Tonsillitis (ENT) Flashcards
Define tonsillitis.
Inflammation of the tonsils; specifically infection of the parenchyma of the palatine tonsils
Describe the clinical distinction between tonsillitis and pharyngitis?
Unclear in the literature - the condition is often referred to as ‘acute sore throat’
What are the two types of causes of tonsillitis?
- viral tonsillitis (more common)
- bacterial tonsillitis
What can viral tonsillitis be caused by?
- rhinovirus
- coronavirus
- adenovirus
- mono (EBV)
- (influenza, parainfluenza, enterovirus, herpes)
What is bacterial tonsillitis caused by?
Streptococcus pyogenes
(Common: Group A beta-haemolytic streptococci, Mycoplasma pneumoniae, Neisseria gonorrhoeae)
What condition is viral tonsillitis associated with?
Infectious mononucleosis (EBV)
How is tonsillitis spread?
Infectious condition and can be spread by exposure to an infected person (hence predominantly a disease of school children)
What are the clinical features of tonsillitis? (10)
- pain on swallowing
- fever >38C (100.5F)
- tonsillar exudate (yellow/white pustules may be present - also prominent in infectious mononucleosis)
- sudden onset of sore throat
- headache
- abdominal pain
- nausea & vomiting
- cough/runny nose
- tonsillar erythema and enlargement
- enlarged anterior cervical lymph nodes
Which age group is acute tonsillitis most common in?
Children 5 to 15 years old
What are some risk factors for tonsillitis? (3)
- age between 5 and 15
- contact with infected people in enclosed spaces e.g. school, prison
- oro-genital sexual activity
What are the first-line investigations for tonsillitis?
- throat culture - definitive diagnosis of bacterial tonsillitis, but results >48h
- rapid streptococcal antigen test - sensitivity lower than culture but immediate results; ordered if suspicious of Group A beta-haemolytic Streptococcus pyogenes (GABHS) using Centor Criteria
When is rapid streptococcal antigen test done for tonsillitis?
1st line if suspicion of Group A beta haemolytic Streptococcus pyogenes (GABHS) via Centor Criteria (3+ = Strep pyogenes):
- presence of tonsillar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- fever 38C
- absence of cough
What other investigations can be considered for tonsillitis? (Split into microbiology and bloods)
Microbiology:
- serological testing for streptococci - suspected rheumatic fever
- vaginal and cervical / penile and rectal cultures - if suspecting gonococcal pharyngitis due to oro-genital involvement
- HIV viral load assay
Bloods:
- WBC count and differential - useful in suspected infectious mononucleosis (raised WBC+neutrophilia=bacterial, raised WBC+lymphocytosis=infectious mononucleosis)
- heterophile antibodies
What are some differential diagnoses for tonsillitis?
- infectious mononucleosis - adolescents (older), does not resolve over 1 week, heterophile antibody testing
- epiglottitis - rare in countries with routine Hib vaccination, muffled voice, drooling, stridor, difficulty breathing, prompt referral to A&E
- peri-tonsillar abscess - trismus/lockjaw, muffled voice, displaced uvula, enlarged tonsil + swelling of peritonsillar region
- retropharyngeal abscess - trismus (lockjaw) / visible neck swelling
- gonococcal pharyngitis
- diphtheria - grey-green membrane, serosanguineous nasal discharge
- HIV - constitutional symptoms (malaise, fatigue, weight loss etc)
What are the Centor criteria?
The Centor criteria give an indication of the likelihood of a sore throat being due to a bacterial infection:
- tonsillar exudate
- tender anterior cervical adenopathy
- fever >38C/100.5F
- absence of cough
3/4 = positive predictive value 40-60% (and rapid streptococcal antigen test can be done)
