TYPES AND CLINCAL FEATURES OF ACUTE TONSILLITIS
- 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.
- 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
- 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
- Chronic Tonsillitis
- Peritonsillar Abscess(Quinsy) and Parapharyngeal Abscess
- Suppurative cervical Lymphadenitis
- Acute Otitis Media
- Rheumatic fever
- Acute Glomerulonephritis
- Infective Endocarditis
DIIFERENTIAL DIAGNOSIS OF ENLARGED TONSILS
- 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.
- 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).
- 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.
- The primary antibiotic treatment for streptococcal pharyngotonsillitis consists of penicillin.
- 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.
- 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.
- 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
- Vincent’s angina (Caused by fusiform bacilli and spirochetes: Borrelia vincentii)
- Candidiasis/monoliasis/oral thrush
- Infectious mononucleosis
- Aphthous ulcers
- Traumatic ulcers
- 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