Gray membrane on tonsils

Introduction The tonsil pseudomembrane has a flaky pseudomembrane on the tonsils, which is gray, and the periphery is congested. The pseudomembrane is not easily peeled off, and the abnormal appearance such as oozing around is wiped off. Mostly caused by bacterial infection of the throat. Need to distinguish from tonsil abscess, when the tonsil abscess, the surface of the gray-white substance attached with a cotton swab gently scraped off, the whole piece can not fall off and there will be a thick juice. After invading the upper respiratory tract mucosa, it only propagates in the epithelial cells of the epithelium, generally does not cause bacteremia. When the local mucosa is damaged, such as measles, scarlet fever, pertussis or upper respiratory tract infection, the invasiveness of diphtheria bacilli is enhanced.

Cause

Mostly caused by bacterial infections in the throat, such as pharyngeal diphtheria caused by diphtheria, or acute tonsillitis can occur.

an examination

Related inspection

Body temperature measurement blood routine electrocardiogram

1. Blood: leukocytosis, generally (10 ~ 20) × 109 / L, the proportion of neutrophils increased, severe cases may appear poisoning particles.

2. Bacteriological examination: smear at the junction of the pseudomembrane and the mucosa, smear examination and culture (Lu's medium), often can find Gram-positive bacilli or diphtheria bacilli, if necessary, can be used for virulence test of diphtheria There are many methods. The guinea pig can be injected intradermally: two guinea pigs are taken, one of which is injected with 250 U antitoxin before the test, and then two guinea pigs are injected intradermally with 0.1 ml of the test solution (cultured in Lu's medium for 18-24 h). After the bacterial liquid washed with 5ml of broth, after 24 to 72 hours, if the injection site of the anti-toxin-injected animal is red and swollen, and the injection does not change, the test strain is proved to be toxic.

3. Serological examination: The fluorescent antibody method is used to detect diphtheria bacilli under a fluorescence microscope, which can be diagnosed early.

4. Rapid diagnosis of potassium citrate.

5. Other examinations: ECG helps to detect toxic myocarditis, urea nitrogen, creatinine, liver function changes in liver and kidney damage.

6. Toxic myocarditis ECG shows that the PR interval prolongs ST-T wave changes.

Differential diagnosis

Thrush

The heat is not high, there are white flaky blocks attached to the oral mucosa, which can spread to the pharynx, the white film is loose, easy to peel off, although the lesion range can be very wide, but the symptoms of poisoning are not significant.

2. Ulcer membranous pharyngitis

There are necrotizing ulcers and pseudomembranes in the pharynx, often accompanied by gingivitis, bleeding, oral malodor, throat swab smear can find Fusobacterium and spirochetes.

3. Infectious mononucleosis

There is a white membrane on the tonsils, which is slow to resolve, smear and culture without diphtheria bacilli, diphtheria antitoxin treatment is ineffective, abnormal lymphocytes in the surrounding blood, blood heterophilic agglutination test can be positive, specific anti-all positive.

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