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Tonsillitis
Aka: Tonsillitis, Acute Tonsillitis, Exudative Pharyngitis, Acute Exudative Tonsillitis, Acute Catarrhal Tonsillitis
- See Also
- Pharyngitis
- Pharyngitis Causes
- Dysphagia
- Group A Streptococcal Pharyngitis
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Lemierre Syndrome
- Diphtheria
- Chronic Pharyngeal Carriage of Streptococcus pyogenes
- Tonsillectomy Indications
- Symptoms
- See Pharyngitis
- Difficulty taking oral intake
- Difficulty swallowing secretions
- Otalgia (common innervation of ear and throat)
- Signs
- Febrile, appears ill
- Mucus membranes dry
- Tonsils enlarged, beefy red, exudate
- Tender cervical adenopathy
- Splenomegaly in Epstein-Barr Virus
- Differential Diagnosis: Select Causes
- See Pharyngitis Causes for complete Pharyngitis differential
- Viral
- Mononucleosis or Mononucleosis-Like Syndrome (Epstein Barr Virus, Cytomegalovirus)
- Acute HIV Infection
- Herpes Simplex Virus
- Coxsackie Virus A (Hand Foot and Mouth Disease)
- Bacterial
- Group A Streptococcal Pharyngitis (10% of causes)
- See Strep Score (Walsh Pharyngitis Criteria, McIsaac Decision Rule, Modified Centor Criteria)
- Still responsible for Acute Rheumatic Fever worldwide (but significantly reduced in U.S. with treatment)
- Other species of Streptococcus (Group C, G) can also cause Tonsillitis, but do not require treatment
- Staphylococcus aureus
- Hemophilus Influenzae (rare in U.S. given Immunizations)
- Gonorrhea
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Lemierre Syndrome or Fusobacterium Necrophorum (Incidence as high as 21% )
- Diphtheria (rare in U.S. due to Immunizations)
- Ludwig Angina
- Fungal
- Oral Candidiasis (Thrush)
- Other
- Kawasaki Disease
- Labs
- Streptococcal Rapid Antigen Test (with follow-up Throat Culture) or Point-Of-Care GAS Nucleic Acid Amplification Test
- Consider Gonorrhea PCR
- Consider Epstein Barr Virus Infection
- Heterophil agglutination (Monospot Test)
- Peripheral Blood Smear with Atypical lymphocytes
- Liver Function Test Elevation
- Management: General
- See Pharyngitis for symptomatic management
- See Group A Streptococcal Pharyngitis for specific antibiotics for Streptococcal Pharyngitis
- Unresponsive to medications for Pharyngitis
- Consider Pharyngitis Causes
- Consider Point-Of-Care GAS Nucleic Acid Amplification Test
- Consider Monospot
- Consider STD Causes (Gonorrhea, Acute HIV Infection, HSV)
- Consider empiric antibiotics for Lemierre Syndrome (Fusobacterium Necrophorum)
- Consider Clindamycin 300 mg orally four times daily (with or without Dexamethasone 10 mg orally once)
- Assess for Peritonsillar Abscess and Retropharyngeal Abscess
- Assess for Laryngeal pathology (e.g. Epiglottitis, Bacterial Tracheitis)
- Consider ENT referral
- Management: Tonsillectomy for Recurrent Tonsillitis
- See Tonsillectomy Indications
- Prognosis following Tonsillectomy
- Reduces Pharyngitis frequency (esp. Streptococcus)
- Effect lasts 2-3 years after surgery
- Resources
- Tonsillitis (Stat Pearls)
- https://www.ncbi.nlm.nih.gov/books/NBK544342/
- References
- Bartlett (2015) J R Nav Med Serv 101(1):69-73 [PubMed]
- Georgalas (2014) BMJ Clin Evid +PMID: 25051184 [PubMed]