Tonsillitis Flashcards
What is tonsillitis
Inflammation of the palatine tonsils as a result of bacterial or viral infection
What are the palatine tonsils?
A concentration of lymphoid tissue within the oropharynx
Name inflammation of other areas occurring in conjunction with the tonsils
Tonsillopharyngitis
Adenotonsillitis
What does the size of tonsils change with?
Growth and development
When are the tonsils at their largest?
Age 4-8 yo
What causes most tonsillitis
Viruses
Name the common viral causes of tonsillitis
Adenovirus
EBV
Name the common bacterial cause of tonsillitis
Group A streptococcus (Strep pyogenes)
What is a risk factor for tonsillitis
Smoking
Describe the clinical history of tonsillitis
Odynophagia Fever Reduced oral intake Halitosis New onset snoring Shortness of breath
Describe the clinical examination findings of tonsillitis
Red inflamed tonsils
White pus/exudate on the tonsils
Cervical lymphadenopathy - region of the upper 3rd of the sternocleidomastoid
How many days does tonsillitis last for?
5-7
How many days does glandular fever symptoms last for?
> 7 days
List the differentials for tonsillitis
Glandular fever Pharyngitis Peritonsillar abscess Tonsillar malignancy Epiglottitis
What scoring systems are used to determine the likelihood of a bacterial infection compared to a viral infection causing tonsillitis
CENTOR
feverPAIN
Streptococcal score card
Describe the centor criteria
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
Fever or history of fever
Absence of cough
A score >3 is highly suggestive of a bacterial infection (40-60% likely)
A score <2 means a bacterial infection is unlikely (80% unlikely)
Describe the feverPAIN score
Fever Purulence Attend rapidly (within 3 days after onset of symptoms) Inflamed (severely) tonsils No cough or coryza
Score 0-1 = 13-18% chance of streptococcal infection
Score 2-3 = 34-40% chance of streptococcal infection
Score 4-5 = 62-65% chance of streptococcal infection
Describe the streptococcal score card
Age 5-15 Season - late autumn and early spring Fever >38.3 Cervical lymphadenopathy Pharyngeal oedema No viral URTI symptoms - cough or coryza
5 Criteria = 59% GAS
6 criteria = 75% GAS
How is tonsillar size graded?
By the proportion of the oropharynx taken up by the tonsils
Grade 0 - tonsils not visible/not present Grade 1 - <25% Grade 2 - 25-50% Grade 3 - 25-75% Grade 4 - tonsils meet in midline
At what age are grade 2 and 3 tonsils at peak incidence?
4-5yo
At what age are grade 2 tonsils predominant?
6yo
What may cause enlarged tonsils
Scarring from recurrent infection
What investigations may be considered for tonsillitis?
FBC - infection - neutrophils in bacterial
LFT - glandular fever
U&E - dehydration
How is tonsillitis managed?
Decide whether or not admission is necessary
Antibiotics for 7-10 days dosed according to child’s weight -benzylpenicillin, switch to oral penicillin V when able to swallow
Analgesia - paracetamol and ibuprofen
When is tonsillectomy considered
> 7 episodes in 1 year
5 episodes per year in 2 years
3 episodes per year in 3 years
List some complications of tonsillitis
Quinsy - peritonsillar abscess
Deep neck space abscess - retropharyngeal or parapharyngeal
Recurrent tonsillitis
List two post streptococcal complications
Post streptococcal glomerulonephritis
Rheumatic fever
At what age does post streptococcal glomerulonephritis tend to present?
6-8yo
What are the symptoms of post streptococcal glomerulonephritis?
Hypertension
Haematuria
Oedema
Proteinuria but without true nephrotic syndrome
What is rheumatic fever?
An autoimmune reaction to group A streptococcus
When does rheumatic fever present?
2-5 weeks after GAS infection
What are the symptoms of rheumatic fever?
Prolonged fever
Arthritis
Pancarditis
Anaemia
What age commonly gets rheumatic fever?
5-14yo
What is a peritonsillar abscess?
Quinsy
Collection of pus in the peritonsillar space
Where is the peritonsillar space?
Potential space that surrounds the palatine tonsils
What are the common causative organisms of a peritonsillar abscess?
Fusobacterium necrophorum - 15-24yo
Group A streptococcus - 30-39yo
Describe how peritonsillar abscesses develop
Result of tonsillitis causing irritation in the peritonsillar space resulting in pus accumulation
How do patients with peritonsillar abscess present?
Severe sore throat - unilateral mostly
Trismus - muscle spasm preventing jaw opening fully
Hot potato voice
Uvula deviation away from the affected side
What is the definitive management of peritonsillar abscess?
Aspiration and drainage
Antibiotics due to mixed organism causes - cover of anaerobes and aerobes
What is the definitive management of peritonsillar abscess?
Aspiration and drainage
Antibiotics due to mixed organism causes - cover of anaerobes and aerobes
IV rehydration
Analgesia
Which antibiotic should you not give in glandular fever and why?
Co-amoxiclav - risk of skin reaction
