Tonsillitis I: Introduction

Viral tonsillitis is most common, caused by rhinovirus, respiratory syncytial virus, adenovirus, influenza, and Epstein-Barr virus. Bacterial tonsillitis is primarily caused by group A beta-hemolytic Streptococcus (Streptococcus pyogenes). Less common bacterial causes include Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Acute tonsillitis presents with sudden onset inflammation lasting 3-4 days to two weeks. Chronic tonsillitis is persistent infection that may cause tonsil stones and chronic sore throat. Recurrent tonsillitis involves five or more episodes within a year, and patients may consider tonsillectomy if quality of life is significantly affected.

Tonsillitis manifests as sore throat, fever, tonsillar exudate (white patches or pus), tender cervical lymph nodes, and neck stiffness. Patients experience odynophagia (pain when swallowing) and dysphagia (difficulty swallowing) due to tonsillar swelling. These symptoms typically appear suddenly in acute cases.

Untreated tonsillitis can lead to peritonsillar abscess (pus pocket around tonsils), middle ear infections, obstructive sleep apnea from enlarged tonsils, and difficulty breathing. Rare but serious complications include scarlet fever, rheumatic fever (which damages the heart), and poststreptococcal glomerulonephritis (which affects the kidneys).

Diagnosis involves physical examination for redness, swelling, white patches, and swollen lymph nodes. A throat swab collects secretions for testing. Rapid antigen detection tests identify streptococcal bacteria within minutes. If rapid antigen testing is negative, throat culture may be performed to confirm bacterial infection.

Viral tonsillitis is the most common form, caused by rhinovirus, adenovirus, and other viruses, typically resolving within days. Bacterial tonsillitis, primarily caused by Streptococcus pyogenes, requires antibiotic treatment. Rapid antigen detection tests and throat cultures help differentiate bacterial from viral causes for appropriate tonsillitis management.

Tonsils are lymphoid tissue masses at the back of the throat that help defend against pathogens. They become infected when viruses or bacteria invade, causing inflammation and swelling. This immune response produces symptoms like sore throat and fever as the body fights the infection.