What is Tonsillitis Clinical Features and Treatment

Tonsillitis

 

Key points

• Acute bacterial or viral infection causing inflammation of the palatine tonsils. Infection may also affect the pharyngeal tonsils or adenoids
• There are 4 types of tonsillar disease: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
• Diagnosis is clinical. On examination, ensure that the airway is not obstructed by tonsils. A gray exudate may indicate diphtheria, an important differential diagnosis
• Treatment for streptococcal tonsillitis is penicillin V, or erythromycin in penicillin-allergic patients
• Other complications of untreated tonsillitis include rheumatic fever

Take urgent action:

• If breathing is severely affected by possible obstruction or if epiglottitis is suspected
• If fever exceeds 104°F (40°C)
• If gray exudate is present and points to diphtheria, hospitalization, isolation, and notification of public health officials is required
• Urgent surgical drainage is indicated if peritonsillar abscess (ie, quinsy) or parapharyngeal abscess is diagnosed
• Severe infections require hospitalization and intravenous antibiotics
• Inability to swallow can lead to dehydration; treat with intravenous fluid

Description

• Acute bacterial or viral infection causing inflammation of the palatine tonsils. The tonsils are large, fleshy, oval masses of tissue that lie in the lateral wall of the oral pharynx
• Infection may also affect the pharyngeal tonsils or adenoids, similar masses of tissue located between the back of the nose and the throat
• Four types of tonsillar disease exist: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
• Features:
  • Fever that can be as high as 104°F (40°C)
  • Sore throat that may impair swallowing
  • Patients with acute tonsillitis often have sore throat, fever, dysphagia, tender cervical lymphadenopathy, and erythematous/exudative tonsils
  • Patients may also report otalgia, headache, and vomiting
  • Tonsillitis and pharyngitis can occur simultaneously

Epidemiology

Incidence

• Peaks in winter and early spring

Demographics
Age:

• Most common in children aged 6 to 12 years; however, all ages are affected
• Tonsillitis in children aged less than 3 years is rare and usually of viral etiology

Gender:

• Affects male and female population equally

Socioeconomic status:

• Further spread of infection may occur from cramped living, traveling, or working conditions

Causes and risk factors

Causes:

• Influenza A and B viruses
• Respiratory syncytial virus (RSV)
• Adenovirus
• Streptococcus groups A and G, group A ß-hemolytic streptococci
• Epstein-Barr virus
• Herpes simplex
• Neisseria gonorrhoeae
• Serious causes:
  • Epstein-Barr virus and Neisseria gonorrhoeae
  • Staphylococcus aureus
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae

Contributory or predisposing factors:

• Enhanced spread of infection due to cramped living, traveling, or working conditions
• Repeat attacks are often caused by reinfection by family members or close contacts
• Also common in school populations; viral tonsillitis is common in the military and closed communities

Associated disorders

• Acute pharyngitis
• Acute adenoiditis
• Acute laryngitis
• Infectious mononucleosis
• Thyroiditis
• Otitis media

Screening

Not applicable.

Primary prevention

Summary approach

Tonsillectomy eliminates risk of recurrent infections.

Preventive measures

• Smoking cessation reduces the risk of tonsillitis and may help reduce severity of throat infections
• Excessive alcohol intake should be discontinued
• Inappropriate or ineffective antibiotic use may increase resistance