What is Tonsillitis?

Tonsillitis is a condition where your tonsils become inflamed. Tonsils are soft tissue masses that sit at the back of the throat at each side. Tonsils help your body fight off respiratory germs. But sometimes they can become infected, which can lead to tonsillitis. Tonsillitis occurs most often in the winter and spring.

Tonsillitis is the inflammation that is associated with the inflammation of pharyngeal tonsils, which usually extends to other related regions like adenoid and lingual tonsils. Due to this spread and extension, the term pharyngitis is used because it affects the whole pharynx area. 

Among various pathological and etiological factors, one mostly affecting is group A beta-hemolytic Streptococcus pyogenes (GABHS). Celsius in around the First century AD perfumed tonsillectomy. He used to perform it with a sharp tool and used vinegar and other herbal product for rinsing after surgery. It was the Celsius contribution for physicians to consider this as a medical condition.

What causes Tonsillitis?
The cause of tonsillitis is usually a virus. In children, bacterial causes are more common. But viruses remain the most frequent reason for tonsillitis for all age groups. Some viruses that can cause tonsillitis to include:

  • Adenovirus
  • Epstein-Barr virus
  • Influenza virus
  • Respiratory syncytial virus (RSV)
  • Parainfluenza virus
  • Rhinovirus

The most common bacteria that lead to tonsillitis is Streptococcus (strep throat). Strep throat causes tonsillitis in up to 15% of cases among adults. But for children between the ages of 5 and 15 years old, it causes tonsillitis up to 30% of the time. Strep throat is less likely to be the cause in children younger than 5 years old.

Some sexually transmitted infections can also cause tonsillitis. These include:
  • Syphilis
  • Gonorrhea
  • Chlamydia
  • HIV

Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation generally spreads to the adenoid and the lingual tonsils; that is the reason the term pharyngitis is used. Here for this article, I am considering pharyngo-tonsillitis and adenotonsillitis equivalent. Lingual tonsillitis is the inflammation of tissues at the base of the tongue.

Tonsillitis becomes a “Carrier state” when there is a positive bacterial culture of group A beta-hemolytic Streptococcus pyogenes as a contributing factor.

Various Disease of the Mouth Including Tonsillitis

Pathophysiology and Etiology of Various Type Tonsillitis
Various causes are considered contributing factors for this disease like some bacteria and viruses and some immunologic factors. A dense population, crowded residential and undernourishment also support tonsillitis. High number of episodes of acute pharyngitis and acute tonsillitis are affected by viruses like:
  • Herpes simplex virus
  • Epstein-Barr virus (EBV)
  • Cytomegalovirus (CMV)
  • Various other strains of herpes viruses
  • Adenovirus
  • Measles virus

One Study has also shown EBV as a causative agent for 19 % of exudative tonsillitis in children without causing mononucleosis. Bacteria contribute for around 15-30% of cases of pharyngotonsillitis. Anaerobes among the bacteria play a notorious role in tonsillar disease. 

As previously mentioned the culprit which cause most cases of bacterial tonsillitis are group A beta-hemolytic streptococcus (GABHS). These GABHS have special adherence capability by binding to specific receptors present on the tonsillar epithelium. 

Other bacteria like Mycoplasma pneumoniae, Corynebacterium diphtheria, and Chlamydia pneumoniae occasionally cause acute pharyngitis. Neisseria gonorrhea may be a contributing factor for tonsillitis in sexually active people. Arcanobacteriumhaemolyticum is a significant source of pharyngitis in Scandinavia people and the people of the United Kingdom but is not recognized as such in America.

Symptoms of Tonsillitis
When tonsils are healthy, they are pink in color like the rest of the throat. Normal tonsils will vary in size from person to person, and they won’t cause a problem with swallowing. With tonsillitis, you may have large, red tonsils. And it can be difficult or painful to swallow.

Some other common symptoms of tonsillitis may include:
  • Fever
  • White patches or pus on tonsils
  • Snoring or mouth breathing
  • Tender lymph nodes in the neck
  • Runny nose, cough, or congestion
  • Headache
  • Stomach ache

How do you diagnose Tonsillitis?
If you think you have tonsillitis, your medical provider can do a physical exam to make the diagnosis. To find the cause, they may swab your throat to check for strep throat infection or other bacteria. They can do a rapid strep test in the office, but results from a throat culture can take several days.

Is Tonsillitis Contagious?
Most acute infections of the tonsils are due to viruses or bacteria and usually is contagious by direct person-to-person contact. Tonsillitis caused by a virus infection usually is contagious for about seven to 10 days.
Bacterial tonsillitis can remain contagious for about two weeks.

Some individuals can become chronic carriers of potentially infectious bacteria and can be mildly contagious for long periods of time. People who are infected by bacteria and are treated with antibiotics are considered non-contagious after approximately 24-48 hours of appropriate antibiotic therapy.

Respiratory droplets easily spread the germs that most often cause tonsillitis. Someone can release these droplets when they:
  • Sneeze
  • Kiss
  • Cough
  • Talk
  • Sing
  • Exercise
  • Breathe

How do you treat tonsillitis?
When the cause is a virus, tonsillitis often gets better on its own. Most treatments aim to help with fever or pain. These can often be in the form of medication or home remedies.

Relief of symptoms can help with both viral and bacterial tonsillitis. To manage pain and fever, you can try over-the-counter medications like ibuprofen or acetaminophen.

If you have strep throat, you’ll likely need treatment with antibiotics. The symptoms can improve without treatment, but antibiotics are helpful to prevent complications. 

These can include:
  • Tonsillar abscess
  • Rheumatic fever (leads to heart disease)
  • Scarlet fever
  • Strep-related arthritis
  • Glomerulonephritis (kidney inflammation)
  • Autoimmune neurological disorders

Experts recommend penicillin or amoxicillin to treat strep throat. If you have a penicillin allergy, there are other antibiotics you can try. Common antibiotic medications are:
  • Cephalosporins (like cefdinir or cefixime)
  • Clindamycin
  • Azithromycin

Home Remedies
Many home remedies may relieve tonsillitis symptoms. Here are some common home remedies:
  • Honey may help to decrease inflammation and speed up recovery. Of note, honey is not safe for children under 12 months.
  • Warm salt water gargles may help decrease pain.
  • Hot drinks may help reduce the symptoms of sore throat.
  • Herbal teas may help decrease inflammation. Herbal infusions of licorice, barberry, thyme, or oregano may be effective.

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