Tonsillitis

Question 1

What is tonsillits?

Answer 1

Tonsillitis is inflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils. 

Question 2

What causes tonsillitis?

Answer 2

1. Acute Tonsillitis is more common in children between 5-15 yrs old
   - Viral Tonsillitis → most commonly caused by rhinovirus, coronavirus and adenovirus infections. In tonsillitis associated with infectious mononucleosis, the most common causative agent is EBV.
   - Bacterial Tonsillitis → most common causative agent is Streptococcus pyogenes
2. Infectious condition and can be spread by exposure to an infected person (hence predominantly a disease of school children).

Question 3

What are the presenting symptoms of tonsillitis?

Answer 3

• Pharyngitis → sore throat
• Fever >38°C and Malaise
• Purulent Tonsillar Exudate → yellow or white pustules may be present
• Pain on Swallowing
• Tonsillar enlargement + erythema
• Enlarged anterior cervical lymph nodes (Lymphadenopathy)

Question 4

What investigations are used to diagnose/ monitor tonsillitis?

Answer 4

1. Throat Culture → standard test for definitive diagnosis of bacterial tonsillitis, however the delay in results (>48hrs) limits its usefulness as a first test
2. Rapid Streptococcal Antigen Test → lower sensitivity than culture, but provides immediate results. Should be ordered if suspicion of GABHS.
3. Centor Criteria (Likelihood of GABHS: group A β haemolytic Streptococcus)
   - presence of tonsillar exudate
   - (tender) anterior cervical lymphadenopathy or lymphadenitis
   - history of fever (>38ºC)
   - absence of cough
   1 point for each (3 or more indicates bacterial - strep pyogenes)

Question 5

How is tonsillitis managed/

Answer 5

1. Acute Tonsillitis (No GABHS) → analgesics (paracetamol/ibruprofen/aspirin/naproxen)
2. Acute Tonsillitis (GABHS if 3 or 4 centor criteria) → analgesics + antibiotic therapy (phenoxymethylpenicillin) + corticosteroids (dexamethasone)
   - If Penicillin Allergic ⇒ Clarithromycin
   - 7 or 10 day course of Abx
3. Recurrent Episodes of Tonsillitis → tonsillectomy
   - Haemorrhage is most common complication following tonsillectomy
   - Primary Haemorrhage (within 24hrs) ⇒ immediate return to theatre due to risk of further, more extensive bleeding

Question 6

Describe the epidemiology behind tonsillitis?

Answer 6

In the UK, tonsillitis is a common condition that predominantly affects children and adolescents, with an estimated 7.4% of GP consultations for children under 15 years involving a sore throat or tonsillitis as the primary reason for the visit.