Abstract
Sixty-two children with febrile exudative tonsillitis were studied to explore whether quantitative measurements of serum C-reactive protein (CRP) are useful in differentiating viral from streptococcal tonsillitis. There were 23 cases of adenoviral tonsillitis, 21 of EB viral tonsillitis and 18 of streptococcal tonsillitis. Measurements of CRP, WBC counts and erythrocyte sedimentation rates (ESR) were not useful in distinguishing viral from streptococcal tonsillitis. Seventy-four percent of patients with adenoviral tonsillitis were under the age of 3 years and 71% of the patients with Epstein-Barr (EB) viral tonsillitis were under the age of 6 years whereas 72% of the patients with streptococcal tonsillitis were over the age of 6 years. Age was clearly the most important factor in distinguishing between viral and bacterial tonsillitis in children.
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Abbreviations
- CRP:
-
C-reactive protein
- ESR:
-
erythrocyte sedimentation rates
- EB:
-
Epstein-Barr
References
Alpert JJ, Pickering MR, Warren RJ (1966) Failure to isolate streptococci from children under the age of 3 years with exudative tonsillitis. Pediatrics 38:663–666
Dawson SF (1957) The significance of the C-reactive protein estimation in streptococcal and allied disease. Arch Dis Child 32:454–460
Edwards EA, Phillips IA, Suiter WC (1982) Diagnosis of group A streptococcal infections directly from throat secretions. J Clin Microbiol 15:481–483
Glezen WP, Clyde WA, Senior RJ, Sheaffev CI, Denny FW (1967) Group A streptococci, mycoplasmas, and viruses associated with acute pharyngitis. JAMA 202:119–124
Henle G, Henle W (1970) Observations on childhood infections with the Epstein-Barr virus. J Infect Dis 121:303–310
Kaplan EL, Top FH Jr, Dudding BA, Wannamaker LW (1971) Diagnosis of streptococcal pharyngitis: Differentiation of active infection from the carrier state in the symptomatic child. J Infect Dis 123:490–501
Kaplan EL, Wannamaker LW (1977) C-reactive protein in streptococcal pharyngitis. Pediatrics 60:28–32
Krober MS, Bass JW, Michels GN (1985) Streptococcal pharyngitis. Placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA 253:1271–1274
Kushner I, Broder ML, Karp D (1978) Serum C-reactive protein kinetics after acute myocardial infarction. J Clin Invest 61:235–242
Meurman O, Ruuskanen O, Sarkkinen H (1983) Immunoassay diagnosis of adenovirus infections in children. J Clin Microbiol 18:1190–1195
Moffet HL, Siegel AC, Doyle HK (1968) Nonstreptococcal pharyngitis. J Pediatr 73:51–60
Nelson JD (1984) The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis. Pediatr Infect Dis 3:10–13
Nikoskelainen J, Leikola J, Klemola E (1974) IgM antibodies specific for Epstein-Barr virus infectious mononucleosis without heterophil antibodies. Br Med J 4:72–75
Peltola H, Laipio M-L, Siimes MA (1984) Quantitative C-reactive protein (CRP) determined by an immunoturbidometric method in rapid differential diagnosis of acute bacterial and viral diseases of children. Acta Pediatr Scand 73:273–274
Quinn RW (1965) Carrier rates for hemolytic streptococci in school children. A six-year study. Am J Epidemiol 82:1–13
Ruuskanen O, Putto A, Sarkkinen H, Meurman O, Irjala K (1985) C-reactive protein in respiratory virus infections. J Pediatr 107:97–100
Ruuskanen O, Sarkkinen H, Meurman O, Hurme P, Rossi T, Halonen P, Hänninen P (1984) Rapid diagnosis of adenoviral tonsillitis: A prospective clinical study. J Pediatr 104:725–728
Shapera RM, Matsen JM (1973) Nitroblue tetrazolium dye reduction by neutrophils from patients with streptococcal pharyngitis. Pediatrics 51:284–288
Siegel AC, Johnson EE, Stollerman GH (1961) Controlled studies of streptococcal pharyngitis in a pediatric population. 1. Factors related to the attack rate of rheumatic fever. New Engl J Med 265:559–566
Stillerman M, Bernstein SH (1961) Streptococcal pharyngitis. Evaluation of clinical syndromes in diagnosis. Am J Dis Child 101:476–489
Sumaya CV (1977) Primary Epstein-Barr virus infections in children. Pediatrics 59:16–21
Yocum RS, Doerner AA (1957) A clinical evaluation of the C-reactive protein test. Arch Intern Med 99:74–81
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Putto, A., Meurman, O. & Ruuskanen, O. C-reactive protein in the differentiation of adenoviral, Epstein-Barr viral and streptococcal tonsillitis in children. Eur J Pediatr 145, 204–206 (1986). https://doi.org/10.1007/BF00446066
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DOI: https://doi.org/10.1007/BF00446066