Tuesday, 16 July 2013

What is Tonsillitis Clinical Features and Treatment


Tonsillitis

 



Key points
  • Acute bacterial or viral infection causing inflammation of the palatine tonsils. Infection may also affect the pharyngeal tonsils or adenoids
  • There are 4 types of tonsillar disease: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
  • Diagnosis is clinical. On examination, ensure that the airway is not obstructed by tonsils. A gray exudate may indicate diphtheria, an important differential diagnosis
  • Treatment for streptococcal tonsillitis is penicillin V, or erythromycin in penicillin-allergic patients
  • Other complications of untreated tonsillitis include rheumatic fever
Take urgent action:
  • If breathing is severely affected by possible obstruction or if epiglottitis is suspected
  • If fever exceeds 104°F (40°C)
  • If gray exudate is present and points to diphtheria, hospitalization, isolation, and notification of public health officials is required
  • Urgent surgical drainage is indicated if peritonsillar abscess (ie, quinsy) or parapharyngeal abscess is diagnosed
  • Severe infections require hospitalization and intravenous antibiotics
  • Inability to swallow can lead to dehydration; treat with intravenous fluid

Description

  • Acute bacterial or viral infection causing inflammation of the palatine tonsils. The tonsils are large, fleshy, oval masses of tissue that lie in the lateral wall of the oral pharynx
  • Infection may also affect the pharyngeal tonsils or adenoids, similar masses of tissue located between the back of the nose and the throat
  • Four types of tonsillar disease exist: acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsillar hyperplasia
  • Features:
    • Fever that can be as high as 104°F (40°C)
    • Sore throat that may impair swallowing
    • Patients with acute tonsillitis often have sore throat, fever, dysphagia, tender cervical lymphadenopathy, and erythematous/exudative tonsils
    • Patients may also report otalgia, headache, and vomiting
    • Tonsillitis and pharyngitis can occur simultaneously

Epidemiology

Incidence
  • Peaks in winter and early spring
Demographics
Age:
  • Most common in children aged 6 to 12 years; however, all ages are affected
  • Tonsillitis in children aged less than 3 years is rare and usually of viral etiology
Gender:
  • Affects male and female population equally
Socioeconomic status:
  • Further spread of infection may occur from cramped living, traveling, or working conditions

Causes and risk factors

Causes:
  • Influenza A and B viruses
  • Respiratory syncytial virus (RSV)
  • Adenovirus
  • Streptococcus groups A and G, group A ß-hemolytic streptococci
  • Epstein-Barr virus
  • Herpes simplex
  • Neisseria gonorrhoeae
  • Serious causes:
    • Epstein-Barr virus and Neisseria gonorrhoeae
    • Staphylococcus aureus
    • Mycoplasma pneumoniae
    • Chlamydia pneumoniae
Contributory or predisposing factors:
  • Enhanced spread of infection due to cramped living, traveling, or working conditions
  • Repeat attacks are often caused by reinfection by family members or close contacts
  • Also common in school populations; viral tonsillitis is common in the military and closed communities

Associated disorders

  • Acute pharyngitis
  • Acute adenoiditis
  • Acute laryngitis
  • Infectious mononucleosis
  • Thyroiditis
  • Otitis media

Screening

Not applicable.

Primary prevention

Summary approach

Tonsillectomy eliminates risk of recurrent infections.

Preventive measures

  • Smoking cessation reduces the risk of tonsillitis and may help reduce severity of throat infections
  • Excessive alcohol intake should be discontinued
  • Inappropriate or ineffective antibiotic use may increase resistance