Treatment efforts involve improving symptoms and decreasing complications.[5]Paracetamol (acetaminophen) andibuprofen may be used to help with pain.[1][5] If strep throat is present the antibioticpenicillin by mouth is generally recommended.[1][5] In those who are allergic to penicillin,cephalosporins ormacrolides may be used.[1][5] In children with frequent episodes of tonsillitis,tonsillectomy modestly decreases the risk of future episodes.[13]
About 7.5% of people have a sore throat in any three-month period and 2% of people visit a doctor for tonsillitis each year.[7] It is most common in school-aged children and typically occurs in the colder months of autumn and winter.[5][6] The majority of people recover with or without medication.[1][5] In 82% of people, symptoms resolve within one week, regardless if bacteria or viruses were present.[4] Antibiotics probably reduce the number of people experiencing sore throat or headache, but the balance between modest symptom reduction and the potential hazards ofantimicrobial resistance must be recognised.[4]
Many viral infections that cause tonsillitis will also cause cough,runny nose,hoarse voice, or blistering in the mouth or throat.[17]Infectious mononucleosis can cause the tonsils to swell with redspots or white discharge that may extend to the tongue.[18] This can be accompanied by fever, sore throat, cervical lymph node swelling, and enlargement of the liver and spleen.[18] Bacterial infections that cause tonsillitis can also cause a distinct"scarletiniform" rash, vomiting, and tonsillar spots or discharge.[1][17]
Anaerobic bacteria have been implicated in tonsillitis, and a possible role in the acute inflammatory process is supported by several clinical and scientific observations.[25]
There is no firm distinction between a sore throat that is specifically tonsillitis and a sore throat caused by inflammation in both the tonsils and also nearby tissues.[1][31] Anacute sore throat may be diagnosed astonsillitis,pharyngitis, ortonsillopharyngitis (also called pharyngotonsillitis), depending upon the clinical findings.[1]
Throat swab
Inprimary care settings, theCentor criteria are used to determine the likelihood of group A beta-hemolytic streptococcus (GABHS) infection in an acute tonsillitis and the need of antibiotics for tonsillitis treatment.[1][15] However, the Centor criteria have their weaknesses in making precise diagnosis for adults. The Centor criteria are also ineffective in diagnosis for tonsillitis in children and insecondary care settings (hospitals).[15] A modified version of the Centor criteria, which modified the original Centor criteria in 1998, is often used to aid in diagnosis. The original Centor criteria had four major criteria but the modified Centor criteria have five. The five major criteria of the modified Centor score are:
The possibility of GABHS infection increases with increasing score. The probability for getting GABHS is 2 to 23% for the score of 1, and 25 to 85% for the score of 4.[15]The diagnosis of GABHS tonsillitis can be confirmed by culture of samples obtained by swabbing the throat and plating them onblood agar medium. This small percentage of false-negative results are part of the characteristics of the tests used but are also possible if the person has received antibiotics prior to testing. Identification requires 24 to 48 hours by culture but rapid screening tests (10–60 minutes), which have a sensitivity of 85–90%, are available. In 40% of the people without any symptoms, the throat culture can be positive. Therefore, throat culture is not routinely used in clinical practice for the detection of GABHS.[15]
Centor and McIsaac scores are equally ineffective at identifying patients who need antibiotics presenting with pharyngitis at hospitals. Too many true positive cases are missed and too many false positives are treated, leading to the over prescription of antibiotics.[32]
Bacterial culture may need to be performed in cases of a negative rapid streptococcal test.[33] An increase in antistreptolysin O (ASO) streptococcal antibody titer following the acute infection can provide retrospective evidence of GABHS infection and is considered definitive proof of GABHS infection, but not necessarily of the tonsils.[34]Epstein Barr virusserology can be tested for those who may haveinfectious mononucleosis with a typicallymphocyte count infull blood count result.[15] Blood investigations are only required for those with hospital admission requiring intravenous antibiotics.[15]
Nasoendoscopy can be used for those with severe neck pain and inability to swallow any fluids to rule out maskedepiglotitis and supraglotitis. Routine nasoendscopy is not recommended for children.[15]
