Tonsillitis

Question 1

Aetiology of tonsillitis

Answer 1

Most common cause is viral (EBV)

Most common bacterial cause is group A streptococcus (Strep. pyogenes)

Other causes:
Strep. pneumoniae
H. influenzae
Moraxella catarrhalis 
Staphy. aureus

Question 2

Distinguishing bacterial and viral tonsillitis

Answer 2

Bacterial more associated with cervical lymphadenopathy

Viral associated with headache, apathy and abdominal pain

Question 3

Clinical features of tonsillitis

Answer 3

Fever

Sore throat

Painful swallow

Red, inflamed, enlarged tonsils

With or without exudate

Question 4

Presentation of tonsillitis in young children

Answer 4

Can present with non-specific symptoms in young children:

Fever

Poor oral intake

Headache

Vomiting

Abdominal pain

Question 5

Management of viral tonsillitis

Answer 5

Education

Safety net

Simple analgesia with paracetamol and ibuprofen

Question 6

Management of bacterial tonsillitis

Answer 6

Centor criteria score of 3/4 or or FEVERPain >4 or at risk:

1st line: Penicillin V 500mg PO QDS for 5-10 days

Alternative in pen allergy: Clarithromycin/Erythromycin 250-500mg PO BD for 5 days

Question 7

When to consider admission for tonsillitis?

Answer 7

Immunocompromised

Systemically unwell

Dehydrated

Stridor

Respiratory distress

Evidence of peritonsillar abscess or cellulitis

Question 8

Complications of tonsillitis

Answer 8

Chronic tonsillitis

Peritonsillar abscess, also known asquinsy

Otitis mediaif the infection spreads to the inner ear

Scarlet fever

Rheumatic fever

Post-streptococcal glomerulonephritis

Post-streptococcal reactive arthritis

Question 9

CENTOR criteria for tonsillitis

Answer 9

Gives an indication of the likelihood of a sore throat being due to bacterial infection

1. Tonsillar exudate
2. Tender anterior cervical lymphadenopathy
3. Fever over 38
4. Absence of cough

Each of the Centor criteria score 1 point (maximum score of 4)

0, 1 or 2 - 3 to 17% likelihood of isolating streptococcus

3 or 4 - 32 to 56% likelihood of isolating streptococcus

Question 10

FeverPAIN Score for tonsillitis

Answer 10

Gives an indication of the likelihood of a sore throat being due to bacterial infection

2 – 3 gives a 34 – 40% probability

4 – 5 gives a 62 – 65% probability

Feverduring previous 24hours

P–Purulence (pus on tonsils)

A–Attended within 3days of the onset of symptoms

I–Inflamed tonsils (severely inflamed)

N–No cough or coryza