Acute tonsillitis

Fig.1: Acute tonsillitis

Tonsillitis occurs mainly in the winter months and spring. It is transmitted by hand contact, saliva and nasal secretions. It can be caused by viruses, bacteria, and very rarely and under special conditions, fungi. The incubation time is 24 to 72 hours.

Viral tonsillitis – Acute angina

The most common possible pathogenic viruses are rhinoviruses, adenoviruses, influenza and parainfluenza viruses. It is the 70% of inflammation of the parsthominal tonsils.

The disease presents with pharyngodynia and dysphagia, low fever movement and malaise. Symptoms of the common cold coexist, such as rhinitis, hoarseness, conjunctivitis and cough, and is accompanied by arthralgias and myalgias. Swollen cervical lymph nodes may be present, depending on the nature of the virus causing the infection.

During the clinical examination, the presence of swollen parotid tonsils is established, without presence of smears, with intense hyperemia and accompanying redness of the pharynx.

Treatment is symptomatic with plenty of fluids, analgesics/anti-inflammatories and rest.

Acute microbial tonsillitis – Streptococcal tonsillitis

The most common microbial causative agent is Group A β-haemolytic streptococcus (GABHS) the pyogenic streptococcus.

The onset of the disease is acute, with fever, malaise and headache, while the main symptom is pharyngodynia. The pain worsens with swallowing and may spread to the ears and neck. The patient presents with painful anterior cervical lymph nodes, while voice alteration and halitosis coexist.

During the clinical examination, the presence of enlarged parotid tonsils, strongly hyperemic, with spotted or diffuse whitish exudate is noted. The general blood count will show an increase in white blood cells, polymorphonuclear type, while the indicators of inflammation will also increase.

The diagnosis of streptococcal acute pharyngotonsillitis can be confirmed by the combination of the strep-test and a tonsil secretion culture, upon a negative strep-test result. However, the clinical diagnosis is based on the search for the four Centor criteria. (Table 1 & 2)

Although the disease is self-infectious, it is recommended to take antibiotic treatment to avoid complications and shorten the period of illness, based on the instructions of the attending physician. Taking plenty of fluids, anti-inflammatory/anti-inflammatory drugs and rest are essential complementary/supportive treatment measures.

Centor criteriaGrades
Discharge in the tonsils1
Tender, swollen anterior cervical lymph nodes1
Absence of cough and rhinitis1
Fever > 38TheC1
Table 1: Classic Centor criteria*
2Strep testIf (+) antibiotic administration
Strep test
Empirical antibiotic treatment
Administration of treatment only if the Strep-test is positive
4NoEmpirical antibiotic treatment
Table 2: Treatment of pharyngitis, based on the Centor criteria*

* Table 1 & 2, are from the guidelines for the diagnosis and treatment of KEELPNO infections

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