Tonsilitis Flashcards

1
Q

Define tonsilitis

A

Acute infection of the parenchyma of the palatine tonsils

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2
Q

What are the causes of tonsilitis

A

Viral: rhinovirus, coronavirus, adenovirus
Infectious mononucleosis (EBV)

Bacterial (10-30%): Group A beta-haemolytic streptococci (s. pyogenes), mycoplasma pneumoniae, neisseria gonorrhoea, other steptococci

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3
Q

What are the risk factors for tonsilitis

A

5-15
Contact with infected people in enclosed spaces e.g. child care centre, schools, prison
Sexually active adolescents, particularly engaging in oral sex (N. gonorrhoea)
Winter/Spring

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4
Q

What causes children to get obstructive sleep apnoea

A

Tonsils and adenoids increase in size until 8 years old, then gradually regress.
In young children, the adenoids grow proportionately faster than their airway, which can lead to narrowing of the airway from 2-8yo.
Airway narrowing can lead to obstructive sleep apnoea (OSA),

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5
Q

What are the symptoms of tonsilitis

A

Sore throat
Pain on swallowing (odynophagia)
Sudden onset
Fever >38
Headache
Abdominal pain
Nausea and vomiting
Cough or runny nose

± symptoms of dehydration (reduced wet nappies, reduced feeds/fluids)

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6
Q

What are the differentials for tonsilitis

A

Infectious mononucleosis
Scarlet fever
Epiglottitis
Peri-tonsilar abscess (quinsy)
retropharyngeal abscess
Gonococcal pharyngitis
Diphtheria

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7
Q

What are the signs of tonsilitis on exam

A

General
? dehydration: reduced skin turgor, prolonged CRT, dry mucous membranes, sunken eyes

ENT
Tonsillar exudate, erythema and enlargement

Lymph node
Enlarged, painful anterior cervical lymph nodes

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8
Q

What investigations should be done for tonsilitis

A

Not required but can be done for those who need diagnosis e.g. rheumatic fever, very young, immunosuppression, severe symptoms

Throat swab for culture
Rapid streptococcal antigen test: positive for GAS

FBC: raised neutrophils (bacterial), lymphocytes (Infectious mono)

Cervical x-ray: assess for retropharyngeal and oropharyngeal enlargement

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9
Q

Describe the FeverPAIN score for tonsilitis

A

score 1 point for each (maximum score of 5)
* Fever over 38°C.
* Purulence (pharyngeal/tonsillar exudate).
* Attend rapidly (3 days or less)
* Severely Inflamed tonsils
* No cough or coryza

A score of 0 or 1 is associated with a 13% to 18% likelihood of isolating streptococcus.
A score of 2 or 3 is associated with a 34% to 40% likelihood of isolating streptococcus.
A score of 4 or 5 is associated with a 62% to 65% likelihood of isolating streptococcus.

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10
Q

Describe the centor criteria for tonsilitis

A

Score 1 point for each:
* Tonsillar exudate
* Tender anterior cervical lymphadenopathy or lymphadenitis
* History of fever (over 38°C)
* Absence of cough

A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating streptococcus.
A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.

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11
Q

What is the management for tonsilitis (non-severe)

A

Supportive:
Ensure adequate fluid intake
Ibuprofen and paracetamol for symptomatic relief
Salt water gargling
Lozenges
Avoid hot water drinks
School exclusion until after fever has resolved and no longer unwell OR Abx for 24h

GAS confirmed OR high risk (FeverPAIN/Centor) → Antibiotics: phenoxymethylpenicillin oral course 10 days (PenAll: clarithromycin), unable to swallow → single IM

Swelling or upper airway limitation: corticosteroids
Recurrent: tonsillectomy

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12
Q

What features of tonsilitis would suggest need for hospital admission

A

Breathing difficulty.
Clinical dehydration.
Peri-tonsillar abscess or cellulitis, parapharyngeal abscess, retropharyngeal abscess, or Lemierre syndrome (as there is a risk of airway compromise or rupture of the abscess).
Signs of marked systemic illness or sepsis.
A suspected rare cause such as Kawasaki disease, diphtheria, or yersinial pharyngitis.

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13
Q

When is a tonsillectomy indicated

A

Recurrent tonsilitis (7 or more episodes in 12 months, 5 or more in each of the 2 previous years, 3 or more in each of the previous 3 years)
Complications develop e.g. quinsy
Sleep disordered breathing e.g. OSA

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14
Q

What safety netting should be done for tonsilitis

A

Seek advice if:
Symptoms do not improve after 3-4 days of Abx therapy
Pain does no improve and/or fever >38
Difficult to swallow saliva or liquids
Difficulty in breathing
One-sided throat swelling

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15
Q

What are the complications of tonsilitis

A

Scarlet fever
Acute sinusitis
Acute otitis media
Peri-tonsillar or neck abscess (quinsy)
Acute rheumatic fever
Acute post-strep glomerulonephritis
Streptococcal toxic shock syndrome
Obstructive sleep apnoea
PANDAS syndrome

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16
Q

What is the prognosis for tonsilitis

A

Acute tonsillitis is an acute, self-limiting infective condition that normally resolves completely within 1 week with no sequelae.

May be more severe in infants → admission to hospital may be advisable