Tonsillitis

• What is tonsillitis?


  Form of pharyngitis

  Acute inflammation of tonsils, often with purulent exudate present in bacterial tonsillitis
• What are the most common causative organism for tonsillitis?

  Streptococcus pyogenes (Group A streptococcus)

  EBV
• What are the RFs of tonsillitis?


  Age 5-15 yrs

  Immunodeficiency

  FHx of tonsillitis

  Close contact with an infected individual
• What are the signs & symptoms of tonsillitis?


  Sore throat -> may also be referred pain in ears of headache

  Changes to sound of child's voice of cry

  Purulent & inflamed tonsils

  Lymphadenopathy
• What are the DDx of tonsillitis?


  Bacterial tonsillitis

  Viral tonsillitis

  Infectious mononucleosis (glandular fever)

  Hand, foot & mouth disease
• What are the Inx for tonsillitis?


  Obs

  Full Hx & examination

  Throat swab

  Monospot test -> for glandular fever
• What criteria can be used to indicate the likelihood of a sore throat being due to bacterial infection?

  CENTOR criteria

  • tonsillar exudate
  • tender anterior cervical lymphadenopathy
  • fever over 38
  • absence of cough

  Each criteria = 1 point

  Results

  • 0-2 = 3-17% likelihood of isolating Streptococcus (viral)
  • 3-4 = 32-56% likelihood of isolating Streptococcus (bacterial)
• What is the management of tonsillitis?

  Bacterial (CENTOR score 3/4) or evidence of systemic upset/immunosuppression

  • Penicillin V PO QDS for 5-10 days
  • Clarithromycin/erythromycin PO BD for 5 days

  Viral (CENTOR score 0-2)

  • advice Abx not needed
  • conservative management (paracetamol & adequate fluid intake)

  If child systemically very unwell or has severe complications -> consider referral to hospital
• What are the possible complications of tonsillitis?

  Quinsy (peritonsillar abscess)

  Acute otitis media

  If tonsillitis is due to Group A beta haemolytic step...

  • rheumatic fever
  • Syndenham's chorea
  • Glomerulonephritis
  • Scarlet fever
• Tonsillitis is usually self-resolving within 3-4 days.
• What are the indications of tonsillectomy?


  Severe recurrent tonsillitis (more than 7 episodes/year for one year, more than 5 episodes/year for two years and more than 3 episodes per year for 3 years)