Tonsillitis (1)

Question 1

What are its causes?

How can the presentation help differentiate between a viral and bacterial cause?

How does it present?

What will be seen O/E?

Answer 1

➊ • Viral
• Bacterial - Group A Strep (strep pyogenes), S. pneumoniae, H. influenzae, M. catarrhalis

➋ • Viral is more associated with headache, apathy and abdominal pain
• Bacterial is more associated with purulent discharge and cervical lymphadenopathy

➌ • Sore throat
• Dysphagia/odynophagia
• Fever

➍ • Red, inflamed tonsils +/- white exudates
• Anterior cervical lymphadenopathy

N.B. Waldeyer’s Tonsillar Ring is the ring of lymphoid tissue, which includes the nasopharyngeal, tubal, palatine, and lingual tonsils

Question 2

Centor Criteria:
What is it used for?

What does it include?

What do the results indicate?

Answer 2

➊ Assess likelihood of a sore throat being due to bacterial infection

➋ • Fever (> 38)
• Exudates
• Tender anterior cervical lymphadenopathy
• No cough

➌ Score of 3+ makes bacterial tonsillitis 40-60% likely

Question 3

Management:
What is given if viral cause?

What is given if bacterial cause (Centor > 3)?

Answer 3

➊ • Safety netting i.e. seek medical attention if temp spike, new exudates, new lymphadenopathy
• Simple analgesia (paracetamol, ibuprofen)

➋ PO Phenoxymethylpenicillin (Pen V) 500mg QDS for 5-10 days - Clarithromycin if pen allergic/intolerant

Question 4

What are its complications?

Answer 4

• Recurrent tonsillitis - Most common complication
• Peritonsillar abscess (Quinsy) - Presents with peritonsillar bulge, uvular deviation, trismus and muffled voice - Managed with abx and aspiration
• Retropharyngeal abscess - Rare complication caused by soft tissue swelling, presenting with a stiff and extended neck