Tonsilitis Flashcards
(12 cards)
Definition
Inflammation of the parenchyma of the palatine tonsils
Epidemiology
Young age: 5-15 years
Infected contacts: school-age child often in close contact with others
Aetiology
Viral tonsillitis:
- Rhinovirus (MC),
- Coronavirus,
- Adenovirus
Bacterial tonsillitis:
- group A beta-haemolytic streptococci (strep pyogenes)
- staph aureus (recurrent tonsillitis due to its anti microbial resistance)
Non-infectious tonsillitis:
- GORD
- Chronic cigarette smoke
- Hayfever
Signs
- Pyrexia: Usually >38 °C
- Tonsillar exudate with enlargement and erythema of the tonsils
- Anterior cervical lymphadenopathy
- Evidence of dehydration if reduced oral intake: e.g. reduced skin turgor, dry mucous membrane
Symptoms
- Sore throat
- Pain on swallowing
- Fever
- Non-specific symptoms:
= headache
= nausea + vomiting
Characteristic features of tonsillitis
- Pharyngitis
- Fever
- Malaise
- Lymphadenopathy
Symptoms often last around 1 week
Diagnosis
Primarily a clinical diagnosis
- GOLD STANDARD: Throat culture = associated with delay in receiving results (>48 hours) limits its utility
- Rapid group A streptococcus antigen test: less sensitive but is useful as offers immediate results
= Only performed if the diagnosis of GAS must be confirmed with certainty e.g high risk of rheumatic fever, vulnerable people (extremes of age) or immunosuppressed
= negative result with suspected GAS requires a throat culture
FeverPAIN criteria
Scored between 0 - 5
- Fever over 38 °C
- Purulence (pharyngeal or tonsillar exudate)
- Attend rapidly (3 days or less)
- Severely inflamed tonsils
- No cough or coryza
Score: Likelhood of streptococcal infection
0-1 = 13 - 18%
2 - 3 = 34 - 40%
4 - 5 = 62 - 65%
Centor clinical prediction score
Score between 0-4
- Presence of tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever
- Absence of cough
Score: Likelihood of streptococcal infection
0 - 2 = 3 - 17%
3 - 4 = 32 - 56%
Management
- FeverPAIN (0-1) or Centor (0 - 2) = Discharge with conservative management (analgesia and adequate fluids)
- FeverPAIN (4 - 5) or Centor (3 - 4) Consider antibiotics:
= FIRST LINE: PHENOXYMETHYLPENICILLIN for 5-10 days
= Penicillin allergy: CLARITHROMYCIN or ERYTHROMYCIN for 5 days (5 - 10 days in children)
(Abx may be considered in middle scores as delayed Abx if fever pain 2-3)
Hospital admission
- Inability to swallow
- Breathing difficulty
- Clinical dehydration
- Peri-tonsillar abscess
- Retropharyngeal abscess or sepsis
Corticosteroids: oral prednisolone or IV/IM dexamethasone may be appropriate if there are severe clinical features e.g.
- significant oropharyngeal swelling,
- upper airway limitation
- inability to tolerate any oral intake.
Complications
- Acute otitis media: MC complications
- Peri-tonsillar abscess (quinsy): local abscess formation due to bacterial tonsillitis, assosciated with ‘hot potato’ voice, trismus (‘lockjaw’) and uvula displacement to the unaffected side
- Parapharyngeal abscess
- Acute rheumatic fever: very rare complication but should be considered as an indication for rapid antigen testing in at risk groups
- Acute post-streptococcal glomerulonephritis: rare complication
