Tonsillitis
Encyclopedia
Tonsillitis is an inflammation
of the tonsil
s most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat
and fever
. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics. It usually takes around three weeks to recover.
Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling
along with sore throat and fever. In this case, the surface of the tonsil may be bright red like an explosion or have a grayish-white coating that looks disturbing, while the lymph node
s in the neck may be swollen.
Tonsillolith
s occur in up to 10% of the population frequently due to episodes of tonsillitis.
viruses (adenovirus, rhinovirus
, influenza
, coronavirus
, respiratory syncytial virus). It can also be caused by Epstein-Barr virus
, herpes simplex virus
, cytomegalovirus
, or HIV
. The second most common causes are bacterial. The most common bacterial cause is Group A β-hemolytic streptococcus (GABHS), which causes strep throat
. Less common bacterial causes include: Staphylococcus aureus
, Streptococcus pneumoniae
, Mycoplasma pneumoniae
, Chlamydia pneumoniae, pertussis
, Fusobacterium
, diphtheria
, syphilis
, and gonorrhea
.
Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsil
s. Within the tonsils, white blood cell
s of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever. The infection may also be present in the throat
and surrounding areas, causing inflammation of the pharynx
. This is the area in the back of the throat that lies between the voice box
and the tonsils.
Tonsillitis may be caused by Group A streptococcal bacteria
, resulting in strep throat
. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus
(the cause of infectious mononucleosis
) or adenovirus.
Sometimes, tonsillitis is caused by an infection
of spirochaeta and treponema
, in this case called Vincent's angina
or Plaut-Vincent angina.
If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin
or amoxicillin
being first line. A macrolide
such as erythromycin
is used for patients allergic to penicillin. Patients who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria such as clindamycin
or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.
When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however may last for up to two weeks. Chronic
cases may be treated with tonsillectomy
(surgical removal of tonsils) as a choice for treatment.
due to the spread of infection.
An abscess
may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess
(or quinsy).
Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome
).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy
can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.
In very rare cases of strep throat, diseases like rheumatic fever
or glomerulonephritis
can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations. Tonsillitis associated with strep throat, if untreated, is hypothesized to lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the tonsil
Tonsil
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....
s most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
and fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics. It usually takes around three weeks to recover.
Symptoms
Common symptoms of tonsillitis include:- red and/or swollen tonsils
- white or yellow patches on the tonsils
- tender, stiff, and/or swollen neck
- sore throat
- painful or difficult swallowing
- cough
- headache
- sore eyes
- body aches
- earacheOtalgiaOtalgia or an earache is ear pain. Primary otalgia is ear pain that originates inside the ear. Referred otalgia is ear pain that originates from outside the ear.Otalgia is not always associated with ear disease...
- fever
- chills
- nasal congestions
- ulceration
Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, and drooling
Drooling
Drooling is when saliva flows outside the mouth...
along with sore throat and fever. In this case, the surface of the tonsil may be bright red like an explosion or have a grayish-white coating that looks disturbing, while the lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s in the neck may be swollen.
Tonsillolith
Tonsillolith
Tonsilloliths, also known as a tonsil stones, are clusters of calcified material that form in the crevices of the tonsils. While they occur most commonly in the palatine tonsils, they may also occur in the lingual tonsils. Tonsilloliths have been recorded weighing from 300 mg to 42 g...
s occur in up to 10% of the population frequently due to episodes of tonsillitis.
Causes
The most common causes of tonsillitis are the common coldCommon cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
viruses (adenovirus, rhinovirus
Rhinovirus
Human rhinoviruses are the most common viral infective agents in humans and are the predominant cause of the common cold. Rhinovirus infection proliferates in temperatures between 33–35 °C , and this may be why it occurs primarily in the nose...
, influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
, coronavirus
Coronavirus
Coronaviruses are species in the genera of virus belonging to the subfamily Coronavirinae in the family Coronaviridae. Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. The genomic size of coronaviruses ranges from approximately 16 to 31...
, respiratory syncytial virus). It can also be caused by Epstein-Barr virus
Epstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
, herpes simplex virus
Herpes simplex virus
Herpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
, cytomegalovirus
Cytomegalovirus
Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
, or HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. The second most common causes are bacterial. The most common bacterial cause is Group A β-hemolytic streptococcus (GABHS), which causes strep throat
Strep throat
Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat is a type of pharyngitis caused by a group A streptococcal infection. It affects the pharynx including the tonsils and possibly the larynx. Common symptoms include fever, sore throat, and enlarged lymph nodes...
