Makindo Medical Notes

👩‍⚕️ Tonsillitis = acute infection of the palatine tonsils, usually viral but sometimes bacterial. Most children experience it; adults less often, but complications (e.g. quinsy) are more severe. Always consider red flags → stridor, drooling, severe dysphagia → 🚨 emergency referral.

🦠 Aetiology

• Viral: EBV (infectious mononucleosis), HSV, Adenovirus 🤒
• Bacterial: Group A β-haemolytic Streptococcus (Strep pyogenes), Mycoplasma, Corynebacterium diphtheriae

🧾 Clinical Presentation

• Severe sore throat, fever 🌡️, headache, malaise
• Tonsillar findings: erythema, exudates, enlargement (torch often needed)
• Lymph nodes: tender anterior cervical lymphadenopathy
• Viral → coryzal symptoms; EBV → splenomegaly + marked fatigue
• Bacterial → white tonsillar exudate more likely

📊 Paradise Criteria (for “true” tonsillitis episodes)

Sore throat + ≥1 of:

• Fever >38.3°C 🌡️
• Swollen/tender cervical lymph node >2 cm
• Tonsillar exudate
• Positive strep culture

👶 Tonsillitis in Children

• Frequent, but tends to improve with age
• Significant impact on schooling (3–5 days absence/episode)

🧑 Tonsillitis in Adults

• Less common than children, but usually more severe
• Can cause prolonged work absence
• Complication: Peritonsillar abscess (Quinsy) → trismus, muffled “hot potato” voice, uvula deviation 🚨

🚨 Red Flags (do not attempt throat exam)

• Stridor, drooling, severe respiratory distress
• Very unwell/systemic sepsis
• Dysphagia, muffled voice, suspicion of epiglottitis
• Immediate hospital transfer required 🚑

🔍 Investigations

• FBC, CRP, U&E in unwell patients
• Throat swab for bacterial culture
• EBV serology (Monospot/Paul Bunnell), atypical lymphocytosis on FBC

⚠️ Complications

• Local: peritonsillar abscess (quinsy), retropharyngeal abscess
• Systemic: scarlet fever, rheumatic fever, glomerulonephritis
• EBV: hepatitis, prolonged fatigue, splenic rupture (rare)

🏥 Severe Complications

• Quinsy: fever, trismus, uvula deviation, “hot potato” voice → ENT referral + IV antibiotics, drainage
• Retropharyngeal abscess: neck swelling, stridor, sepsis → surgical emergency
• Lemierre’s syndrome: septic thrombophlebitis of jugular vein → ICU risk

📌 Admission Criteria

• Airway compromise (stridor, drooling, severe dysphagia)
• Severe systemic illness or dehydration
• Peritonsillar cellulitis/abscess
• Immunocompromised, diphtheria suspicion, or unusual systemic illness

💊 Management

• Analgesia: paracetamol/ibuprofen for fever & pain
• Hydration: oral fluids; IV if unable to swallow
• Antibiotics (if severe/systemic, bacterial suspected):
  • First-line: Penicillin V (phenoxymethylpenicillin) 5–10 days
  • Avoid amoxicillin in EBV → rash 🚫
  • Alternative: clarithromycin if penicillin-allergic
• Tonsillectomy: Consider if recurrent tonsillitis (Paradise criteria) or after quinsy → ENT referral

📚 References

• NHS Tonsillitis & Tonsillectomy Guidelines