Tonsilitis Flashcards
Define tonsillitis
Form of pharyngitis - characterised by acute inflammation of the tonsils
Often with a purulent exudate present in bacterial tonsilitis
What is the key epidemiology of tonsilitis?
Common in children and adolescents
What is the most common causative organism of tonsillitis?
Streptococcus pyogenes (Group A strep)
EBV also common
What are some risk factors for tonsilitis?
Age 5-15yrs
Immunodeficiency
FH
Close contact with an infected individual
What are the key signs and symptoms of tonsilitis?
Sore throat - may refer pain to ears or headache
Changes to child voice or cry
Purulent and inflamed tonsils
Lymphadenopathy
What are the key ways to differentiate between nacterial and virtual tonsillitis?
Bacteria tends to have more severe symptoms such as fevet, tonsillar exudate and cervical lymphadenopathy.
Viral - milder, coryzal symptoms (cough, rhinorrhoea)
What are some important differentials for tonsilitis?
Infectious mononucleosis - glandular fever, teenagers, enlarged tonsils, fatigue and splenomegaly
hand, foot and mouth disease - coxasackie virus, blisters on the osnisils and roof of the child mouth, feet and hands.
What is the CENTOR criteria for identifying bacterial tonsilitis?
Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever over 38 degrees
Absence of a cough
Each criteria scores 1 point -2 or below is 17% bacterial, 3 or 4 i a 30-60% bacterial streptococcus
What is the use of the FeverPAIN score for tonsilitis?
Fever
Pus on tonsils
Attended within 3 days of symptoms onset
Inflamed tonsils
No cough or coryza
Higher score indicates increase risk of bacterial tonsilitis
How is tonsilitis diagnosed?
Typically is a clinical diagnosis
May also do a throat swab for microscopy and culture
Monospot (heterophil antibody) test to rule out glandular fever.
When should antibiotics be prescribed for tonsilitis?
CENTOR 3/4
FeverPAIN of 4/5
Or systemic upset/immunosuppression.
What antibiotics are typically given for tonsilitis?
Penicillin V PO QDS for 5-10days
If allergic - clarithromycin/erythromycin PO BD for 5 days
What are some potential complications of tonsilitis?
Qunisy (peritonsillar abscess)
Acute otitis media
If groupA beta haemolytic strep - Rheumatic fever, Syndenhams chorea, glomerulonephritis, scarlet fever.
What is the prognosis for tonsilitis?
Self resolving within 3-4days
Tonsillectomy is severe recurrent - diathermy or coblation
What are the criteria for tonsillectomy?
Severe recurrent
More than 7 episodes for one year
More than 5 episodes per year for two years
More than 3 episodes per year for 3 years.