If the tonsillitis is caused bygroup A streptococcus, thenantibiotics are useful, withpenicillin oramoxicillin being primary choices.[1][15]Cephalosporins andmacrolides are considered good alternatives to penicillin in the acute care setting.[1][36] A macrolide, such asazithromycin orerythromycin, is used for people allergic to penicillin.[1] If penicillin therapy fails, bacterial tonsillitis may respond to treatment effective against beta-lactamase producing bacteria such asclindamycin oramoxicillin-clavulanate.[37] Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.[38] There is no significant difference in efficacy of various groups of antibiotics for treating tonsillitis.[15] Intravenous antibiotics can be for those who are hospitalized with inability to swallow and presented with complications.[citation needed] Oral antibiotics can be resumed immediately if the person is clinically improved and able to swallow orally.[15] Antibiotic treatment is usually taken for seven to ten days.[1][5]
Corticosteroids reduce tonsillitis pain and improve symptoms in 24 to 48 hours. Oral corticosteroids are recommended unless the person is unable to swallow medications.[15]
When tonsillitis recurs frequently, often arbitrarily defined as at least five episodes of tonsillitis in a year,[41] or when the palatine tonsils become so swollen that swallowing is difficult as well as painful, atonsillectomy can be performed to surgically remove the tonsils. A randomised controlled trial of tonsillectomy versus medical treatment (antibiotics and pain killers) in adults with frequent tonsillitis found that tonsillectomy was more effective and cost effective. It resulted in fewer days with sore throat.[42][43]
Children have had only a modest benefit from tonsillectomy for repeated cases of tonsillitis.[44]
Since the advent of penicillin in the 1940s, a major preoccupation in the treatment of streptococcal tonsillitis has been the prevention ofrheumatic fever, and its major effects on thenervous system andheart.
Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, andpharyngitis due to the spread of infection.[22][23][24][30]
Anabscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis.[citation needed] This is termed aperitonsillar abscess (or quinsy).
Tonsillitis occurs throughout the world, without racial or ethnic differences.[48] Most children have tonsillitis at least once during their childhood,[49] although it rarely occurs before the age of two.[48] It most typically occurs between the ages of four and five; bacterial infections most typically occur at a later age.[48]
^abKlug TE, Rusan M, Fuursted K, Ovesen T (August 2016). "Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection?".Otolaryngol Head Neck Surg (Review).155 (2):199–207.doi:10.1177/0194599816639551.PMID27026737.S2CID13540245.
^abcdBochner RE, Gangar M, Belamarich PF (February 2017). "A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses".Pediatr Rev (Review).38 (2): 82.doi:10.1542/pir.2016-0072.PMID28148705.S2CID31192934.
^[non-primary source needed]Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]".Acta Otorhinolaryngol Belg (in Dutch).30 (3):334–45.PMID1015288. — fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta
^[non-primary source needed]Ezzeddini R, Darabi M, Ghasemi B, Jabbari Moghaddam Y, Jabbari Y, Abdollahi S, et al. (2012). "Circulating phospholipase-A2 activity in obstructive sleep apnea and recurrent tonsillitis".Int J Pediatr Otorhinolaryngol.76 (4):471–4.doi:10.1016/j.ijporl.2011.12.026.PMID22297210.
^van Kempen MJ, Rijkers GT, Van Cauwenberge PB (May 2000). "The immune response in adenoids and tonsils".Int. Arch. Allergy Immunol. (Review).122 (1):8–19.doi:10.1159/000024354.PMID10859465.S2CID33290556.
^Leung AK, Newman R, Kumar A, Davies HD (2006). "Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis".Expert Rev Mol Diagn (Review).6 (5):761–6.doi:10.1586/14737159.6.5.761.PMID17009909.S2CID35041911.
^Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children".Pediatrics (Meta-analysis).113 (4):866–882.doi:10.1542/peds.113.4.866.PMID15060239.
^Brook I (2007). "Microbiology and principles of antimicrobial therapy for head and neck infections".Infect Dis Clin North Am (Review).21 (2):355–91.doi:10.1016/j.idc.2007.03.014.PMID17561074.
^[non-primary source needed]Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]".Wiad. Lek. (in Polish).54 (1–2):56–63.PMID11344703.
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Wetmore RF (2007). "Tonsils and adenoids". In Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds.).Nelson textbook of pediatrics (18th ed.). Philadelphia: Saunders.ISBN978-1-4160-2450-7.