. Less common bacterial causes include: Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
, Streptococcus pneumoniae
Streptococcus pneumoniae
Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, aerotolerant anaerobic member of the genus Streptococcus. A significant human pathogenic bacterium, S...
, Mycoplasma pneumoniae
Mycoplasma pneumoniae
Mycoplasma pneumoniae is a very small bacterium in the class Mollicutes.It causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia, and is related to cold agglutinin disease.-Cell wall/Treatment:...
, Chlamydia pneumoniae, pertussis
Pertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...
, Fusobacterium
Fusobacterium
Fusobacterium is a genus of filamentous, anaerobic, Gram-negative bacteria, similar to Bacteroides.Fusobacterium contribute to several human diseases, including periodontal diseases, Lemierre's syndrome, and topical skin ulcers...
, diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
, syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, and gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
.
Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsil
Tonsil
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....
s. Within the tonsils, white blood cell
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
s of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever. The infection may also be present in the throat
Throat
In vertebrate anatomy, the throat is the anterior part of the neck, in front of the vertebral column. It consists of the pharynx and larynx...
and surrounding areas, causing inflammation of the pharynx
Human pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
. This is the area in the back of the throat that lies between the voice box
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
and the tonsils.
Tonsillitis may be caused by Group A streptococcal bacteria
Group A streptococcal infection
The group A streptococcus bacterium is a form of β-hemolytic Streptococcus bacteria responsible for most cases of streptococcal illness. Other types may also cause infection...
, resulting in strep throat
Strep throat
Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat is a type of pharyngitis caused by a group A streptococcal infection. It affects the pharynx including the tonsils and possibly the larynx. Common symptoms include fever, sore throat, and enlarged lymph nodes...
. Viral tonsillitis may be caused by numerous viruses such as the Epstein-Barr virus
Epstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
(the cause of infectious mononucleosis
Infectious mononucleosis
Infectious mononucleosis is an infectious, widespread viral...
) or adenovirus.
Sometimes, tonsillitis is caused by an infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
of spirochaeta and treponema
Treponema
Treponema is a bacterial genus. The major species is Treponema pallidum, whose subspecies are responsible for diseases such as syphilis and yaws.The species Treponema hyodysenteriae and Treponema innocens have been reclassified into Serpula....
, in this case called Vincent's angina
Trench mouth
Acute necrotizing ulcerative gingivitis or necrotizing ulcerative gingivitis is a sub-classification of necrotizing periodontal disease, an infection of the gum tissue. This presents as an acute infection of the gingiva without involvement of the other tissues of the periodontium...
or Plaut-Vincent angina.
Treatment
Treatments to reduce the discomfort from tonsillitis symptoms include:- pain relief, anti-inflammatory, fever reducing medications (acetaminophen/paracetamol and/or ibuprofen)
- sore throat relief (salt water gargle, lozenges, warm liquids)
If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
or amoxicillin
Amoxicillin
Amoxicillin , formerly amoxycillin , and abbreviated amox, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral...
being first line. A macrolide
Macrolide
The macrolides are a group of drugs whose activity stems from the presence of a macrolide ring, a large macrocyclic lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, may be attached. The lactone rings are usually 14-, 15-, or 16-membered...
such as erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
is used for patients allergic to penicillin. Patients who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria such as clindamycin
Clindamycin
Clindamycin rINN is a lincosamide antibiotic. It is usually used to treat infections with anaerobic bacteria but can also be used to treat some protozoal diseases, such as malaria...
or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.
When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however may last for up to two weeks. Chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
cases may be treated with tonsillectomy
Tonsillectomy
A tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or...
(surgical removal of tonsils) as a choice for treatment.
Complications
Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitisPharyngitis
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
due to the spread of infection.
An abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess
Peritonsillar abscess
Peritonsillar abscess , also called a quinsy or abbreviated as PTA is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil .-Symptoms and signs:...
(or quinsy).
Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome
Lemierre's syndrome
Lemierre's syndrome is a form of thrombophlebitis usually caused by the bacterium Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium and usually affects young, healthy adults...
).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years), or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy
Tonsillectomy
A tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or...
can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.
In very rare cases of strep throat, diseases like rheumatic fever
Rheumatic fever
Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as strep throat or scarlet fever. Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after...
or glomerulonephritis
Glomerulonephritis
Glomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys...
can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations. Tonsillitis associated with strep throat, if untreated, is hypothesized to lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).