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Tonsillitis

Tonsillitides

Tonsillitis is an infectious disease characterized by inflammation of the tonsils in the throat region. It is caused either due to viral or bacterial infection.


Presentation

Children with tonsillitis have swollen tonsils that turn red accompanied by fever and inability to swallow food due to sore and painful throat. Affected individuals also complain of headache, stiffness in neck, stomach pain, and muffled voice. Children who develop tonsillitis have swollen lymph nodes in the neck and also develop patches on the tonsils. Young children who are unable to express the symptoms often turn fussy and show disinterest towards food due to difficulty in swallowing it.

Cervical Lymphadenopathy
  • We report the case of an 8-year-old boy presenting with a history of acute tonsillitis and cervical lymphadenopathy in which the diagnosis of Kawasaki syndrome became apparent 4 days after admission.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: In the differential diagnosis of cervical lymphadenopathy in patients with frequent episodes of tonsillitis, Kikuchi-Fujimoto disease should be taken into account.[ncbi.nlm.nih.gov]
  • Patients may present with a variety of symptoms including painful throat (may be unilateral), dysphagia, fevers, tender cervical lymphadenopathy and/or tonsillar exudate. Ear pain and trismus can also occur 1 .[radiopaedia.org]
  • Patients may present with a variety of symptoms including painful throat (may be unilateral), dysphagia, fevers, tender cervical lymphadenopathy and/or tonsillar exudate. Ear pain and trismus can also occur 1.[radiopaedia.org]
  • The most common presentations are cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. Investigations It is recommended that throat swabs and rapid antigen tests should not be performed routinely.[patient.info]
Fever
  • None had signs of acute rheumatic fever. All three patients received penicillin therapy when the signs of myocarditis appeared. Their recovery was good.[ncbi.nlm.nih.gov]
  • Lancefield's GABS can cause rheumatic fever , Sydenham's chorea , glomerulonephritis and scarlet fever . Streptococcal infection may cause a flare-up of guttate psoriasis .[patient.info]
  • It can also lead to a skin rash ( scarlet fever ), sinusitis , pneumonia , and ear infections.[web.archive.org]
  • Differences in days of fever and illness were tested by one-way analysis of variance.[ncbi.nlm.nih.gov]
Infectious Mononucleosis
  • We describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis. The role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed.[ncbi.nlm.nih.gov]
  • Viral tonsillitis is usually caused by enterovirus, influenza, parainfluenza, adenovirus, rhinovirus and Epstein-Barr virus (causing infectious mononucleosis).[ncbi.nlm.nih.gov]
  • Interval TE should not be performed, the approach is not supported by contemporary clinical studies. (3) In patients with infectious mononucleosis TE should not be performed as a routine procedure for symptom control.[ncbi.nlm.nih.gov]
  • mononucleosis and acute non-streptococcal and GABHS tonsillitis.[ncbi.nlm.nih.gov]
  • This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis.[bestpractice.bmj.com]
Streptococcal Pharyngitis
  • Haverkorn MJ, Valkenburg HA, Goslings WR (1971) Streptococcal pharyngitis in the general population. I. A controlled study of streptococcal pharyngitis and its complications in the Netherlands.[doi.org]
  • Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis . 2012;55(10):1279-1282.[medlineplus.gov]
  • Adverse and beneficial effects of immediate treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin . Pediatr Infect Dis J. 1987 ;6: 635 - 643 . Google Scholar Medline ISI 81.[doi.org]
  • A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. acute sore throat ( ICD-10-CM Diagnosis Code J02 J02 Acute pharyngitis J02.0 Streptococcal pharyngitis[icd10data.com]
Malaise
  • PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for[ncbi.nlm.nih.gov]
  • The symptoms are sore throat, difficulty in swallowing, fever, malaise, and enlarged lymph nodes on both sides of the neck. The infection lasts about five days.[britannica.com]
  • The patient may also complain of headache, thick speech, marked feeling of malaise, as well as swelling and tenderness of the neck glands (lymph nodes).[ghorayeb.com]
  • Assessment and recognition Odynophagia Dysphagia Anorexia Pyrexia Malaise Swollen tonsils with or without exudate 'Thick' or 'hot potato' voice (not hoarse voice) Lymphadenopathy (especially Level II/III ) Referred otalgia (the glossopharyngeal nerve[entsho.com]
Severe Pain
