Tonsillitis and Pharyngeal Infections
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Tonsil and pharyngeal infections refer to inflammatory conditions of the tonsils and pharynx, commonly caused by viral or bacterial pathogens, leading to sore throat and systemic symptoms.
Aetiology
- Viral infections (most common): rhinovirus, adenovirus, influenza, Epstein-Barr virus (EBV).
- Bacterial infections: Group A Streptococcus (Streptococcus pyogenes), Haemophilus influenzae, Neisseria gonorrhoeae.
- Fungal infections: Candida spp. (in immunocompromised patients).
Pathophysiology
- Pathogens invade the mucosa of the pharynx and tonsils, triggering an inflammatory response.
- Local inflammation leads to swelling, erythema, and exudate formation.
- Severe bacterial infections can result in peritonsillar abscess formation.
Risk Factors
- Close contact with infected individuals.
- Weakened immune system (e.g., HIV, chemotherapy).
- Smoking and exposure to irritants.
- Frequent upper respiratory infections.
Signs and Symptoms
- Sore throat: worsened by swallowing.
- Tonsillar enlargement: with erythema and possible exudates.
- Fever: common in bacterial infections.
- Cervical lymphadenopathy: tender, enlarged lymph nodes.
- Odynophagia: painful swallowing.
- Peritonsillar abscess: severe unilateral throat pain, "hot potato" voice, uvular deviation.
Investigations
- Rapid antigen detection test (RADT): for Group A Streptococcus.
- Throat swab culture: confirms bacterial pathogens.
- Monospot test: for suspected Epstein-Barr virus infection.
- Full blood count (FBC): leukocytosis may suggest bacterial infection.
Management
1. Supportive Care:
- Analgesia: paracetamol or ibuprofen for pain and fever.
- Hydration: adequate fluid intake to prevent dehydration.
- Saltwater gargles: for symptomatic relief.
2. Antibiotic Therapy (if bacterial):
- Phenoxymethylpenicillin: first line treatment for Group A Streptococcus.
- Clarithromycin: alternative in penicillin-allergic patients.
- IV antibiotics: for severe infections or peritonsillar abscess.
3. Management of Complications:
- Peritonsillar abscess (quinsy): requires needle aspiration or incision and drainage.
- Rheumatic fever and post-streptococcal glomerulonephritis: prevented with timely antibiotic treatment.
4. Referral:
- ENT specialist: for recurrent tonsillitis requiring tonsillectomy.
- Emergency referral: if airway compromise is suspected due to severe swelling.