Tonsillitis – common diseases in changing seasons

Estimated reading time: 5 minutes

1. Introduction

Tonsillitis is a common condition characterized by inflammation of the tonsils, two oval-shaped lymphatic tissues located at the back of the throat. It can affect individuals of all ages but is most common in children. Tonsillitis can be caused by viral or bacterial infections and often results in sore throat, difficulty swallowing, and swollen glands.

2. Causes of Tonsillitis

Tonsillitis can result from a variety of viral and bacterial infections, with the most common causes being:

2.1 Viral Infections:

• Viral infections are responsible for approximately 70% to 95% of tonsillitis cases (Smith et al., 2023).
• Common viruses include Epstein-Barr virus (causing mononucleosis), adenovirus, rhinovirus, influenza virus, and cytomegalovirus (Georgalas et al., 2009).

2.2 Bacterial Infections:

• Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes, is the leading bacterial cause (Sidell & Shapiro, 2012).
• Bacterial infections account for 5% to 15% of adult cases and 15% to 30% in children (Smith et al., 2023).
• Other bacterial causes include Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis (Loganathan et al., 2006).

2.3 Risk Factors:

• Young age (children are more susceptible).
• Frequent exposure to infectious agents in schools or daycare settings.
• Weakened immune system (CDC, 2023) (WHO, 2023).

3. Symptoms of Tonsillitis

Common symptoms include:

• Severe sore throat
• Swollen and red tonsils
• White or yellow patches on the tonsils
• Difficulty swallowing
• Swollen lymph nodes in the neck
• Fever and chills
• Bad breath
• Ear pain

4. Diagnosis of Tonsillitis

Accurate diagnosis of tonsillitis is crucial for appropriate treatment.

4.1 Physical Examination:

• A visual inspection of the throat, tonsils, and neck glands.
• Symptoms like red, swollen tonsils with white or yellow patches are key indicators (Windfuhr et al., 2016).

4.2 Throat Swab Test:

• A throat swab is performed to identify bacterial causes, specifically Group A Streptococcus.
• Rapid Antigen Detection Test (RADT) can quickly identify bacterial presence but has low sensitivity (Georgalas et al., 2014).

4.3 Blood Tests:

• In cases of suspected viral infections like Epstein-Barr virus, blood tests (e.g., Monospot Test) may be conducted (Sidell & Shapiro, 2012).
• Blood tests can also help rule out other underlying causes.

4.4 Clinical Scoring Systems:

Centor Score and McIsaac Score are used to estimate the likelihood of bacterial infection and guide antibiotic prescription (Windfuhr et al., 2016).

5. Treatment of Tonsillitis

Treatment for tonsillitis varies based on whether the infection is viral or bacterial and the severity of symptoms. Effective treatment aims to relieve symptoms, reduce the duration of illness, and prevent complications.

5.1 Viral Tonsillitis:

• Supportive Care: Since antibiotics are not effective against viral infections, treatment focuses on symptom relief.
  • Adequate hydration.
  • Plenty of rest.
  • Over-the-counter medications such as ibuprofen or acetaminophen to reduce fever and throat pain.
  • Throat lozenges and warm teas can provide temporary relief.
• Duration: Symptoms typically resolve within 7 to 10 days.

5.2 Bacterial Tonsillitis:

• Antibiotics: Penicillin remains the first-line antibiotic for Group A Streptococcus infections.
• Alternative antibiotics include amoxicillin, cephalosporins, or macrolides (e.g., erythromycin) for those allergic to penicillin (Windfuhr et al., 2016).
• Treatment Duration: A full course of antibiotics (usually 10 days) is essential to prevent complications.
• Symptom Relief: Pain management through over-the-counter pain relievers and hydration.

5.3 Chronic or Recurrent Tonsillitis:

• Surgical Intervention (Tonsillectomy): Recommended in cases of recurrent infections, particularly if:
  • Seven or more episodes occur in one year.
  • Five or more episodes per year occur over two consecutive years.
  • Symptoms significantly impact daily activities.
• Post-Surgical Care: Includes hydration, soft diet, pain control, and avoidance of physical strain.

5.4 Emergency Situations:

• Hospitalization may be required in cases of severe tonsillitis leading to complications such as peritonsillar abscess or breathing difficulties.
• Intravenous antibiotics and fluids might be administered in severe bacterial infections.

5.5 Preventive Measures During Treatment:

• Regular handwashing to prevent the spread of infection.
• Avoiding close contact with others until the contagious period has passed.
• Completing the full course of prescribed antibiotics.

Early diagnosis and adherence to treatment protocols are essential for minimizing complications and preventing recurrence.

6. Home Remedies for Tonsillitis Relief

• Drinking warm liquids like tea with honey
• Gargling with salt water
• Using throat lozenges
• Staying hydrated
• Getting plenty of rest

7. Complications of Untreated Tonsillitis

• Peritonsillar abscess
• Difficulty breathing
• Obstructive sleep apnea
• Spread of infection to surrounding tissues

8. Prevention of Tonsillitis

• Practice good hand hygiene.
• Avoid close contact with infected individuals.
• Avoid sharing personal items.
• Ensure regular dental hygiene.
• Stay up-to-date with vaccinations.
• Encourage a balanced diet.
• Manage stress effectively

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