Evaluation of clinical and laboratory findings of acute exudative tonsillitis in children

Introduction and purpose: Acute exudative tonsillitis is one of the most common upper respiratory tract infections in childhood. The most frequent bacterial cause is Group A β-hemolytic streptococci (GABHS). In this study, it was aimed to investigate the viral and bacterial causes of exudative tonsillopharyngitis and to determine whether these factors are related to the clinical and laboratory findings of the patient. Materials and Methods: In this study, Zonguldak Bulent Ecevit University School of Medicine and Pediatrics and Pediatric Emergency Medicine admitted to the 1-15 age among the total of 152 patients with exudative tonsilopharyngitis rapid strep test, a throat culture taken. Ebstein-Barr virus IgM and cytomegalovirus IgM were studied in the cases of fast strep test negative. In addition, white blood cells, Absolute Neutrophil Count (ANS), C-Reactive Protein (CRP) and Procalcitonin (PCT) were analyzed in all patients. Viral and bacterial tonsillopharyngitis patients were compared with each other in terms of these parameters. Results: In our study, 40 of the 152 acute exudative tonsillopharyngitis patients who received throat culture were GABHS positive. In 112 patients, normal throat flora was detected. The mean age of 40 patients with GABHS positive in throat culture was 8,68 ± 3,46, the mean age of the 112 GABHS negative patients was 6.11 ± 3.08 (p = <0.001). In our study, all of our patients who had positive Rapid Antigen Detection Test (RADT) were breeding in the throat cultures. The white blood cells counts of those who are positive for throat culture is 15,600 cells/mm3 (µL) (4,400-25,700), white blood cells counts of throat culture negative was 11,750 cells/mm3 (µL) (3,200-27,000) (p = 0.002). The Absolute Neutrophil Count (ANC) of those with throat culture positive was 11.800 cells/mm3 (µL) (2.300 - 23.000). ANC of throat culture negative was 7.100 cells/mm3 (µL) (500-21000) (p<0.001). The CRP value of throat culture positive was 30.5 mg/l (2.2-173). CRP value of throat culture negative was 18 mg/l (0.4-227) (p =0,015). Procalcitonin (PCT) of those with throat culture positive was 0.109 ng/ml (0.03-2). PCT of throat culture negative was 0.079 ng/ml (0.010-2.86) (p=0,083). Conclusion: In our study, high CRP and white blood cell counts were not useful in distinguishing viral-bacterial tonsillopharyngitis. However, low CRP and white blood cell counts indicate viral tonsillopharyngitis. In our study, all of our patients who had positive Rapid Antigen Detection Test (RADT) were breeding in the throat cultures. Therefore, our study showed that the RADT alone was sufficient in defining Group A β-Hemolytic Streptococcus. In cases where fast strep test can not be performed, low values detected in CRP and White sphere tests may reduce the use of antibiotics.