title: Evaluation of the etiologic agents for acute suppurative tonsillitis in children.
abstract: BACKGROUND
  Acute suppurative tonsillitis is one of the most common pediatric infectious diseases, and has Group A beta-hemolytic streptococci (GABHS) as its most frequent bacterial cause. Prevention of acute rheumatic fever is the principal goal of treatment. Antimicrobial agents, in contrast, is not needed. Therefore, the cause of acute suppurative tonsillitis in children must be determined.
  
  
  METHODS
  Fifty-nine children were diagnosed as having acute febrile suppurative tonsillitis with the etiologies of Gr. A streptococci, adenovirus and Epstein-Barr (EB) virus. There were 25 cases of adenoviral tonsillitis, 20 cases of Epstein-Barr viral tonsillitis, and 14 cases of Gr. A streptococcal tonsillitis. This study aimed to find out whether the serum CRP, ESR or peripheral WBC counts could differentiate the etiological agents of acute tonsillitis from group A streptococcal to EB-viral or adenoviral infection. We also evaluated the effectiveness of epidemiological and clinical factors in predicting the etiology of acute suppurative tonsillitis in childhood.
  
  
  RESULTS
  There was no difference between adenoviral and streptococcal groups in the measurement of serum CRP, neither in WBC count or the level of ESR. Patients with Gr. A streptococcal tonsillitis were significantly older than those with EB-viral or adenoviral tonsillitis (p < 0.05). Seventy-two percent of patients with adenoviral tonsillitis were under 4 years of age, 70% of the patients with EB-viral tonsillitis were under 6 years of age, whereas 71% of the patients with streptococcal tonsillitis were over 6 years of age.
  
  
  CONCLUSIONS
  It is impossible to differentiate the etiology of acute suppurative tonsillitis by laboratory examinations (including serum CRP, peripheral WBC counts and ESR), based on its limited clinical pictures and epidemiological factors. Age was clearly the most important factor in distinguishing between viral and bacterial tonsillitis in children.
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC.
authors.forename: John
authors.initials: J
authors.lastname: Sun
authors.forename: W
authors.initials: W
authors.lastname: Keh-Gong
authors.forename: Betau
authors.initials: B
authors.lastname: Hwang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013492:Suppuration; D014069:Tonsillitis / Q000209:etiology*
chemical_list: D002097:C-Reactive Protein