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Table 1 Distinguishing options of acute follicular tonsillitis and diphtheria Features Acute follicular tonsillitis Diphtheria previous historical past Recurrent sore throat with fever Contact with diphtheria affected person Diphtheria vaccination taken Not taken Age No age bar Children Onset Acute Insidious throat pain Severe delicate Fever High grade Low grade Hoarseness of voice and respiratory Never current in advanced illness misery Neck bull as a result of cervical Absent Not uncommon lymphadenopathy pulse price In proportion to fever Out of proportion to fever and weak toxemia Absent current in advanced illness tonsillar membrane Limited to tonsil and easily May prolong adjoining buildings, and diffcult to removed remove, and leaves uncooked bleeding area throat swab Streptococci Corynebacterium diphtheriae Urine No albumin Albumin usually current First line of treatment Antibiotics Antidiphtheric serum mortality Nil High Clinical options Clinical features 427 the afected crypt gradually enlarges, and may ulcerate on Discomfort on swallowing medial floor of tonsil. 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