Acute Tonsillitis

Question 1

What are the possible aetiologies for tonsillitis? What is the most common pathogen responsible for tonsillitis?

Answer 1

Most common: Group A beta-haemolytic streptococci
Group C or G streptococci

S. pneumonie, S. aureus, H. influenza, M. catarrhalis

EBV

Question 2

What is trismus?

Answer 2

Trismus is the disturbance of the trigeminal nerve which leads to spasm of the muscles of mastication and causes difficulty opening the mouth (lockjaw)

Question 3

What are the clinical symptoms of tonsillitis?

Answer 3

Sore throat
Dysphagia, odynophagia, trismus
Malaise, fever
Otalgia (referred)

Question 4

What are the clinical signs associated with tonsillitis and which are associated with specific diseases?

Answer 4

Tender, cervical lymphadenopathy
Tonsils enlarged, inflammation with or without exudates and white follicles
Strawberry tongue with scarlatiniform rash (scarlet fever)
Palatal petichiae (infectious mononucleosis)

Question 5

What are 4 differential diagnoses for a sore throat?

Answer 5

Streptoccocal pharyngitis
Viral pharyngitis
Infectious mononucleosis
Tonsilitis
Peritonsillar Abscess
Foreign body/trauma
Leukaemia
Hodgkins disease

Question 6

What are the investigations that are required when confirming the diagnosis of tonsillitis?

Answer 6

Full Blood Count – raised WBC with increased neutrophils is bacterial but lymphocytosis is infectious mononucleosis
Throat Swab for MC&S
Rapid streptococcal antigen test
Monospot test (reactive heterophile antibodies) for infective mononucleosis

Question 7

What are 3 complications that are associated with tonsillitis and its various causes?

Answer 7

Rheumatic Heart Disease (streptococcus)
Arthritis
Scarlet Fever
Peritonsillar Abscess (Quinsy), intratonsillar
Deep neck space infection
Sepsis
Glomerulonephritis

Question 8

What is the basic primary principles of management in tonsillitis?

Answer 8

Basic

• Soft diet with adequate fluid intake
• Gargle with warm saline solution
• Analgesics and antipyretics

Management of tonsillitis is related to whether group A beta-haemolytic strep or not.

Acute tonsillitis not due to group A beta-haemolytic strep – analgesics
Acute tonsillitis DUE to group A beta-haemolytic strep – analgesics + ABx + steroids

Question 9

What are the ABx required in the treatment of tonsillitis based on the causative pathogen?

Answer 9

1st line – penicillin or amoxicillin

If penicillin allergy - erythromicin