Tonsillitis

Aka: Tonsillitis, Acute Tonsillitis, Exudative Pharyngitis, Acute Exudative Tonsillitis, Acute Catarrhal Tonsillitis

advertisement

II. Definitions

  1. Tonsillitis
    1. Tonsillar Inflammation

III. Epidemiology

  1. Incidence: 0.4% of outpatient clinic visits in U.S.

IV. Pathophysiology

  1. Droplet transmission is primary route of infectious causes

V. Symptoms

  1. Pharyngitis
  2. Difficulty taking oral intake
  3. Difficulty Swallowing secretions
  4. Otalgia (common innervation of ear and throat)

VI. Signs

  1. Fever
  2. Appears ill
  3. Mucus membranes dry
  4. Tonsils enlarged, beefy red, and with exudate
  5. Tender cervical adenopathy
  6. Splenomegaly in Epstein-Barr Virus
  7. Palatal Petechiae in Group A Streptococcal Pharyngitis

VII. Differential Diagnosis: Select Causes

  1. See Pharyngitis Causes for complete Pharyngitis differential
  2. Viral (70 to 95% of cases)
    1. Common viruses (e.g. Rhinovirus, Respiratory Syncytial Virus, Adenovirus, Coronavirus)
    2. Mononucleosis or Mononucleosis-Like Syndrome (Epstein Barr Virus, Cytomegalovirus)
    3. Acute HIV Infection
    4. Herpes Simplex Virus
    5. Coxsackie Virus A (Hand Foot and Mouth Disease)
  3. Bacterial
    1. Group A Streptococcal Pharyngitis (5 to 15% of cases in adults, 15 to 30% of cases in children age 5 to 15 years)
      1. See Strep Score (Walsh Pharyngitis Criteria, McIsaac Decision Rule, Modified Centor Criteria)
      2. Still responsible for Acute Rheumatic Fever worldwide (but significantly reduced in U.S. with treatment)
      3. Other species of Streptococcus (Group C, G) can also cause Tonsillitis, but do not require treatment
    2. Staphylococcus Aureus
    3. Hemophilus Influenzae (rare in U.S. given Immunizations)
    4. Gonorrhea
    5. Peritonsillar Abscess
    6. Retropharyngeal Abscess
    7. Lemierre Syndrome or Fusobacterium Necrophorum (Incidence as high as 21% in young adults)
    8. Diphtheria (rare in U.S. due to Immunizations)
    9. Ludwig Angina
    10. Epiglottitis
  4. Fungal
    1. Oral Candidiasis (Thrush)
  5. Other
    1. Kawasaki Disease

VIII. Labs

  1. Streptococcal Rapid Antigen Test (with follow-up Throat Culture) or Point-Of-Care GAS Nucleic Acid Amplification Test
    1. See Group A Streptococcal Pharyngitis for protocols
  2. Consider Gonorrhea PCR
  3. Consider Epstein Barr Virus Infection
    1. Heterophil Agglutination (Monospot Test)
    2. Peripheral Blood Smear with Atypical lymphocytes
    3. Liver Function Test Elevation

IX. Imaging

  1. Indications: Evaluate for complications (e.g. abscess, Epiglottitis, Lemierre Syndrome, Ludwig Angina)
    1. Hemodynamic instability
    2. Toxic appearance
    3. Inability to swallow oral fluids or control secretions
    4. Trismus
    5. Asymmetric oropharyngeal swelling
  2. Modalities
    1. CT soft tissue neck with contrast

X. Management: General

  1. See Pharyngitis for symptomatic management
  2. See Group A Streptococcal Pharyngitis for specific Antibiotics for Streptococcal Pharyngitis
  3. Consider Dexamethasone single dose orally: 10 mg in adults and 0.6 mg/kg (up to 10 mg) in children
  4. Unresponsive to medications for Pharyngitis
    1. Consider Pharyngitis Causes
    2. Consider Point-Of-Care GAS Nucleic Acid Amplification Test
    3. Consider Monospot
    4. Consider STD Causes (Gonorrhea, Acute HIV Infection, HSV)
    5. Consider empiric Antibiotics for Lemierre Syndrome (Fusobacterium Necrophorum)
    6. Consider Clindamycin 300 mg orally four times daily (with or without Dexamethasone 10 mg orally once)
    7. Assess for Peritonsillar Abscess and Retropharyngeal Abscess
    8. Assess for Laryngeal pathology (e.g. Epiglottitis, Bacterial Tracheitis)
    9. Consider ENT referral

