Tonsillitis

Question 1

Natural history of tonsillitis

Answer 1

• Intense inflammation of tonsils
• Often with purulent exudate
• Hard to differentiate between viral and bacterial (1/3) clinically
  
  • surface exudates seen in infectious mononucleosis
  • headache, apathy, abdominal pain, white tonsillar exudate, cervical lymphadenopathy –> bacterial

Question 2

Causative agents of tonsilitis

Answer 2

• Group- A B-haemolytic streptococci
• Epstein-Barr virus (infectious mononucleosis)

Question 3

Treatment and advice to parents

Answer 3

• Abx
  
  • penicillin/ erythromycin
• Severe (if unable to swallow solids or liquids): hospital admission, IV fluids and analgesia
• AMOXICILLIN best avoided–> widespread maculopapular rash (ED viral cause)
• Tonsillectomy
  
  • ​recurrent severe tonsilitis
  • peritonsillar abscess/ quinsy
  • obstructive sleep apnoea (adenoid removal)