Tonsillitis

Question 1

Define tonsillitis

Answer 1

Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils

Question 2

What are the causes/risk factors of tonsillitis?

Answer 2

• Tonsillitis is usually viral; it is most commonly caused by:

• Rhinovirus
• Coronavirus
• Adenovirus.
• Less commonly it is caused by the influenza virus, the parainfluenza virus, enteroviruses, or herpes viruses.

In tonsillitis associated with infectious mononucleosis, the most common infective agent is the Epstein-Barr virus.

Common bacterial pathogens include group A beta-haemolytic (Streptococcus Pyogenes) and other streptococci.

Question 3

What are the symptoms of tonsillitis?

Answer 3

• sudden onset of sore throat and pain on swallowing
• sore throat is typically accompanied by fever and patients may have headache, abdominal pain, nausea, and vomiting.
• The absence of a cough or runny nose makes a bacterial rather than a viral infection more likely

Question 4

What are the signs of tonsillitis?

Answer 4

• Examination of the throat may show tonsillar exudate and enlargement and erythema of the tonsils.
• There may be anterior cervical lymphadenopathy.
• However, a Centor score ≥3 is a well calibrated CPR score for suggesting a high probability of a patient >14 years old with acute tonsillitis having a GABHS infection:
• The Centor Criteria:
- History of fever over 38°C
- Tonsillar exudate
- Absence of cough
- Tender anterior cervical lymphadenopathy.

Question 5

What investigations are carried out for tonsillitis?

Answer 5

• Throat Culture - culture of pathogen
• Rapid Streptococcal Antigen Test - identification of group A beta-haemolytic streptococci (GABHS).
• Serology - anti-Streptolysin Antigen
• FBC - may show raised neutrophil and/or lymphocyte count.
- A raised WBC count with neutrophilia is suggestive of a bacterial infection, whereas a raised WBC count with lymphocytosis and atypical lympocytes is suggestive of infectious mononucleosis.
• HIV Viral Load Assay - indicated in high-risk patients with persistent infection and severe constitutional symptoms (malaise, tiredness, weight loss, generalised lymphadenopathy)