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]

  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

  For example the Epstein-Barr virus, which is the cause of glandular fever (infectious mononucleosis), is a common cause. [netdoctor.co.uk]

  Complications of tonsillitis including rheumatic fever, scarlet fever and death have decreased significantly due to use of more advanced methods for treating tonsillitis. Viral infections are the most common cause of tonsillitis. [symptoma.com]

  Lancefield's GABS can cause rheumatic fever, Sydenham's chorea, glomerulonephritis and scarlet fever. Streptococcal infection may cause a flare-up of guttate psoriasis. Enlarged and chronically infected tonsils interfere with children's sleep[11]. [patient.info]

  It can also lead to a skin rash ( scarlet fever ), sinusitis, pneumonia, and ear infections. [web.archive.org]

• Fatigue

  A 23-year-old white man with a history of over 20 episodes of tonsillitis in the preceding 2 years was admitted to our hospital because of cervical unilateral lymphadenopathy, fever, night sweating, weight loss, and fatigue. [ncbi.nlm.nih.gov]

  […] palatine tonsils Difficulty to swallow (constricted fauces) Ulcerations of the mucous membrane Suppurative, fibrinous coating ("stipple") Fetid breath Swelling of lymphatic nodes Scarlatiniform exanthem General symptoms (fever, headaches and abnormal fatigue [flexikon.doccheck.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 12, 2019 [patientslikeme.com]

  Tonsillitis: Overview Symptoms of acute tonsillitis include sore throat, difficulty swallowing, fever and fatigue. More frequent tonsil infections can be a real problem, and may also lead to complications in rare cases. [web.archive.org]

• 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]

  This may include: Taking acetaminophen or ibuprofen (as a liquid or pills) for pain; 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 [cooperhealth.org]

  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. [childrensnational.org]

• 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]

  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]

  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]

• 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]

  Lethargy and malaise are common. [entnet.org]

  Lethargy and malaise are common. These symptoms usually resolve in three to four days, but may last up to two weeks despite therapy. [bmc.org]

  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]

  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]

• Sore Throat

  […] and sore throat days. [doi.org]

  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]

  Sore throat – acute, Clinical knowledge Summaries (April 2008). [netdoctor.co.uk]

  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]

• 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]

  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]

• Cough

  Abstract Lingual tonsillitis can cause various signs and symptoms including nocturnal or supine cough, constant discomfort in the throat, glossal pain, and otalgia. Most patients with lingual tonsillitis have already had palatine tonsillectomy. [ncbi.nlm.nih.gov]

  If a child doesn’t have swollen glands, and is only experiencing a sore throat, low grade temperature, cough, and congestion, it’s more likely the child has a viral infection. [youtube.com]

  Similar to a cold, tonsillitis is contagious and spread by coughing, sneezing, and breathing. Children between the ages 3 to 7 years are affected by Tonsillitis because at this age their tonsils are in the most active period, battling infections. [thelymphnodes.com]

  Tonsillitis is spread through the air in droplets when an infected person breathes, coughs, or sneezes. [uofmhealth.org]

• Dysphagia

  Abstract A 45-year-old woman presented to the emergency department (ED) with a 3-day history of fever, progressive sore throat, dysphagia, and difficulty speaking. She was diagnosed with acute lingual tonsillitis. [ncbi.nlm.nih.gov]

  Learn More About Topic Dysphagia Dysphagia means that you can’t swallow well. Many factors may cause dysphagia, and most are temporary and non-life-threatening. [entnet.org]

  Acute: temporary tonsillitis that includes sore throat, fever, dysphagia, and other symptoms Recurrent: several episodes of acute tonsillitis within a year Chronic: ongoing sore throat halitosis, and tender cervical nodes Peritonsillar abscess: sever [entshadygrove.com]

  In patients with infectious mononucleosis (glandular fever) requiring hospital admission, corticosteroids may have a role when pain and swelling threaten the airway or where there is very severe dysphagia[2]. [patient.info]

• Odynophagia

  We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. [ncbi.nlm.nih.gov]

  • Acute tonsillitis: Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes. [entnet.org]

  Acute tonsillitis: Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes. [bmc.org]

  Symptoms of acute tonsillitis include: Fever Sore throat Bad breath Difficulty swallowing (called dysphagia) Painful swallowing (called odynophagia) Dehydration Tender lymph nodes in the neck Mouth breathing, snoring, or sleep apnea Tiredness, lethargy [med.uth.edu]

  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]

• Failure to Thrive

  […] to thrive, and sometimes even heart problems. [health24.com]

• Melena

  Presentations may not be straightforward and there may be misleading histories of epistaxis, hemoptysis, hematemesis and even melena. [ncbi.nlm.nih.gov]

• Jaundice

  It may affect the liver and spleen, and may lead to jaundice. Symptoms Acute tonsillitis The typical symptoms of acute tonsillitis are a very sore throat with bright red, swollen tonsils. The onset of pain may be rapid or gradual. [health24.com]

• 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]

  Halitosis is a common symptom to know about the disease because bad breathing is usually common among such patients. [healthguidehq.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]

  • Chronic tonsillitis: Individuals often have chronic sore throat, halitosis, tonsillitis, and persistently tender cervical nodes. • Peritonsillar abscess: Individuals often have severe throat pain, fever, drooling, foul breath, trismus (difficulty [entnet.org]

• Malocclusion

  Some orthodontists believe that chronic mouth breathing from large tonsils and adenoids causes improper alignment of the teeth (malocclusion). [web.archive.org]

  This may sometimes cause the teeth to become badly aligned (malocclusion). [health24.com]

  […] symptoms include: Frequent awakening from sleep Restless sleep Nightmares Bedwetting Mood changes Excessive sleepiness Heart problems Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes improper alignment of the teeth (malocclusion [medicinenet.com]

• Otalgia

  Abstract Lingual tonsillitis can cause various signs and symptoms including nocturnal or supine cough, constant discomfort in the throat, glossal pain, and otalgia. Most patients with lingual tonsillitis have already had palatine tonsillectomy. [ncbi.nlm.nih.gov]

  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 Include 1 Throbbing headache with otalgia brought about by the infected tonsils and swollen lymph nodes. 2 The foul odor can be largely attributed to the pus formation or the cheese-like coating that envelope the affected tonsils [visihow.com]

  Ramsay Sedation Scale [220] ) for analgesic use, food intake, otalgia, kindergarten or school downtime are using popular surrogate parameters. An interesting postoperative pain benchmarking project was constructed by W. [egms.de]

• Neck Swelling

  If your child’s sore throat is severe and includes difficulty swallowing or breathing, drooling, stiff neck or neck swelling, call 911 or your local emergency number. [childrensnational.org]

  If your child’s sore throat is severe and includes difficulty swallowing or breathing, drooling, stiff neck, or neck swelling, call 911 or your local emergency number. [stlouischildrens.org]

• Headache

  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. [symptoma.com]

  Some lack of fluid in the body can make headaches and tiredness much worse. Paracetamol or ibuprofen eases pain, headache and fever. [patient.info]

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]

• Lymphocytopenia

  CONCLUSION: Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis. [ncbi.nlm.nih.gov]

• Clostridium Perfringens

  Bacterial infection with Clostridium perfringens in children less than 2 years of age is frequently associated with meningitis, necrotizing gastrointestinal infection, and postoperative infections. [ncbi.nlm.nih.gov]

• Gram-Positive Rods

  Microscopically, large numbers of gram-positive rods were easily recognized and were compatible with C. perfringens. [ncbi.nlm.nih.gov]

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].

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.

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].

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].

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].

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.

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].

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.

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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.