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• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - Pathophysiology - General information
    • 2 - Rhinopharyngitis
      • 2.1 - Etiologies
      • 2.2 - Diagnosis
      • 2.3 - Treatment
      • 2.4 - Complications associated with rhinopharyngitis
      • 2.5 - Differential diagnosis
      • 2.6 - Hypertrophy of adenoid vegetations causing recurrent rhinopharyngitis
      • 2.7 - Other factors favoring nasopharyngeal infections
    • 3 - Angina
      • 3.1 - Etiology
      • 3.2 - Clinical diagnosis
      • 3.3 - Bacteriological diagnosis
      • 3.4 - Clinical forms
        • 3 . 4 . 1 - Acute catarrhal angina (or erythematous angina)
        • 3 . 4 . 2 - Angina with purulent exudate (or erythemato-pultaceous angina)
        • 3 . 4 . 3 - Pseudomembranous angina (or false-membrane angina)
        • 3 . 4 . 4 - Ulcerative and necrotic angina
        • 3 . 4 . 5 - Vesicular angina
        • 3 . 4 . 6 - Gangrenous, necrotizing angina
      • 3.5 - Treatment
      • 3.6 - Differential diagnosis of angina
    • 4 - Chronic tonsillitis
      • 4.1 - Chronic tonsillitis in children
      • 4.2 - Chronic tonsillitis in adults
    • 5 - Complications of tonsillar infection
      • 5.1 - Local complications
      • 5.2 - General complications
    • 6 - Tonsillectomy indications
      • 6.1 - Indications
      • 6.2 - Contraindications
  • Key points
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• Appendix
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3 . 3  -  Bacteriological diagnosis

Rapid diagnostic tests (RDTs), which can be carried out by the practitioner, are recommended. In the laboratory, these tests have a similar specificity to those of cultures, and a higher sensitivity at 90%.  Following the collection of an oropharyngeal sample, these tests allow the wall antigens (M protein) of Streptococcus pyogenes to be observed (taxonmic name for GAS) following extraction. The results are available in approximately 5 minutes.

In infants and children under 3 years of age, RDTs are commonly pointless, as the angina seen in this age group are generally viral, and only very occasionally caused by streptococcus.

RDTs are recommended in all patients with erythematous or erythemato-pultaceous angina :

• a positive RDT result confirms the GAS etiology and justifies the prescription of antibiotics;
• a negative RDT in a subject with no acute articular rheumatism (AAR) risk factors does not justify any additional systematic testing by culturing or antibiotic treatment. Hence, only analgesic and antipyretic agents are useful.

Certain rare circumstances (occasional in main land France) evoke a context of AAR risk, these include :

• medical history of AAR;
• age between 5 - 25 years, accompanied by a previous history of multiple GAS angina episodes or visits to regions where AAR is endemic (Africa or French overseas department and region), and possibly certain environmental factors (social conditions, sanitary and economic conditions, promiscuity, and a closed community).

In the context of AAR risk, a negative RDT can be confirmed by culturing. If the culture result is positive, antibiotic treatment is initiated.

3 . 4  -  Clinical forms

Numerous other bacteria can be found in throat samples of patients suffering from angina. Certain species have no pathogenic role and are commensal: Haemophilus influenzae and para-influenzae, Branhamella catarrhalis, pneumococcus, staphylococcus, various anaerobic germs, etc. Others have a minor pathogenic role, such as Groups C, G, E, and F streptococcus, gonococcus (adults, epidemiological context), and Arcanobacterium haemolyticum, whereas Corynebacterium diphtheriae is rarely responsible for angina in France.

These bacterial germs :

• either only rarely give rise to complications: Groups C, G, E, F streptococci and Arcanobacterium haemolyticum;
• or are not sensitive to penicillin and do not grow on the culture medium used for angina, such as: gonococcus, Arcanobacterium haemolyticum, and Corynebacterium diphteriae. In other words, neither systematic treatment with penicillin nor systematic throat samples are suitable for patient screening and treatment;
• or exhibit a context or clinical symptoms that are sufficient to require testing and appropriate treatments (ulcerative necrotic angina, false-membrane angina, etc.).

With the exception of diphteric angina,  gonococcus angina,  or necrotic angina caused by anaerobic germs (Vincent's disease) that all justify adapted antibiotic therapy, no study has confirmed the usefulness of antibiotic treatment in the following cases :

• viral origin angina;
• b-hemolytic streptococcal angina that does not belong to Group A.

Depending on the appearance of the oropharynx, various etiologies are evoked.