XI. Management: Tonsillectomy for Recurrent Tonsillitis

  1. See Tonsillectomy Indications
  2. Prognosis following Tonsillectomy
    1. Reduces Pharyngitis frequency (esp. Streptococcus)
    2. Effect lasts 2-3 years after surgery

XII. Complications

  1. Peritonsillar Abscess
  2. Retropharyngeal Abscess
  3. Lemierre Syndrome
  4. Group A Streptococcal Pharyngitis Complications
    1. Poststreptococcal Glomerulonephritis
    2. Rheumatic Fever
    3. Scarlet Fever

XIII. Resources

  1. Tonsillitis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK544342/

XIV. References

  1. Bartlett (2015) J R Nav Med Serv 101(1):69-73 [PubMed]
  2. Georgalas (2014) BMJ Clin Evid +PMID: 25051184 [PubMed]
  3. Smith (2023) Am Fam Physician 107(1): 35-41 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Tonsillitis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Ontology: Acute tonsillitis (C0001361)

Definition (NCI) An acute inflammation of the tonsils caused by viruses or bacteria. Signs and symptoms include fever, enlargement of the tonsils, difficulty swallowing, and enlargement of the regional lymph nodes.
Concepts Disease or Syndrome (T047)
ICD9 463
ICD10 J03 , J03.9, J03.90
SnomedCT 195665006, 312424000, 155503001, 195678006, 17741008
English Acute tonsillitis NOS, Acute tonsillitis, unspecified, acute tonsillitis, acute tonsillitis (diagnosis), Tonsillitis acute NOS, Tonsillitis (acute) NOS, Tonsillitis;acute, infective tonsillitis, Acute Tonsillitis, Tonsillitis (& acute) (disorder), Infective tonsillitis (disorder), Acute tonsillitis NOS (disorder), Tonsillitis (& acute), Acute tonsillitis, Infective tonsillitis, Acute tonsillitis (disorder), Tonsillitis acute, Acute tonsillitis, NOS, Tonsillitis, infective
Italian Tonsillite acuta, Tonsillite acuta NAS
Dutch tonsillitis acuut NAO, Acute tonsillitis, Acute tonsillitis, niet gespecificeerd, acute tonsillitis
French Angine aiguë SAI, Amygdalite aiguë
German Tonsillitis akut NNB, Akute Tonsillitis, nicht naeher bezeichnet, Akute Tonsillitis, akute Tonsillitis
Portuguese Amigdalite aguda NE, Amigdalite aguda
Spanish Amigdalitis aguda NEOM, amigdalitis aguda, SAI, amigdalitis aguda, SAI (trastorno), amigdalitis aguda (trastorno), amigdalitis aguda, amigdalitis infecciosa, Amigdalitis aguda
Japanese 急性扁桃炎, 急性扁桃炎ＮＯＳ, ｷｭｳｾｲﾍﾝﾄｳｴﾝNOS, ｷｭｳｾｲﾍﾝﾄｳｴﾝ
Czech Akutní tonzilitida NOS, Akutní tonzilitida
Korean 급성 편도염, 상세불명의 급성편도염
Hungarian acut tonsillitis, Tonsillitis acuta k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Tonsillitis (C0040425)