  • You should also contact your doctor if a sore throat doesn't improve in a few days or causes: difficulty breathing or swallowing a persistent fever severe pain, particularly if it’s mainly on one side of your throat.[healthdirect.gov.au]
  • This causes severe pain when swallowing, a narrowing of the throat and a head cold. It also causes a high temperature, coughing and congestion.[medic8.com]
  • Other medicines or treatments may be recommended for severe pain. Increasing how much your child drinks. Some teas have ingredients that soothe the throat. Eating smooth, cool foods such as gelatin, ice cream, and ice pops.[stlouischildrens.org]
  • Other medicines or treatments may be recommended for severe pain Increasing how much your child drinks.[childrensnational.org]
Sore Throat
  • A GP with a list of 2,000 can expect to see around 120 cases of sore throat a year with considerable seasonal variation - see the separate Sore Throat article [ 1 ] .[patient.info]
  • […] and sore throat days.[doi.org]
  • Chinese medicinal herbs for sore throat Sore throat is a widespread acute respiratory tract illness which affects all age groups. In China, many Chinese herbal medicines are used to treat this illness.[web.archive.org]
  • Sore throat – acute, Clinical knowledge Summaries (April 2008).[netdoctor.co.uk]
Pharyngitis
  • Mycoplasma pneumoniae, Corynebacterium diphtheriae, and Chlamydia pneumoniae rarely cause acute pharyngitis. Neisseria gonorrhea may cause pharyngitis in sexually active persons.[emedicine.com]
  • The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p 0.001).[ncbi.nlm.nih.gov]
  • After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG.[ncbi.nlm.nih.gov]
  • Haverkorn MJ, Valkenburg HA, Goslings WR (1971) Streptococcal pharyngitis in the general population. I. A controlled study of streptococcal pharyngitis and its complications in the Netherlands.[doi.org]
  • It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to generalised infection of the pharynx and commonly affects young healthy adults.[ncbi.nlm.nih.gov]
Odynophagia
  • Assessment and recognition Odynophagia Dysphagia Anorexia Pyrexia Malaise Swollen tonsils with or without exudate 'Thick' or 'hot potato' voice (not hoarse voice) Lymphadenopathy (especially Level II/III ) Referred otalgia (the glossopharyngeal nerve[entsho.com]
  • Symptoms of tonsillitis/pharygnitis include: sore throat; fever; odynophagia; hoarse voice; vomiting; cough; diarrhoea; arthralgia; tonsillopharyngeal erythema; tonsillopharygneal exudate; soft palate petechiae; cervical lymphadenitis; rash; conjunctivitis[dontforgetthebubbles.com]
  • The signs and symptoms may include: Painful swallowing ( odynophagia ) Difficulty swallowing ( dysphagia ) Inflammation and enlargement of the tonsils Pockets or patches of white on the tonsils (tonsillar exudates) Swollen lymph nodes, mostly around the[coldflu.about.com]
Thrombosis
  • The neurological complications encountered in young previously healthy adults were: facial palsy and hemiplegia; superior sagittal sinus thrombosis with communicating hydrocephalus and papilloedema; Guillain-Barré syndrome and facial palsy.[ncbi.nlm.nih.gov]
Halitosis
  • […] sore throat, fever, drooling, halitosis, difficulty opening the mouth, and muffled voice Once the cause and type of tonsillitis is determined, your doctor will determine the appropriate course of treatment.[entshadygrove.com]
  • […] spots developing on the tonsils Headaches and pain felt in the temple and forehead region Fevers and high temperatures (chills may also be experienced) Associated shooting or stabbing ear pain A furry white to yellow coating developing on the tongue Halitosis[sinuswars.com]
  • There are two types of tonsillitis: recurrent tonsillitis: multiple episodes of acute tonsillitis a year chronic tonsillitis: episodes last longer than acute tonsillitis in addition to other symptoms that include: chronic sore throat bad breath, or halitosis[healthline.com]
  • Because of this, halitosis or bad breath is a frequent symptom. In addition, a chronically sore throat and enlarged or sore lymph nodes in the neck are usually present.[livestrong.com]
Subcutaneous Nodule
  • One had maculopapular erythema and 2 had abdominal pain of unknown origin, but none had cardiac involvement, chorea and subcutaneous nodule. HLA examination revealed that 4 had B39 (p[ncbi.nlm.nih.gov]
Guillain-Barré Syndrome
  • The neurological complications encountered in young previously healthy adults were: facial palsy and hemiplegia; superior sagittal sinus thrombosis with communicating hydrocephalus and papilloedema; Guillain-Barré syndrome and facial palsy.[ncbi.nlm.nih.gov]

