TONSILLITIS

Signs and symptoms

The tonsils are fleshy clusters of tissue that lie in two bands on either side of the back of the throat. Tonsillitis is an inflammation of the tonsils caused by an infection. In tonsillitis, the tonsils are enlarged, red, and often coated (either partly or entirely) by a membrane that is yellow, gray, or white.

Tonsillitis usually occurs as part of a pharyngitis (throat infection). In older children and adults, illness usually begins with sudden sore throat, with pain on swallowing. There may also be loss of appetite, malaise (a generally ill feeling), chills, and fever over 101 degrees F (38.3 degrees C). Glands in the neck and at the angle of the jaw may be swollen and tender. In infants, tonsillitis may bring symptoms that appear to be less focused on the throat. Their most noticeable symptoms may be poor feeding, runny nose, and a slight fever.

Description

Tonsillitis is an infection of the tonsils that usually occurs as part of a pharyngitis (throat infection). Tonsillitis may be caused by either viruses or bacteria, and often the symptoms are the same no matter which germ is causing the infection. The big difference is in treatment - bacterial tonsillitis can be treated with antibiotics, but viral tonsillitis cannot. Doctors differentiate between the two by taking a throat culture (painless swab of the back of the throat) and sending it to the laboratory to see if bacteria grow. Usually, the throat culture is specifically designed to find Group A streptococci, since these bacteria are the kind that most commonly cause bacterial throat infections. In about 30 percent of throat cultures, streptococci are found, and the infection is presumed to be a strep infection. In the remaining 70 percent of throat cultures that are negative for strep, the cause of the throat infection is most probably a virus, or (rarely) a species of bacteria other than strep.

Of the viruses that cause tonsillitis and throat infection, the most common ones are: adenoviruses (common in early childhood and account for up to 10 percent of respiratory infections); influenza or flu virus; Epstein-Barr virus (the virus which usually causes mononucleosis); the parainfluenza viruses (which cause respiratory infections like croup, laryngitis and bronchiolitis) the enteroviruses (which usually inhabit the intestinal tract); or herpes simplex virus. When the cause is either an enterovirus or herpes simplex virus, the throat may show tiny blistered or ulcerated areas, and this sometimes helps your doctor in making a diagnosis. When an enterovirus is the cause, the illness is called herpangina.

Prevention

To prevent tonsillitis, avoid exposure to anyone who already has tonsillitis or a sore throat. At home, when someone is sick with tonsillitis, be sure to keep drinking glasses and eating utensils separate from others in the family, and wash these items in hot, soapy water. Wash your own hands frequently if you are caring for someone who is sick with tonsillitis.

Incubation

When tonsillitis is caused by Group A streptococci, the incubation period is usually two to seven days. For tonsillitis caused by viruses, the incubation period varies widely: 18 to 72 hours for influenza virus; three to six days for parainfluenza virus; four to eight weeks for Epstein-Barr virus.

Duration

When tonsillitis is caused by Group A streptococci, fever usually stops within 3-5 days, and the sore throat passes soon afterward. With antibiotic treatment, the illness is usually cured within 10-12 days, but it may take several weeks for the tonsils and swollen glands to return to normal size.

When tonsillitis is caused by viruses, the length of illness depends on which virus is involved - generally 2-5 days. Most people are almost completely recovered within one week. With parainfluenza virus, children may feel better after only 1-2 days of illness. With Epstein-Barr virus, the sore throat is more severe for the first 5-7 days of illness, but improves 7-10 days later.

Contagiousness

All forms of tonsillitis, whether caused by bacteria or viruses, are contagious illnesses. Tonsillitis usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected. This is why parents who care for a child with tonsillitis should keep the child's drinking glass and eating utensils separate from those of other family members. They should also wash their hands frequently as they care for a child who is sick with tonsillitis, especially if they are also caring for younger children who are not ill. Infections caused by streptococci cause special problems. Estimates are that in a home where someone already has strep, about one out of every four family members will get it too. There are also cases where persons, especially children, can be carriers of strep bacteria without having any symptoms. Among school-age children, 15-20% may be asymptomatic carriers of strep bacteria.

Home treatment

A child with tonsillitis may find swallowing so painful that eating is difficult. Try changing the child's diet to include more liquids and soft foods. Include soothing teas and warm nutritious soups, or cool soft drinks, milk shakes, ice cream and popsicles. Make sure that the child drinks plenty of fluids, and take the temperature at least once each morning and each evening. Use a nonprescription pain reliever, like acetaminophen or ibuprofen, for throat pain. Let the child rest in bed, or play quietly.

Children who are old enough to gargle can try gargling with either double-strength tea or warm, salty water. Be sure that they spit out the salty water after they've finished.

Use a cool-mist humidifier to add moisture to the air, since this will help soothe the child's sore throat. A moist, warm towel may also help soothe swollen glands around the child's neck.

If your doctor has prescribed antibiotics for a strep tonsillitis, make sure that your child takes all doses on schedule for as many days as your doctor has directed. This will help prevent complications like rheumatic fever or an abscess (a localized infected pocket of pus) around the tonsils.

Professional treatment

Tonsillitis that is caused by a bacterial infection can be treated with antibiotics, but tonsillitis that is caused by a viral infection cannot. Doctors cannot usually tell the difference just by looking at the tonsils. They need to check for growth of bacteria (usually streptococci) by taking a throat culture.

A doctor who suspects that your child has strep tonsillitis will take a throat culture by painlessly swabbing your child's throat to get a sample of throat secretions. This sample is sent to a laboratory to see if streptococci grow. If they do grow, this will confirm a strep infection and be the basis for your doctor's ordering antibiotic treatment. Some doctors also use an "instant" strep test that can confirm a strep infection within 10 to 30 minutes during your office visit.

Once a strep infection has been confirmed, it is treated with some form of penicillin that may either be injected or given by mouth. Since the risk of allergic reactions may be lower when oral medication is given, many doctors do not give a penicillin injection but prefer to give an oral antibiotic prescription to be taken at home. They depend on the patient's parents to make sure that the full course of antibiotics is taken. This means about 10 days of medicine at home. Taking the full course of antibiotics will help prevent complications, like rheumatic fever or an abscess around the tonsils. In children allergic to penicillin, some form of erythromycin is usually given.

When a child has frequent episodes of tonsillitis (usually seven episodes in one year, or five in each of two years), doctors sometimes suggest removing the tonsils with a surgical procedure called a tonsillectomy. This was once a very common form of surgery in childhood, almost a rite-of-passage. Now some doctors question its effectiveness and it is performed much less frequently.

When to call your Doctor

Call your doctor whenever your child has symptoms of tonsillitis, including: sore throat, pain on swallowing, headache, fever, chills or swollen glands in the neck. If your child is already being treated for tonsillitis, call your doctor immediately for any of the following symptoms: fever that returns after several days of normal temperature; skin rash; earache; nasal discharge with discolored or bloody mucus; cough, especially if it produces mucus; chest pain, shortness of breath, or extreme tiredness; convulsions; painful, red, or swollen joints; nausea or vomiting.