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Tonsillitis

Overview
  • Definition: Inflammation of the palatine tonsils located at the back of the throat.
Classification
  • Acute Tonsillitis: Sudden onset, typically resolving within a few days to a week.
  • Chronic Tonsillitis: Recurrent episodes over a prolonged period.
Aetiology/ Causes
  • Viral: Adenovirus, rhinovirus, Epstein-Barr virus (EBV), influenza virus.
  • Bacterial: Most commonly Group A beta-haemolytic Streptococcus (GABHS or Streptococcus pyogenes).
Clinical Features
  • Throat: Sore throat, dysphagia, odynophagia.
  • General: Fever, malaise, headache.
  • Enlarged and erythematous tonsils, possibly with exudate.
  • Cervical lymphadenopathy.
  • Bad breath (halitosis).
Investigations
  • Not usually required but can include:
    • Monospot Test: If infectious mononucleosis (caused by EBV) is suspected.
    • Full blood count (can show raised white cell count in bacterial infections).
Management
  • Conservative: hydration.
  • Medical:
    • Analgesia (e.g, paracetamol, ibuprofen).
    • Antibiotics (e.g, penicillin) if bacterial cause confirmed or highly suspected. Important for preventing complications such as rheumatic fever.
  • Surgical: Tonsillectomy may be considered in recurrent or chronic tonsillitis.
Complications
  • Peritonsillar abscess (quinsy).
  • Spread of infection to nearby tissues (e.g., retropharyngeal abscess).
  • Rheumatic fever (following GABHS infections).
  • Glomerulonephritis.
Key Points
  • Tonsillitis can be caused by both viruses and bacteria, with the latter often requiring antibiotic treatment.
  • It’s crucial to differentiate bacterial from viral causes to guide treatment.
  • Chronic or recurrent tonsillitis may necessitate a tonsillectomy.

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