Acute tonsillitis

                                 Acute Tonsillitis

                  

Tonsillitis is inflammation of the tonsils which is  two oval-shaped pads of  lymphoid tissue at the back of the throat in tonsillar fossa ,one tonsil on each side.

                                 

                                  Fig:Acute follicular tonsilitis

Classification:

 1. Acute catarrhal or superficial tonsillitis
 Here tonsillitis is a part of generalized pharyngitis and is mostly seen in viral infections.

 2. Acute follicular tonsillitis.

 Infection spreads into the crypts which become filled with purulent material, presenting at the openings of crypts as yellowish spots .

3. Acute parenchymatous tonsillitis. 

Here tonsil substance is affected. Tonsil is uniformly enlarged and red. 

4. Acute membranous tonsillitis.  

 Exudation from the crypts coalesces to form a membrane on the surface of tonsil. 

AETIOLOGY

Haemolytic streptococcus is the most commonly infecting organism.  staphylococci, pneumococci or H. influenzae are other cause of infection.

Bacterial infection may be followed by acute viral infection.

SYMPTOMS 

1. Sore throat.

2. Difficulty in swallowing

3. Fever. 38 to 40°C and may be associated with chills and rigors

4. Earache. 

5. Constitutional symptoms include headache, general body aches, malaise and constipation. Abdominal pain due to mesenteric lymphadenitis simulating a clinical picture of acute appendicitis may present.

SIGNS

 1. Often the breath is foetid and tongue is coasted. 

 2. There is hyperaemia of pillars, soft palate and uvula.

 3. Tonsils are red and swollen with yellowish spots of purulent material presenting at the opening of crypts (acute follicular tonsillitis) or there may be a whitish membrane on the medial surface of tonsil which can be easily wiped away with a swab . The tonsils may be enlarged and congested so much so that they almost meet in the midline along with some oedema of the uvula and soft palate (acute parenchymatous tonsillitis).

 4. Enlarged and tender jugulodigastric lymph nodes .

GRADING OF TONSIL ENLARGEMENT

Friedman Grading scale                                                                                                    

0-No tonsil seen                                                                

1-In tonsillar fossa

2-Visible beyond anterior pillar

3-Extend 3/4 of way to midline

4-Completely obstructing airway(Kissing tonsil)

Brodsky Grading Scale

TREATMENT

 1. Patient is put to bed and encouraged to take plenty of fluids. 

 2. Analgesics (aspirin or paracetamol) are given according to the age of the patient to relieve local pain and bring down the fever. 

 3. Antimicrobial therapy. Most of the infections are due to Streptococcus and penicillin is the drug of choice. Patients allergic to penicillin can be treated with erythromycin. Antibiotics should be continued for 7–10 days.

COMPLICATIONS

 1. Chronic tonsillitis with recurrent acute attacks

 2. Peritonsillar abscess. 

3. Parapharyngeal abscess.

4. Cervical abscess due to suppuration of jugulodigastric lymph nodes. 

5. Acute otitis media. 

6. Rheumatic fever. 

7. Acute glomerulonephritis. 

8. Subacute bacterial endocarditis. 

DIFFERENTIAL DIAGNOSIS OF  WHITE MEMBRANE OVER THE TONSIL

1. Membranous tonsillitis

2. Faucial diphtheria

3.Vincent angina

4.Infectious mononucleosis

5.Agranulocytosis

6.Leukemia 

7.Aphthous ulcer

8.Malignancy tonsil

9.Traumatic Ulcer

10.Candidal infection of tonsil

 mnemonics :MF Can InVeNT AT  Any Pt TiLL death

Unilateral enlargement of tonsil