Tonsilitis Flashcards
Causes of tonsilitis
Strep pneumoniae and strep A (strep pyogenes) are most common causative organisms especially in recurrent in children
EBV = another common cause
Clinical features
Sore throat (sudden onset)
Headache
Pyrexia
Abdominal pain
Nausea and vomiting
Pain on swallowing
Cervical lymphadenopathy – more associated with bacterial cause
Red, inflamed and enlarged tonsils with/without exudates
Investigations
Throat swabs and rapid antigen tests shouldn’t be performed routinely
Blood tests mainly for those with immunodeficiency
See Centor/feverPAIN criteria for consideration of antibiotics
Management
Paracetamol and ibuprofen
Antibiotics (penicillin 500mg 5-10days or clarithromycin/erythromycin 250-500mg 5 days if allergy) if features of:
Marked systemic upset
3+ Centor criteria
Immunodeficiency
History of rheumatic fever
In severe cases where patient has not been eating/drinking due to pain and is dehydrated = won’t tolerate oral antibiotics = requires hospital admission
Complications
Recurrent tonsillitis – most common
Retropharyngeal abscess – rare complication, more common in young children and commonly present w/ stiff and extended neck and fail to eat/drink
Peritonsillar abscess (quinsy)
Lemierre’s syndrome
Otitis media
Very rarely rheumatic fever and glomerulonephritis
Indications for tonsillectomy
NICE recommends surgery considered if meet all criteria:
Sore throats are due to tonsillitis
5+ episodes per year
Symptoms occurring for at least year
Episodes are disabling and prevent normal functioning
Other indications:
Recurrent febrile convulsions secondary to tonsillitis episodes
Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
Peritonsillar abscess if unresponsive to standard treatment
Complications of tonsillectomy
Primary - <24 hours – haemorrhage (mostly due to inadequate homeostasis), pain
Secondary – 24 hours to 10 days – haemorrhage (mostly due to infection), pain
