Tonsillitis

Tonsilitis
Classification and external resources
A culture positive case of Streptococcal pharyngitis with typical tonsillar exudate
ICD-10	J03, J35.0
ICD-9	463
DiseasesDB	13165
MedlinePlus	001043
eMedicine	article/871977
MeSH	D014069

Tonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis otherwise known as the common cold, bacterial causes such as streptococcal pharyngitis are treatable with antibiotics. It usually takes one to three weeks to recover.

Symptoms

Common symptoms of tonsillitis include:

• red and/or swollen tonsils
• white or yellow patches on the tonsils
• tender, stiff, and/or swollen neck
• swollen lymph nodes
• sore throat
• cough
• headache
• sore eyes
• body aches
• earache
• fever
• chills
• nasal congestions
• ulceration

In cases of acute tonsillitis, the surface of the tonsil may be bright red and with visible white areas or streaks of pus.

Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.

Causes

The most common causes of tonsillitis are the (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus). It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. The second most common causes are bacterial. The most common bacterial cause is Group A β-hemolytic streptococcus (GABHS), which causes strep throat. Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.

Anaerobic bacteria have been implicated in tonsillitis. These include pigmented Prevotella and Porphyromonas, Fusobacterium and Actinomyces spp. The possible role of anaerobes in the acute inflammatory process in the tonsils is supported by several clinical and scientific observations: anaerobes have been isolated from the cores of tonsils of children and adults with recurrent GABHS and non streptococcal tonsillitis, and peritonsillar and retropharyngeal abscesses in many cases without any aerobic bacteria, their recovery as pathogens in well-established anaerobic infections of the tonsils (Vincent's angina), the increased recovery rate of encapsulated pigmented Prevotella and Porphyromonas spp. in acutely inflamed tonsils, and the response to antibiotics in patients with non streptococcal tonsillitis.

Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever. The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. This is the area in the back of the throat that lies between the voice box and the tonsils.

Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.

Treatment

Treatments to reduce the discomfort from tonsillitis symptoms include:

• pain relief, anti-inflammatory, fever reducing medications (acetaminophen/paracetamol and/or ibuprofen)
• sore throat relief (salt water gargle, lozenges, warm liquids)

If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line. A macrolide such as erythromycin is used for people allergic to penicillin. Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins. When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, symptoms may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment.

Complications

Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.

In very rare cases of strep throat, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations. Tonsillitis associated with strep throat, if untreated, is hypothesized to lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).