Workup

The following diagnostic procedures are conducted to determine tonsillitis.

  • Physical examination: A preliminary physical examination is done to assess the degree of distress that has made swallowing difficult in affected children. The examination is done with the help of lighted instruments to carefully look for signs of infection. In many cases, the nose and ears are also checked. In addition, the child’s cheeks are palpated to check for signs of swollen lymph nodes.
  • Throat swab: This is utmost necessary to assess the nature of infection present and the causative agent. In this test, throat secretions are collected and sent to laboratory for further testing [6].
  • Blood test: Blood test to assess complete blood count will help in determining the cause of tonsillitis [7].
Lymphocytopenia
  • CONCLUSION: Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis.[ncbi.nlm.nih.gov]

Treatment

Treatment of tonsillitis largely depends on the cause of the disease. The following methods are employed for treating the condition:

Viral infection: The child should get better within a week to 10 days. The affected child should be allowed to take as much rest as possible and should also be asked to rest his voice. In addition, he should be given foods that are easy to swallow and which would not trouble the throat much. Warm foods would provide relief to the sore throat. Gargling with salt water also can help treat the condition faster and promote quick recovery. Other symptoms of pain and fever can be treated with mediations.

Bacterial infection: In case, the cause of tonsillitis is bacterial infections then antibiotics form the basis of treatment regime. Penicillin is given which needs to be taken for 10 days. Complete course of antibiotic regime should be strictly followed to ensure complete recovery from the infection [8].

Surgery is the method of choice when all the above mentioned treatment regimes fail to bring about desired results. Surgical procedure to remove the tonsils is known as tonsillectomy. It is used in conditions when children get recurrent bouts of tonsillitis or the condition results in debilitating complications which cannot be managed with medications alone [9] [10].

Prognosis

The prognosis of tonsillitis is usually favorable owing to improvements in its treatment regime. With more advancements treatment methods being introduced, the development of complications has decreased to a great extent [5]. Complications of tonsillitis including rheumatic fever, scarlet fever and death have decreased significantly due to use of more advanced methods for treating tonsillitis.

Etiology

Viral infections are the most common cause of tonsillitis. However, in some cases bacterial infections too can cause symptoms of sore throat in children and adults. Children are more susceptible to contract tonsillitis compared to adults owing to low immunity. The viruses that are known to play a role in causation of this condition include adenovirus, coronavirus, influenza, rhinovirus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus and HIV. As already stated, tonsillitis can also be caused by bacteria and the causative agent includes Group A B-hemolytic streptococcus [2].

Epidemiology

Tonsillitis is a common occurrence in children older than 2 years. Tonsillitis due to bacterial infections strike children between the age group of 5 – 15 years. Sore throat, a common condition of tonsillitis affects 100 in 1000 individuals. The condition is considered to be the 8th most common disease in UK [3].

Sex distribution
Age distribution

Pathophysiology

The tonsils produce white blood cells for protecting the body against infections. In the process of safeguarding the body against various foreign agents, the tonsils can themselves get infected. Viruses and bacteria that enter the body through the mouth are not allowed entry into the system by the tonsils. However, in certain conditions, the tonsils get infected by the bacteria or viruses giving rise to the condition known as tonsillitis. Children fall easy prey to viral or bacterial infections when they come in contact with other children who are already suffering from tonsillitis [4].

