Tonsillitis
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Tonsillitis
Pathophysiology
Tonsillitis, or inflammation of the tonsils, occurs via droplets from patients with acute tonsillitis and rarely from an asymptomatic carrier. The most common viral causes include rhinovirus, respiratory syncytial virus, adenovirus, and coronavirus. Group A beta-hemolytic streptococcus (GABHS) accounts for tonsillitis in significant number of children 5-15 years of age. It can also occur in adults. It may occur in isolation or as part of a generalized pharyngitis.
Signs and symptoms
The most common signs and symptoms of tonsillitis are fever, tonsillar exudate, sore throat, and tender anterior cervical lymphadenopathy. Other symptoms include odynophagia and dysphagia, particularly if tonsillar swelling is present. On physical examination, the tonsils appear enlarged or erythematous. Tonsillar exudate, if present, appears yellow or white.
Diagnosis
The differential diagnosis of tonsillitis includes pharyngitis, retropharyngeal abscess, epiglottitis, peritonsillar abscess, and submandibular space infections (Ludwig's angina). The Centor score and rapid strep test, if indicated, are used to rule strep pharyngitis in or out. A throat culture is considered the diagnostic standard for GABHS tonsillitis.
Treatment
Acute tonsillitis is usually a self-limited disease that rarely results in hospitalization. Because acute tonsillitis is often caused by viruses, treatment is usually supportive, including analgesia with NSAIDs and maintaining hydration. Corticosteroids, in a single dose, have been shown to decrease pain scores and i1nprove ti1ne to recovery. If given, the dose for children is 0.6 mg/kg, with a 1naximum of IO mg. If GABS is detern1ined to be the cause, antibiotics should be given as for strep throat. Treatment of recurrent tonsillitis (five or more episodes in one year) includes watchful waiting or surgical management with tonsillectomy.
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