A 7-year-old boy complains of fever up to 38°C, headache, sore throat. Objectively: slightly hyperemic soft palate mucosa, anterior palatine arches and tonsils exhibit erosions. Submandibular lymph nodes are slightly enlarged, painless. What is the causative agent of this disease?

Answer options

1. Bordet-Gengou bacillus
2. Coxsackie virus
3. Loeffler’s Bacillus
4. Herpes simplex
5. Epstein-Barr virus

Explanation

First of all pay attention to distracters. Which diseases do they correspond to? What kind of clinical manifestations is typical for each disease? For diagnosis. It is necessary to consider the patient's age, the start of diseases, type, amount, localization of the affection elements. (Answer the questions. When did the first symptoms of the disease start? What is the reason for their appearance? Are there the skin manifestations?) Coxsackievirus belongs to enteroviruses – is the causative agent of herpetic angina. The disease affects children of all ages, mostly preschool and junior (7-year-old boy). Herpetic angina starts abruptly, is characterized by acute fever with an increase of body temperature to 38.0–39.0 °С (up to 38 °C) and small vesicles in the pharynx. (A boy has a sore throat. There are erosions on the slightly hyperemic mucosa of the soft palate, anterior palatal bars, and tonsils). Oral mucosa of the soft palate, anterior palatine arches, tonsils, and tongue is covered with small vesicles, which quickly turn into erosions, is located on moderately hyperemic mucosa. Submandibular lymph nodes are enlarged and slightly painful. Skin rash and gingivitis are not present in the case of herpetic angina. Herpes simplex virus – is the causative agent of acute herpetic stomatitis. It affects children of 6months to 3 years old (most often) but the disease may also occur in older children. The disease is often characterized by body temperature to 37.5–39.0 °С. Lymphadenitis of submandibular (more rarely –cervical) lymph nodes Hyperemia, bleeding gums (catarrhal gingivitis), catarrhal angina is defined in the oral cavity. Multiple rash elements appear in the background of increased hyperemia. The elements located on the oral mucosa of lips, cheeks, tongue, soft and hard palates, and gums. vesicles(1–3 mm in diameter) forming secondary elements- round or oval erosions with yellowish fibrinous coating and thin red halo; Epstein-Barr virus – filtered virus – is the causative agent of infectious mononucleosis (Filatov – Pfeiffer's disease) is a low contagious infectious disease characterized by fever, inflammation of the pharynx, enlarged lymph nodes, spleen, liver, and mononuclear reaction in the blood. It affects children from 1 to 10–12 years old mainly. The disease begins gradually. The symptoms: rhinitis, a slight increase of body temperature, enlargement of lymph nodes, cervical (along with the "clavisternomastoid" muscle), and submandibular, in particular, are the most constant features. Sometimes, inguinal, axillary, and other lymph nodes are also enlarged, but their individual enlargement (without the cervical ones) is not typical for the infectious mononucleosis and some features of affection of the throat. Collateral inflammation around them is observed, but the inflammatory features are expressed on the skin. An expressed hyperemia of tonsils is typical for all children with infectious mononucleosis. The process can resemble lacunar, follicular or catarrhal angina. In the case of angina, parts of the tonsils are coated with a yellowish-grey coating. Thus, the presence of coating resembles diphtheria; however, in the case of infectious mononucleosis, the coating is crumbly and easy to remove. Klebs-Loeffler bacillus synonym Corynebacterium diphtheria – gram-positive – is the causative agent of Diphtheria It affects children. It is characterized by local fibrinous inflammation of mucosa (more often oral and nasal pharyngeal), general intoxication, and affection of circulatory and nervous systems. headache. Diphtheria begins with pain in the throat and an increase in body temperature. Hyperemia and edema of tonsils' are the typical symptoms. Whitish gray areas appear on the tonsils; the areas gradually acquire the appearance of the thick coating, typical for diphtheria, the coating has a smooth surface with clear borders. It is tightly attached to the adjacent tissues. (pp. 204–205) Bordet-Gengou bacillus- is the causative agent of Whooping cough (pp. 203–204). It affects children of acute infectious disease, which is characterized by a specific spasmodic cough that gradually increases, catarrhal inflammation of the upper respiratory tract. The body temperatureis subfebrile. Cyanosis of the face and the oral mucosa is observed during coughing, ulcers on the lingual frenulum.