Prevention

Infections from viruses or bacteria are the major cause of tonsillitis. Therefore, the best way of preventing this disease is to practice good hygiene and maintain a safe distance from individuals suffering from this disease. Tonsillitis is contagious and children should be taught to wash hands often, especially after coming in contact with individuals who have the disease. Covering mouth while coughing and sneezing is also another way of preventing the spread of the disease.

Summary

Tonsils are the 2 lymph nodes which are situated on either side towards back of the throat. These safeguard the body from various infections. Tonsillitis can occur at any age; but commonly strikes the children. The condition can be appropriately treated if the exact cause is identified. Surgical removal of tonsils is carried out when the conditions occurs repeatedly and other treatment regimes fail to yield positive outcome [1].

Patient Information

Definition

Tonsillitis is defined as inflammation of the tonsils due to either bacterial or viral infections. The tonsils usually provide protection to the body against various infections. In the process of warding of infectious agents, the tonsils gets infected and inflamed.

Cause

Viruses are the most common cause of tonsillitis followed by bacteria. Certain types of viruses such as adenovirus, influenza, rhinovirus, cytomegalovirus and respiratory syncytial virus are known to play foul in causation of tonsillitis.

Symptoms

Symptoms of tonsillitis include inflammation of the tonsils, high fever, headache, and stomach ache, development of white patches on the tonsils, bad breath, and difficulty in swallowing food and loss of appetite.

Diagnosis

Diagnosis of tonsillitis begins with a physical examination to check for signs of infection and development of rashes. Following this, throat swab is conducted to detect the causative organism and blood test to assess complete blood count is done.

Treatment

Treatment of tonsillitis is cause dependant. If bacteria are the source of infection then antibiotic penicillin is administered. If viruses are the cause then medicines for treating fever and other symptoms are given. Surgery is usually the last resort to treat tonsillitis if the condition occurs frequently and medications do not help.

References

Article

  1. Benarrosh C. [Multicenter double blind study of tiaprofenic acid versus placebo in tonsillitis and pharyngitis in children]. Arch Fr Pediatr 1989; 46:541.
  2. Brook I. The role of anaerobic bacteria in tonsillitis. Int J Pediatr Otorhinolaryngol. Jan 2005;69(1):9-19.
  3. Kvestad E, Kvaerner KJ, Roysamb E, Tambs K, Harris JR, Magnus P. Heritability of recurrent tonsillitis.Arch Otolaryngol Head Neck Surg. May 2005;131(5):383-7.
  4. Brook I, Gober AE. Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis. Arch Otolaryngol Head Neck Surg. May 1999;125(5):552-4.
  5. Schmidt RJ, Herzog A, Cook S, O'Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy. Arch Otolaryngol Head and Neck Surg. 2007;133:925-928
  6. Robinson AC, Hanif J, Dumbreck LA, Prichard AJ, Manners BT. Throat swabs in chronic tonsillitis: a time-honoured practice best forgotten. Br J Clin Pract. Apr-May 1997;51(3):138-9.
  7. Brodsky L. Tonsillitis, tonsillectomy and adenoidectomy. In: Bailey B, Johnson JT, Kohut RI, Pillsbury HC, Tardy ME Jr, eds. Head and Neck surgery-Otolaryngology. Vol 1. Philadelphia, Pa: Lippincott Williams & Wilkins; 1993:833-47
  8. Lan AJ, Colford JM, Colford JM Jr. The impact of dosing frequency on the efficacy of 10-day penicillin or amoxicillin therapy for streptococcal tonsillopharyngitis: A meta-analysis. Pediatrics. Feb 2000;105(2):E19.
  9. Paradise JL, Bluestone CD, Bachman RZ, et al. History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented. N Engl J Med 1978; 298:409.
  10. Lock C, Wilson J, Steen N, et al. Childhood tonsillectomy: who is referred and what treatment choices are made? Baseline findings from the North of England and Scotland Study of Tonsillectomy and Adenotonsillectomy in Children (NESSTAC). Arch Dis Child 2010; 95:203.

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Last updated: 2017-08-09 17:44