Tonsillitis Flashcards
Define tonsillitis.
Acute infection of parenchyma of palatine tonsils. May occur in isolation or as part of generalised pharyngitis.
How common is tonsillitis?
Very common - more common in children 5-15yrs
What is the aetiology of tonsillitis?
Viral
- Most common - rhinovirus, coronavirus, adenovirus
- Less common - influenza, parainfluenza, enteroirus, herpes virus (EBV if actually infectious mononucleosis)
- Associated with IM infection
Bacterial
- Group A beta-haemolytic streptococci (15-30%)
- Mycoplasma pneumoniae
- Neisseria gonorrhoea
What are the risk factors for tonsillitis?
- Age 5-15 yrs
- Contact with infected people in enclosed spaces (e.g. child care, schools, prison)
What criteria is used to distinguish between viral and bacterial tonsillitis?
CENTOR criteria
The Centor criteria give an indication of the likelihood of a sore throat being due to bacterial infection. The criteria are:
- Tonsillar exudate
- Tender anterior cervical adenopathy
- Fever over 38°C (100.5°F) by history
- Absence of cough.
If 3 or 4 of Centor criteria are met, the positive predictive value is 40% to 60%. The absence of 3 or 4 of the Centor criteria has a fairly high negative predictive value of 80%.
What percentage of tonsillitis is bacterial?
10-30%
What are the signs of tonsillitis?
- Fever >38oC
- Tonsillar exudate - particularly GABHS, usually bacterial but also common in infectious mononucleosis
- Tonsillar erythema
- Tonsillar enlargement
- Enlarged anterior cervical lymph nodes -
What are the symptoms of tonsillitis?
- Pain on swallowing
- Sudden onset sore throat
- Headache
- Nausea
- Abdominal pain
- Cough or runny nose suggest viral
What investigations would you do for tonsillitis?
- Rapid streptococcal antigen test - usually done first; identification of GABHS
- Throat culture - not necessary, more routine in US; results only in 48hrs
What is the management of tonsillitis? (not on Sofia)
Viral -
- analgesia (paracetamol 500-100mg/4-6hrs, max 4g OR ibuprofen 200-400mg/4-6hrs, max 2.4g)
Bacterial -
- analgesia
- antibiotics - phenoxymethylpenicillin 500mg 2-3 times a day for 10days OR amoxicillin 250-500mg TDS for 10days
- corticosteroids - dexamethasone 10mg IM/IV single dose in severe symptoms
Recurrent episodes -
- tonsillectomy
- antibiotics