Tonsilitis

Question 1

Define Tonsillitis

Answer 1

Acute infection of the parenchyma of the palatine tonsils

Question 2

Aetiology of Tonsillitis

Answer 2

Viral: rhinovirus | coronavirus | adenovirus

Infectious mononucleosis: EBV

Bacterial (10-30%): Group A beta-haemolytic streptococci | Other beta-haemolytic and streptococci | Mycoplasma pneumoniae | Neisseria gonorrhoea (sexually active adolescents (particularly those engaging in oral-genital sex)

Question 3

Pathophysiology an risk factors of Tonsillitis

Answer 3

Local inflammatory pathways -> oropharyngeal swelling, oedema, erythema, and pain.
Rarely, the swelling may progress to the soft palate and uvula (uvulitis), or inferiorly to the region of the supraglottis (supraglottitis).

Age 5-15
Contact with infected people in enclosed spaces e.g. child care centre, schools, prison

Question 4

Epidemiology of Tonsillitis

Answer 4

Acute tonsillitis most commonly seen in the winter and early spring
More common in children 5-15

Question 5

Symptoms of Tonsillitis

Answer 5

Sore throat (odynophagia, sudden onset)
Fever >38 
Headache
Abdominal pain
Nausea and vomiting 
Cough or runny nose

Question 6

Signs of Tonsillitis on examination

Answer 6

Tonsillar: exudate | erythema | enlargement
Enlarged painful anterior cervical lymph nodes (particularly in acute bacterial group A beta-haemolytic streptococcal tonsillitis)

Question 7

Investigations for Tonsillitis

Answer 7

Throat culture: culture of pathogen (not necessary)
Rapid streptococcal antigen test: identify group A beta-haemolytic streptococci

Vaginal and cervical + penile + rectal cultures: may show N. gonorrhoea

Serological testing for streptococci: +ve if fourfold rise
WBC count: raised neutrophil (bacterial) and/or lymphocyte count (viral)
Heterophile antibodies: ?EBV/infectious mononucleosis
HIV viral load assay: Identify high risk patients

Lateral cervical view X-ray: may show enlarged retropharyngeal and posterior oropharyngeal soft tissue (for those who do not improve)