Tonsillitis is inflammation of the tonsils, usually rapid onset. This is a type of pharyngitis. Symptoms may include sore throat, fever, enlarged tonsils, difficulty swallowing, and large lymph nodes around the neck. Complications include peritonsillar abscess.
Tonsillitis is most commonly caused by viral infections, with about 5% to 40% of cases caused by bacterial infection. When caused by a group of bacteria A streptococcus, this is referred to as sore throat. Rare bacteria like Neisseria gonorrhoeae , Corynebacterium diphtheriae , or Haemophilus influenzae may be the cause. Usually the infection spreads among people in the air. An assessment system, such as a Centor score, can help separate possible causes. Confirmation is possible with a throat swab or a rapid strep test.
Treatment efforts include symptom improvement and decreased complications. Paracetamol (acetaminophen) and ibuprofen can be used to help with pain. If sore throat is present penicillin antibiotics through the mouth is generally recommended. In those allergic to penicillin, cephalosporins or macrolides can be used. In children with episodes of frequent tonsillitis, a simple tonsillectomy reduces the risk of future episodes.
Approximately 7.5% of people experience a sore throat in a period of three months and 2% of people visit the doctor for tonsillitis each year. This is most common in school-aged children and usually occurs in the autumn and winter months. The majority of people heal with or without medication. In 40% of people, symptoms disappear within three days, and in 80% symptoms disappear within a week, regardless of whether streptococcus is present. Antibiotics decrease the duration of symptoms by about 16 hours.
Video Tonsillitis
Signs and symptoms
Common signs and symptoms include:
- sore throat
- red, swollen tonsils
- pain during swallowing
- high temperature (fever)
- headache
- fatigue
- cold
- general feeling of malaise
- white pus spots on the tonsils
- swollen lymph nodes (glands) in the neck
- pain in the ears or neck
- weight loss
- difficulty swallowing and swallowing feed/fluid intake
- sleeping difficulties
The less common symptoms include:
- nausea
- fatigue
- abdominal pain
- vomit
- hairy tongue
- bad breath (halitosis)
- sound changes
- difficulty opening mouth (trismus)
- loss of appetite
- anxiety/fear of choking
In the case of acute tonsillitis, the surface of the tonsils can be bright red and with white areas or visible pus lines.
Tonsilloliths occur up to 10% of the population often due to tonsillitis episodes.
Maps Tonsillitis
Cause
The most common causes are viral infections and include adenovirus, rhinovirus, influenza, coronavirus, and syncytial respiratory virus. It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. The second most common cause is the dominant bacterial infection is Group A? -hemolytic streptococcus (GABHS), which causes sore throat. Less common causes of bacteria include: Staphylococcus aureus (including methicillin resistant Staphylococcus aureus or MRSA), Streptococcus pneumoniae , Mycoplasma pneumoniae , Chlamydia pneumoniae , Bordetella pertussis , Fusobacterium sp., Corynebacterium diphtheriae , Treponema pallidum , and Neisseria gonorrhoeae .
Anaerobic bacteria have been implicated in tonsillitis and the possible role in the acute inflammatory process is supported by several clinical and scientific observations.
Under normal circumstances, because viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. In the tonsils, white blood cells of the immune system destroy viruses or bacteria by producing inflammatory cytokines like A2 phospholipase, which also causes fever. Infection can also be present in the throat and surrounding areas, causing pharyngeal inflammation.
Occasionally, tonsillitis is caused by spirochaeta and treponemal infections, in this case called Vincent angina or Plaut-Vincent angina.
Diagnosis
Group Diagnosis A beta-hemolytic streptococcus (GABHS) tonsillitis can be confirmed by the culture of the sample obtained by swabs of both the tonsils surface and the posterior wall of the pharynx and plating them on sheep blood agar medium. The level of isolation can be increased by incubating cultures under anaerobic conditions and using selective growth media. A single throat culture has a 90-95% sensitivity to detect GABHS (which means that GABHS actually presents 5-10% of the time culture indicating that it does not exist). This small percentage of false negative results is part of the test characteristics used but it is also possible if the patient has received antibiotics prior to testing. Identification takes 24 to 48 hours by culture but a rapid screening test (10-60 minutes), which has a sensitivity of 85-90%, is available. Longer antigen tests detect the surface of the Lancefield group A carbohydrate. The new test identifies the GABHS serotype using a nucleic acid probe (DNA) or polymerase chain reaction. A bacterial culture may need to be done in the case of a rapidly negative streptococcal test.
The actual infection with GABHS, rather than colonization, is arbitrarily defined as the presence of & gt; 10 GABHS colonies per blood agar plate. However, this method is difficult to implement due to overlap between the operator and the infected patient. Increased antistreptolysin O (ASO) streptococcal antibody titer 3-6 weeks after acute infection may provide retrospective evidence of GABHS infection and is considered the definitive proof of GABHS infection.
Increased values ​​of phospholipase A2 secreted and changed fatty acid metabolism in patients with tonsillitis may have diagnostic benefits.
Treatment
Treatments to reduce the discomfort of tonsillitis include:
- pain and fever reduce drugs such as paracetamol (acetaminophen) and ibuprofen
- warm gargling salt water, suction tablets, or warm liquids
When tonsillitis is caused by a virus, the duration of pain depends on the virus involved. Usually, complete recovery is done in one week; However, symptoms can last up to two weeks.
Antibiotics
If tonsillitis is caused by group A streptococcus, then antibiotics are useful, with penicillin or amoxicillin as the primary choice. Cephalosporins and macrolides are considered a good alternative to penicillin in an acute setting. Makrolids such as erythromycin are used for people allergic to penicillin. Individuals who fail penicillin therapy may respond to effective treatment of beta-lactamase-producing bacteria such as clindamycin or amoxicillin-clavulanate. The aerobic and anaerobic beta-lactamaceous bacteria located in the tonsil tissue can "protect" the streptococcal A strains of penicillin.
Surgery
Chronic cases can be treated with tonsillectomy (surgical removal of the tonsils) as an option for treatment. Children have little benefit from tonsillectomy for cases of chronic tonsillitis.
Prognosis
Since the advent of penicillin in the 1940s, the great preoccupation in the treatment of tonsillitis is the prevention of rheumatic fever, and its main effects on the nervous system (Sydenham's chorea) and heart. Recent evidence will show that the rheumatogenic strains of the hemolytic group A beta have become less pronounced and are present only in small pockets as in Salt Lake City, USA. It questioned the reason for treating tonsillitis as a way to prevent rheumatic fever.
Complications may rarely include dehydration and renal failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.
The abscess may develop lateral tonsillitis during infection, usually a few days after onset of tonsillitis. This is called peritonsillar abscess (or quinsy).
Rarely, the infection may spread beyond the tonsils resulting in inflammation and infection of the internal jugular vein leading to the spread of septicemia infection (Lemierre syndrome).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the previous year, five episodes in each of the previous two years or three episodes in each of the previous three years), or in acute cases where the palatine tonsils become so swollen. that swallowing is disturbed, tonsillectomy can be done to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by other parts of the immune system.
In strep throat, very rare diseases such as rheumatic fever or glomerulonephritis can occur. These complications are very rare in developed countries but remain a significant problem in poor countries. Tonsillitis associated with sore throat, if untreated, is hypothesized to cause autoimmune pediatric neuropsychiatric disorders associated with streptococcal infection (PANDAS).
References
External links
Source of the article : Wikipedia
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