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==Overview==
Acute tonsillitis will usually present with [[erythema]] and [[edema]] of the [[tonsils]] rapidly upon infiltration of the pathogen. It is usually self-limited and symptoms will be resolved within 3-4 days. Recurrent tonsillitis will usually not resolve itself and will require [[antimicrobrial]] therapy or [[tonsillectomy]] when indicated. Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually [[bacterial]]. The prognosis for acute tonsillitis without treatment is usually good, while the prognosis for untreated recurrent tonsillitis will vary based on presence of life-threatening complications. With treatment, the prognosis of acute and recurrent tonsillitis is usually good.


==Natural History==
==Natural History==
* Tonsillitis will often run its course, of feverish symptoms accompanied by a sore throat, in a few days.
*Acute tonsillitis will usually present with [[erythema]] and [[edema]] of the [[tonsils]] rapidly upon infiltration of the pathogen.<ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
 
**Symptoms, including [[fever]] and [[sore throat]], will usually manifest within 24 hours of infection.
* In certain cases, an [[abscess]] may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a [[peritonsillar abscess]] (or [[quinsy]]).  Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading [[septicaemia]] infection ([[Lemierre's syndrome]]).
*Acute tonsillitis is usually self-limited and will be resolved within 3-4 days.
 
*Recurrent tonsillitis will usually not resolve itself and will require [[antimicrobrial]] therapy or [[tonsillectomy]] when indicated.<ref name="pmid19561812">{{cite journal |vauthors=Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T |title=Tonsillectomy in children |journal=Dtsch Arztebl Int |volume=105 |issue=49 |pages=852–60; quiz 860–1 |year=2008 |pmid=19561812 |pmc=2689639 |doi=10.3238/arztebl.2008.0852 |url=}}</ref>
* In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),<ref>{{cite book | title=Management of Sore Throat and Indications for Tonsillectomy | url=http://www.sign.ac.uk/guidelines/fulltext/34/index.html | chapter=6.3 Referral Criteria for Tonsillectomy | chapterurl=http://www.sign.ac.uk/guidelines/fulltext/34/section6.html | publisher=[http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network] | id=ISBN 1-899893-66-0 | year=1999 | month=January}} - notes though that these criteria "have been arrived at arbitrarily" from:<br>{{cite journal |author=Paradise JL, Bluestone CD, Bachman RZ, ''et al'' |title=Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials |journal=N. Engl. J. Med. |volume=310 |issue=11 |pages=674–83 |year=1984 |pmid=6700642 |doi=}}</ref><ref name="pmid12093941">{{cite journal |author=Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M |title=Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=7–15 |year=2002 |pmid=12093941 |doi=10.1542/peds.110.1.7}} - this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"</ref><ref name="pmid15195718">{{cite journal |author=Wolfensberger M, Mund MT |title=[Evidence based indications for tonsillectomy] |language=German |journal=Ther Umsch |volume=61 |issue=5 |pages=325–8 |year=2004 |pmid=15195718 |doi=}} - review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"</ref> or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a [[tonsillectomy]] can be performed to remove the tonsils. Patients whose tonsils have been removed are certainly still protected from infection by the rest of their immune system.
**Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.
 
* Towards the end of the infection, bacteria feeding on [[mucus]] may accumulate in the pits (referred to as "crypts") of the tonsils may produce whitish-yellow deposits known as [[tonsillolith]]s. These may emit an odor due to the presence of [[Volatility (chemistry)|volatile]] [[sulfur]] compounds.
 
==Complications==
==Complications==
The complications can be listed as:
Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually [[bacterial]] - and include the following:<ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
* Blocked [[airway]] from swollen tonsils
*[[Otitis media]]
 
*[[Peritonsillar abscess]]
* [[Dehydration]] from [[difficulty swallowing]] fluids
*[[Sleep apnea]]
 
*[[Scarlet fever]]
* [[Peritonsillar abscess]] in other parts of the throat behind the tonsils
*[[Rheumatic fever]]
 
*[[Glomerulonephritis]]
* Post-streptococcal [[glomerulonephritis]]  
*[[Tonsilloliths]]<ref name="pmid18037821">{{cite journal |vauthors=Rio AC, Franchi-Teixeira AR, Nicola EM |title=Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis |journal=Br Dent J |volume=204 |issue=2 |pages=E4 |year=2008 |pmid=18037821 |doi=10.1038/bdj.2007.1106 |url=}}</ref>
 
* [[Rheumatic fever]] and other heart problems
 
==Prognosis==
==Prognosis==
Tonsillitis symptoms due to strep usually get better about 2 or 3 days after you start the antibiotics. Children with strep throat should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
*The prognosis for acute tonsillitis without treatment is usually good; the disease is usually self-limited and will resolve itself within 3-4 days.<ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
*The prognosis for recurrent tonsillitis varies based on the presence of life-threatening complications.<ref name="urlRheumatic fever: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003940.htm |title=Rheumatic fever: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*With treatment, the prognosis of acute and recurrent tonsillitis is usually good.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Inflammations]]
[[Category:Infectious disease]]
[[Category:Primary care]]
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Latest revision as of 00:26, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Acute tonsillitis will usually present with erythema and edema of the tonsils rapidly upon infiltration of the pathogen. It is usually self-limited and symptoms will be resolved within 3-4 days. Recurrent tonsillitis will usually not resolve itself and will require antimicrobrial therapy or tonsillectomy when indicated. Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually bacterial. The prognosis for acute tonsillitis without treatment is usually good, while the prognosis for untreated recurrent tonsillitis will vary based on presence of life-threatening complications. With treatment, the prognosis of acute and recurrent tonsillitis is usually good.

Natural History

  • Acute tonsillitis will usually present with erythema and edema of the tonsils rapidly upon infiltration of the pathogen.[1]
    • Symptoms, including fever and sore throat, will usually manifest within 24 hours of infection.
  • Acute tonsillitis is usually self-limited and will be resolved within 3-4 days.
  • Recurrent tonsillitis will usually not resolve itself and will require antimicrobrial therapy or tonsillectomy when indicated.[2]
    • Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.

Complications

Complications of tonsillitis are caused by persistence and/or spread of the responsible pathogen - usually bacterial - and include the following:[1]

Prognosis

  • The prognosis for acute tonsillitis without treatment is usually good; the disease is usually self-limited and will resolve itself within 3-4 days.[1]
  • The prognosis for recurrent tonsillitis varies based on the presence of life-threatening complications.[4]
  • With treatment, the prognosis of acute and recurrent tonsillitis is usually good.

References

  1. ↑ 1.0 1.1 1.2 "Tonsillitis - NHS Choices".
  2. ↑ Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T (2008). "Tonsillectomy in children". Dtsch Arztebl Int. 105 (49): 852–60, quiz 860–1. doi:10.3238/arztebl.2008.0852. PMC 2689639. PMID 19561812.
  3. ↑ Rio AC, Franchi-Teixeira AR, Nicola EM (2008). "Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis". Br Dent J. 204 (2): E4. doi:10.1038/bdj.2007.1106. PMID 18037821.
  4. ↑ "Rheumatic fever: MedlinePlus Medical Encyclopedia".

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