gingiva. Affected teeth generally are tender to percussion
and temperature.
 Dentoalveolar ridge edema is evidenced by a periodontal,
periapical, and subperiosteal abscess
 Retropharyngeal space infection is identified by stiff neck,
sore throat, dysphagia, hot potato voice, and stridor with
possible spread to the mediastinum. These infections are
due to infections of the molars.
 With spread to the deeper areas of the neck, signs and
symptoms of vagal injury, Horner syndrome, and lower
cranial nerve injury may be seen.
 There is teeth, gingiva and pharyngeal involvement in
this disease

11. Tonsillitisand
tonsillarcancer/
tumor
Fig 1: Squamous
cell carcinoma of
the tonsils
Fig 2:
Tonsillar
cancer

12.  Patients with tonsillar carcinomas may present with a
neck mass. This is because carcinomas arise deep within
the aforementioned crypts. These are deep epithelial
invaginations of the surface epithelium.
 A squamous carcinoma may originate at 1 or more sites
within the deep nests or branches within the tonsil.
 Sore throat, ear pain, foreign body or mass sensation, and
bleeding are all possible. Trismus is an ominous sign
because it probably indicates involvement of the
parapharyngeal space. Such tumors may be large enough
to involve or encase the carotid sheath. In addition, the
tumor may extend to the skull or mediastinum.
 Exophytic fungating mass with central ulceration and
heaped-up edges may be present. It may be deep red to
white