All of the following cause a gray-white membrane on the tonsils, except
DIFFERENTIAL DIAGNOSIS OF MEMBRANE OVER THE TONSIL 1. Membranous tonsillitis:- It occurs due to pyogenic organisms. An exudative membrane forms over the medial surface of the tonsils, along with the features of acute tonsillitis. 2. Diphtheria:- Unlike acute tonsillitis which is abrupt in onset, diphtheria is slower in onset with less local discomfo, the membrane in diphtheria extends beyond the tonsils, on to the soft palate and is diy grey in colour. It is adherent and its removal leaves a bleeding surface. Urine may show albumin. Smear and culture of throat swab will reveal Corynebacterium diphtheriae. 3. Vincent angina:- It is insidious in onset with less fever and less discomfo in throat. Membrane, which usually forms over one tonsil, can be easily removed revealing an irregular ulcer on the tonsil. Throat swab will show both the organisms typical of disease, namely fusiform bacilli and spirochaetes. 4. Infectious mononucleosis:- This often affects young adults. Both tonsils are very much enlarged, congested and covered with membrane. Local discomfo is marked. Lymph nodes are enlarged in the posterior triangle of neck along with splenomegaly. Attention to disease is attracted because of failure of the antibiotic treatment. Blood smear may show more than 50% lymphocytes, of which about 10% are atypical. White cell count may be normal in the first week but rises in the second week. Paul-Bunnell test (mono test) will show high titre of heterophil antibody. 5. Agranulocytosis:- It presents with ulcerative necrotic lesions not only on the tonsils but elsewhere in the oropharynx. Patient is severely ill. In acute fulminant form, total leucocytic count is decreased to <2000/cu mm or even as low as 50/cu mm and polymorph neutrophils may be reduced to 5% or less. In chronic or recurrent form, total count is reduced to 2000/cu mm with less marked granulocytopenia. 6. Leukaemia:- Inchildren, 75% of leukaemias are acute lymphoblastic and 25% acute myelogenous or chronic, while in adults 20% of acute leukaemias are lymphocytic and 80% nonlymphocytic. Peripheral blood shows TLC >100,000/cu mm. It may be normal or less than normal. Anaemia is always present and may be progressive. Blasts cells are seen on examination of the bone marrow. 7. Aphthous ulcers:- Theymay involve any pa of oral cavity or oropharynx. Sometimes, it is solitary and may involve the tonsil and pillars. It may be small or quite large and alarming. It is very painful. 8. Malignancy tonsil. 9. Traumatic ulcer:- Anyinjury to oropharynx heals by formation of a membrane. Trauma to the tonsil area may occur accidently when hit with a toothbrush, a pencil held in mouth or fingering in the throat. Membrane appears within 24 hrs. 10. Candidal infection of tonsil. Ref:- Dhingra; pg num:-259,260
Infectious mononucleosis
Streptococcal tonsillitis
Diphtheria
Ludwig's angina
Pharynx