Definition (MSH) Inflammation of the tonsils, especially the PALATINE TONSILS but the ADENOIDS (pharyngeal tonsils) and lingual tonsils may also be involved. Tonsillitis usually is caused by bacterial infection. Tonsillitis may be acute, chronic, or recurrent.
Definition (MSHCZE) Zánět krčních mandlí. Katarální t. – zarudnutí a zvětšení tonzil. Folikulární t. s tvorbou hnisavých čepů. Lakunární t. s tvorbou splývavých povlaků; původci větš. různé typy virů, často též beta-hemolytické streptokoky (srov. fokální infekce). Monocytární t. – viz infekční mononukleóza. Ulceromembranózní t. – viz Plautova-Vincentova angína. Dalšími typy jsou např. t. při agranulocytóze, herpetiformní t., syfilitická t. apod. Akutní zánět mandlí se označuje jako angína. Chronický zánět bývá následkem jedné nebo více angín, může být zdrojem tzv. fokální infekce. Krypty při chronické t. často obsahují tzv. čepy tvořené zahuštěným hnisem na rozdíl od „povlaků“ při angíně tvořených řídkým hnisem. Větší čep vyvolává pocit cizího tělesa v krku, zpravidla se uvolní spontánně a pacient jej vyplivne. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Concepts Disease or Syndrome (T047)
MSH D014069
SnomedCT 195665006, 90176007
English Tonsillitides, TONSILLITIS, Tonsillar inflammation, tonsillitis (diagnosis), tonsillitis, Tonsillitis NOS, Tonsillitis [Disease/Finding], tonsil inflammation, Inflammation;tonsils, inflammation tonsils, tonsils inflammation, Throat infection - tonsillitis, Inflammation of tonsil, Tonsillitis (disorder), inflammation; tonsil, tonsil; inflammation, Tonsillitis, Tonsillitis, NOS, inflammation of the tonsils
French AMYGDALITE, Amygdalite SAI, Angine, Amygdalite, Inflammation des amygdales, Tonsillite
Portuguese AMIGDALITE, Inflamação amigdalina, Amigdalite NE, Angina Tonsilar, Amigdalite, Tonsilite
Spanish AMIGDALITIS, Inflamación tonsilar, Amigdalitis NEOM, tonsilitis, Amigdalitis, amigdalitis (trastorno), amigdalitis, Tonsilitis
German TONSILLITIS, Tonsillitis NNB, Mandelentzuendung, Tonsillitis, Gaumenmandelentzündung, Mandelentzündung
Dutch tonsillitis NAO, ontsteking van amandelen, ontsteking; tonsil, tonsil; ontsteking, tonsillitis, Tonsillitis
Italian Infiammazione tonsillare, Tonsillite NAS, Tonsillite
Japanese 扁桃の炎症, 扁桃炎, 扁桃炎ＮＯＳ, ﾍﾝﾄｳｴﾝNOS, ﾍﾝﾄｳｴﾝ, ﾍﾝﾄｳﾉｴﾝｼｮｳ
Swedish Halsfluss
Czech tonzilitida, angína, Zánět mandlí, Tonzilitida NOS, Tonzilitida, tonsilitida
Finnish Tonsilliitti
Russian TONZILLIT, ТОНЗИЛЛИТ
Croatian TONZILITIS
Polish Zapalenie migdałków podniebiennych
Hungarian Mandulagyulladás, tonsillitis k.m.n., tonsillitis
Norwegian Tonsillitt, Halsbetennelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Acute catarrhal tonsillitis (C0396012)

Concepts Disease or Syndrome (T047)
SnomedCT 195669000
English Acute catarrhal tonsillitis (diagnosis), tonsillitis acute catarrhal, Acute catarrhal tonsillitis, Acute exudative tonsillitis, Acute catarrhal tonsillitis (disorder)
Spanish amigdalitis catarral aguda (trastorno), amigdalitis catarral aguda, amigdalitis exudativa aguda (trastorno), amigdalitis exudativa aguda
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Exudative pharyngitis (C0747555)

Concepts Disease or Syndrome (T047)
SnomedCT 126664009
English Exudative pharyngitis (disorder), Exudative pharyngitis
Spanish faringitis exudativa (trastorno), faringitis exudativa
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Throat Disease

advertisement

2025 Family Practice Notebook, LLC. Terms | Privacy | About | Site Map | Newsletter | Blog

Footer Site Logo