Tonsillitis Flashcards

1
Q

Define tonsillitis.

A

Acute infection of parenchyma of palatine tonsils. May occur in isolation or as part of generalised pharyngitis.

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2
Q

How common is tonsillitis?

A

Very common - more common in children 5-15yrs

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3
Q

What is the aetiology of tonsillitis?

A

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
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4
Q

What are the risk factors for tonsillitis?

A
  • Age 5-15 yrs
  • Contact with infected people in enclosed spaces (e.g. child care, schools, prison)
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5
Q

What criteria is used to distinguish between viral and bacterial tonsillitis?

A

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%.

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6
Q

What percentage of tonsillitis is bacterial?

A

10-30%

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7
Q

What are the signs of tonsillitis?

A
  • Fever >38oC
  • Tonsillar exudate - particularly GABHS, usually bacterial but also common in infectious mononucleosis
  • Tonsillar erythema
  • Tonsillar enlargement
  • Enlarged anterior cervical lymph nodes -
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8
Q

What are the symptoms of tonsillitis?

A
  • Pain on swallowing
  • Sudden onset sore throat
  • Headache
  • Nausea
  • Abdominal pain
  • Cough or runny nose suggest viral
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9
Q

What investigations would you do for tonsillitis?

A
  • Rapid streptococcal antigen test - usually done first; identification of GABHS
  • Throat culture - not necessary, more routine in US; results only in 48hrs
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10
Q

What is the management of tonsillitis? (not on Sofia)

A

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
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