Acute Tonsilitis – 15 Previous Year AIIMS PG Question for Practice

ACUTE TONSILLITIS

TYPES AND CLINCAL FEATURES OF ACUTE TONSILLITIS

Types:

  • Acute Follicualr Tonsillitis:where inflammatory exudate from the crypts marks the reddened surface with whitish spots.
  • Acute Parenchymatous Tonsillitis:when the whole tonsil is uniformly congested.
  • Acute Membranous Tonsillitis:in which exudate from the cyrpts coalesces to form a membrane over the surface.

Symptoms:

  • Throat pain-aggravated on swallowing,may get referred to the ear via Glossopharyngeal nerve
  • Fever,Malaise and Headache
  • Neck swelling-Jugulodigastric Lymph node enlargement.
  • Difficulty in swallowing

Signs:

  • Fever,Tachycardia.
  • Tonsils are enlarged and congested.
  • Pharynx is also inflammed.
  • Tender and enlarged jugulo-digastric lymph nodes.
  • Breath is foetid and tongue is coated.

COMPLICATIONS OF ACUTE TONSILLITIS

Local:

  • Chronic Tonsillitis
  • Peritonsillar Abscess(Quinsy) and Parapharyngeal Abscess
  • Suppurative cervical Lymphadenitis
  • Acute Otitis Media

Systemic

  • Rheumatic fever
  • Acute Glomerulonephritis
  • Infective Endocarditis

DIIFERENTIAL DIAGNOSIS OF ENLARGED TONSILS

BACTERIAL PHARYNGOTONSILLITIS

  • Etiology
    Group A beta-haemolytic streptococcus is the most common and important pathogen causing acute bacterial pharyngotonsillitis. This infection most commonly presents in children aged 5-6 yrs.
  • Symptoms
    • It is characterized by fever, dry sore throat, cervical adenopathy, dysphagia and odynophagia. The tonsils and
    • pharyngeal mucosa are erythematous and may be covered with purulent exudate-may be covered by grey-white membrane on the tonsils; the tongue may also become red
    • (strawberry tongue).
  • Diagnosis
    • In cases of strongly suspected pharyngitis caused by group A beta hemolytic streptococcus the combination of rapid
    • strep tests based on ELISA (enzyme-linked immunosorbent assay) or latex agglutination, with a throat culture if negative, increases the sensitivity and specificity of either test alone.
  • Treatment
    • The primary antibiotic treatment for streptococcal pharyngotonsillitis consists of penicillin.

INFECTIOUS MONONUCLEOSIS

  • Epstein-Barr virus (EBV) is the usual cause of heterophile-positive infectious mononucleosis; cytomegalovirus is responsible for a minority of cases.
  • Patient presents with fatigue and difficulty swallowing.
  • Physical exam reveals exudative tonsillitis-may be covered by grey-white membrane on the tonsils, palatal petechiae, cervical lymphadenopathy, and tender hepatosplenomegaly.
  • A complete blood count reveals mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia.
  • Coombs’ test is positive.
  • Splenic rupture is the most likely complication.

DIPHTHERIA

  • Fever, cervical lymphadenopathy and grey membrane on the tonsil extending to anterior pillar is suggestive of diphtherial infection.
  • For rapid growth the specimen is inoculated on Loeffler’s serum slope which shows the growth in 4-8 hrs..
  • Loeffler’s medium shows early growth (in 4-8 hrs), but it is not a selective medium for C. diphtheriae.
  • Best diagnosis of any bacteria is made by culture of specimen in the “selective media” and the selective medium forC. diphtheriae is tellurite agar.

TANGIER DISEASE

  • It is an autosomal co dominant condition caused by mutation in the gene coding for ABCA 1.
  • These patients have low levels of HDL-C, ApoA – I and LDL-C. There may be a slightly elevated triglyceride levels.
  • The accumulation of cholesterol in the reticulo endothelial system is responsible for Mononeuritis multiplex, hepatosplenomegaly,enlarged orange coloured tonsils. 

WHITISH MEMBRANE IN THE THROAT AND TONSILS

  • Pyogenic organisms viz. Streptococci, Staphylococci causing membranous tonsillitis
  • Diphtheria
  • Vincent’s angina (Caused by fusiform bacilli and spirochetes: Borrelia vincentii)
  • Candidiasis/monoliasis/oral thrush
  • Infectious mononucleosis
  • Agranulocytosis
  • Leukemia
  • Aphthous ulcers
  • Traumatic ulcers

Exam Question of

  • During Tonsillitis, pain in the ear is due to involvement of Glossopharyngeal Nerve.
  • Splenic Rupture in the most likely complication in a patient suffering from exudative tonsillitis,palatal petechiae, cervical lymphadenopathy,tender hepatosplenomegaly,complete blood count revealing mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia and Coombs’ test is positive suggestive of infectious mononucleosis.
  • Pathognomonic enlarged, grayish yellow or orange tonsils are seen in Tangier disease.
  • Commonest causative organism for acute tonsillitis is Group A beta Hemolytic Streptococcus.
  • Fever, cervical lymphadenopathy and grey membrane on the tonsil extending to anterior pillar is suggestive of diphtherial infection. For rapid growth the specimen is inoculated on Loeffler’s serum slope.
  • but diagnosis is best made by culture in Tellurite medium

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Acute Tonsilitis

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