Tonsillitis

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Tonsillitis
Classification and external resources
File:Tonsillitis.jpg
Enlarged, red tonsils and exudative white patches of tonsillitis
ICD-10 J03., J35.0
ICD-9 463
DiseasesDB 13165
eMedicine article/871977
MeSH D014069

Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While viral tonsillitis must resolve on its own, tonsillitis caused by bacteria is treatable with antibiotics, which usually resolves symptoms in two to three days.

Symptoms

Common symptoms of tonsillitis include:[1][2][3][4]

  • red and/or swollen tonsils
  • white or yellow patches on the tonsils
  • tender, stiff, and/or swollen neck
  • bad breath
  • sore throat
  • painful or difficult swallowing
  • cough
  • headache
  • sore eyes
  • body aches
  • fever
  • chills
  • nasal congestions

Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. [5]

Causes

The most common causes of tonsillitis are the common cold viruses (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus).[1][4][3][2] It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV.[1][4][3][2] The second most common causes are bacterial. The most common bacterial cause is Group A β-hemolytic streptococcus (GABHS), which causes strep throat.[1][4][3][2] Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.[1][4][3][2]

Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils.[6][7] Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever.[6][7] The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx.[8] This is the area in the back of the throat that lies between the voice box and the tonsils.

Tonsillitis may be caused by Group A streptococcal bacteria,[9] resulting in strep throat.[9] Viral tonsillitis may be caused by numerous viruses[9] such as the Epstein-Barr virus[9] (the cause of infectious mononucleosis)[10] or adenovirus.[9]

Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.[11]

Treatment

Palliative treatments to reduce the discomfort from tonsillitis symptoms include:[1][4][3][2][12][13][14]

  • pain relief, anti-inflammatory, fever reducing medications (acetaminophen, ibuprofen, aspirin)
  • sore throat relief (salt water gargle, lozenges, warm liquids)
  • hydration
  • rest

If the tonsillitis is caused by bacteria, then antibiotics are prescribed, with penicillin being most commonly used.[15] Erythromycin and Clarithromycin are used for patients allergic to penicillin. When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, some rare infections may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment[16].

Complications

The most common complications of Tonsillitis are dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.[4][1][3][2][12]

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[17][18][19] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.

In very rare cases of strep throat, diseases like rheumatic fever[20] or glomerulonephritis[21] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[22][23] Tonsillitis associated with strep throat, if untreated, can also lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).[24]

See also

References

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External links


Acute
Chronic
Processes
Specific types
ar:التهاب اللوزتين

az:Angina bg:Ангина ca:Amigdalitis cs:Angína da:Halsbetændelse de:Tonsillitis dv:ޓޮންސިލް ދުޅަވުން el:Αμυγδαλίτιδα es:Amigdalitis eo:Tonsilito eu:Amigdalitis fr:Angine ko:편도염 hr:Tonzilitis id:Radang amandel it:Tonsillite nl:Tonsillitis ja:扁桃炎 pl:Angina pt:Tonsilite qu:Amuqlli unquy ru:Ангина simple:Tonsilitis sr:Упала крајника sv:Halsfluss ta:அடிநா அழற்சி tr:Tonsilit uk:Гострий тонзиліт yi:אנגינע

zh:扁桃體炎
  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Tonsillopharyngitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch090/ch090i.html. Accessed July 26, 2010.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Wetmore RF. Tonsils and adenoids. In:Bonita F. Stanton; Kliegman, Robert; Nelson, Waldo E.; Behrman, Richard E.; Jenson, Hal B. (2007). Nelson textbook of pediatrics Robert M. Kliegman, Richard E. Behrman, Hal B. Jenson, Bonita F. Stanton. Philadelphia: Saunders. ISBN 1-4160-2450-6. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Thuma P (2001). Pharyngitis and tonsillitis. In:Hoekelman, Robert A. (2001). Primary pediatric care. St. Louis: Mosby. ISBN 0-323-00831-3. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Simon HB (2006). Bacterial infections of the upper respiratory tract. In: Dale, David (2005). ACP Medicine, 2006 Edition (Two Volume Set) (Webmd Acp Medicine). WebMD Professional Publishing. ISBN 0-9748327-6-6. 
  5. ↑ Tonsillitis and Adenoid Infection MedicineNet. Retrieved on 2010-01-25
  6. ↑ 6.0 6.1 Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
  7. ↑ 7.0 7.1 Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
  8. ↑ Tonsillitis Overview Medline Plus. Retrieved on 2010-01-25
  9. ↑ 9.0 9.1 9.2 9.3 9.4 Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520. 
  10. ↑ Renn CN, Straff W, Dorfmüller A, Al-Masaoudi T, Merk HF, Sachs B (2002). "Amoxicillin-induced exanthema in young adults with infectious mononucleosis: demonstration of drug-specific lymphocyte reactivity". Br. J. Dermatol. 147 (6): 1166–70. doi:10.1046/j.1365-2133.2002.05021.x. PMID 12452866.  -Renn studied 4 patients who where treated amoxicillin for throat infection and lymphadenopathy. Infectious mononucleosis was present in the patient’s blood due to trace of Epstein-Barr antibodies. The three tests performed where the patched test, intracutaneous test, and lymphocyte transformation test. The results of the patched test assas the caused of their rash were 1 out of 4 patients. The intracutaneous showed 2 out of 4 patients with positive results that pointed to amoxicillin. The LTT results showed 3 out of 4 that pointed to amoxicillin
  11. ↑ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]". Acta Otorhinolaryngol Belg (in Dutch; Flemish). 30 (3): 334–45. PMID 1015288.  - fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta
  12. ↑ 12.0 12.1 Medline Plus, http://www.nlm.nih.gov/medlineplus/ency/article/001043.htm
  13. ↑ Boureau, F.; et al. (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation. 17: 1–8. doi:10.2165/00044011-199917010-00001. 
  14. ↑ Praskash, T.; et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic. 98: 124–127. 
  15. ↑ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378. 
  16. ↑ Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. 
  17. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found. - notes though that these criteria "have been arrived at arbitrarily" from:
    Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. 
  18. ↑ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics. 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941.  - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
  19. ↑ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch (in German). 61 (5): 325–8. PMID 15195718.  - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
  20. ↑ Del Mar CB, Glasziou PP, Spinks AB (2004). "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140.  - Meta-analysis of published research
  21. ↑ Zoch-Zwierz W, Wasilewska A, Biernacka A; et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]". Wiad. Lek. (in Polish). 54 (1-2): 56–63. PMID 11344703. 
  22. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found. - Canadian Medical Association Journal commentary on Cochrane analysis
  23. ↑ Danchin, MH; Curtis, N; Nolan, TM; Carapetis, JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA. 177 (9): 512–515. PMID 12405896.  - Medical Journal of Australia commentary on Cochrane analysis
  24. ↑ American Academy of Pediatrics (2006). Group A streptococcal infections. In: Pickering, Larry K. (2006). Red Book: 2006 Report of the Committee on Infectious Diseases (Red Book Report of the Committee on Infectious Diseases). Amer Academy of Pediatrics. ISBN 1-58110-194-5. 
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