Tonsillitis

Question 1

What is tonsillitis?

Answer 1

Infection of the tonsils

Question 2

What are the common causes for tonsillitis?

Answer 2

Normally due to viral infections

• rhinovirus
• coronavirus
• adenovirus

Might be caused by bacterial infection (rarer) (10-30% of cases)

• Streptococcal disease (A beta-haemolytic streptococci (GABHS) –> streptococcus pyogenes
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Question 3

What are the risk factors for developing tonsillitis?

Answer 3

1. Age between 5-15 Years
2. contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)
   
   • normally infectous in both, viral and bacterial disease

Question 4

What are the presenting symptoms of someone with tonsilitis?

Answer 4

• Sudden onset
  
  • Sore throat
  • dysphagia
  • Fever
• Painful lumbs on neck
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Question 5

What are signs on examination of acute tonsillitits?

Answer 5

• Foul breath
• lymphadenopathy in neck
• Red, swollen pharynx
• with Visible exudate on tonsills
• If Viral
  
  • headache
  • earache
  • nasal congestion
  • cough

Question 6

How can you differentiate between viral and bacterial tonsilltits?

Answer 6

FeverPAIN criteria are: score 1 point for each (maximum score of 5)

1. Fever over 38°C.
2. Purulence (pharyngeal/tonsillar exudate).
3. Attend rapidly (3 days or less)
4. Severely Inflamed tonsils
5. No cough or coryza
   
   • the higher the score, the higher the likelyhood of bacterial tonsillitis

Question 7

Which investigations would you consider in a patient with suspected tonsillitis?

Answer 7

Normally diagnosis done clincally but additional might be:

• throat culture
• rapid streptococcal antigen test

Question 8

How would you treat an acute tonsillitis?

Answer 8

Normally self limiting –> symptomatic approach

• salt-water gurgeling
• analgesia

If indicative of streptococcal disease

• Analgesia
• ABX (10 days phenoxymethylpenicillin)
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Question 9

What is the epidemiology of tonsillitis?

Answer 9

• 10% of GP patients sore throat
• more common between children between 5-15
• normally seen in winter and early spring
  
  • might occur any time of year

Question 10

When would you consider secondary care referral in a person with Tonsilllitis?

Answer 10

1. Drooling with respiratory distress warrants referral for hospital admission. Possible causes include epiglottitis in a child and peri-tonsillar abscess (quinsy).
2. Severe dehydration with difficulty taking oral fluids warrants referral for rehydration.
3. Peri-tonsillar abscess warrants hospital admission as there is a risk of airway compromise or rupture of the abscess and consequent sepsis.
4. Suspected Kawasaki disease warrants hospital admission for assessment and specialist management.