File Name: acute and chronic tonsillitis .zip
Metrics details. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis.
Tonsillitis is the second most common presenting condition in general practice for the age group and the eighth most common overall in the UK. Signs and symptoms Confusion exists over the term 'tonsillitis' as, although it is a parenchymal infection of the palatine tonsils, it can occur in isolation or as part of a generalised pharyngitis. In general practice, the usual presenting symptom of tonsillitis is a sudden-onset sore throat with associated features of odynophagia, pyrexia and tonsillar exudates, and is more common in year olds.
Other symptoms are tonsillar erythema, enlargement, anterior cervical lymphadenopathy and referred otalgia, in addition to headache, halitosis and vomiting. Tonsillitis is viral in the majority of cases and bacterial in 10 to 30 per cent of cases. Viral or bacterial The prevalence of bacterial tonsillitis, most commonly due to group A beta-haemolytic streptococci GABHS , is per cent in children with sore throat and per cent in adults. Bacterial tonsillitis can occasionally cause rheumatic fever and acute glomerulonephritis, which can be prevented by penicillin.
Less common bacterial pathogens are group C beta-haemolytic streptococci 5 per cent with rarer bacterial causes including Mycoplasma pneumoniae and Neisseria gonorrhoeae. Cytomegalovirus infection may also result in the clinical picture of infectious mononucleosis, and the differential diagnosis also includes toxoplasmosis, HIV, hepatitis A, rubella and diphtheria.
It is difficult to differentiate between viral or bacterial aetiology. Rapid antigen testing and bacterial culturing both have low sensitivities and are not recommended except in those at risk of complications of GABHS-tonsillitis. Blood testing should include an infectious mononucleosis screen. The diagnosis of tonsillitis is clinical. Centor criteria will aid in the diagnosis or exclusion of GABHS-tonsillitis and determine whether antibiotics are an option.
Centor criteria includes: tonsillar exudate; tender anterior cervical lymph node; absence of cough and a history of fever. Presence of three of these clinical signs suggests the chance of the patient having GABHS is per cent, so the patient may benefit from antibiotic treatment. Absence of three of four Centor criteria suggests there is an 80 per cent chance that the patient does not have a streptococcal sore throat and antibiotics are unlikely to benefit.
Tonsillitis usually resolves in one week with no sequelae. This, in addition to poor evidence from research, has made the management of tonsillitis controversial. Antibiotics NICE guidelines recommend antibiotics should not routinely be given for tonsillitis. Penicillin is the antibiotic of choice. Ampicillin-based antibiotics, including co-amoxiclav, must be avoided as first line treatment due to the risk of causing a non-allergic rash in those with infectious mononucleosis.
For those who are allergic to penicillin, erythromycin should be offered. Referral to secondary care Patients with acute tonsillitis not able to maintain an oral intake or those with complications, such as peritonsillar cellulitis or quinsy, should be referred to secondary care.
Patients with more than five episodes per year who want a tonsillectomy may be referred for ENT specialist opinion. Before top and after below tonsillectomy; one of the most common surgical procedures.
Tonsillectomy Tonsillectomy is one of the most common surgical procedures performed in the UK. The benefits have to be weighed against the risks of perioperative morbidity and postoperative haemorrhage. SIGN guidelines recommend that the following should be indications for tonsillectomy:. Serious bleeding is a real risk and accounts for the rare deaths which happen after tonsillectomy.
Evidence base For tonsillectomy versus no surgery in adults, a systematic review only identified one eligible RCT showing surgery 'may be more effective at reducing the frequency and duration of sore throat at five to six months, but we don't know the long-term effects'. The most recent systematic review found tonsillectomy significantly reduced episodes of sore throat compared with control at one to three years.
However, the systematic review concluded that there was little clear evidence of clinical effectiveness and cost effectiveness of surgical or medical management in either adults or children.
A recently published RCT examining the cost effectiveness of tonsillectomy in children in comparison with standard non-surgical management has shown tonsillectomy reduced the likelihood of having an episode of sore throat by 30 per cent in the first year and 46 per cent in the second year.
Surgery also reduced the mean number of sore throats by 33 per cent in the first year and 73 per cent in the second year. References 1. Management of sore throat and indications for tonsillectomy.
Edinburgh, SIGN. Available from www. Respiratory tract infections - antibiotic prescribing. London, NICE, Cochrane Database Syst Rev , Issue 1. Art No:CD DOI: Health Technol Assess ; No Sign in. Register Now. Stay signed in.
Anterior cervical lymphadenopathy is a symptom of tonsillitis Photograph: SPL. Before top and after below tonsillectomy; one of the most common surgical procedures Tonsillectomy Tonsillectomy is one of the most common surgical procedures performed in the UK. SIGN guidelines recommend that the following should be indications for tonsillectomy: Sore throats caused by tonsillitis. Five or more episodes of sore throat per year. Symptoms for at least a year. Episodes of sore throat that are disabling and prevent normal functioning.
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Professional Reference articles are designed for health professionals to use. You may find the Tonsillitis article more useful, or one of our other health articles. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Tonsillitis is inflammation due to infection of the tonsils.
Most cases resolve spontaneously and do not require antibiotics. Antibiotics are used to treat group A beta-hemolytic streptococcal infection. There is some evidence that tonsillectomy may be effective in selected children with recurrent severe acute tonsillitis. Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalized pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as "acute sore throat".
More than , patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy i. Routinely performed blood tests for acute tonsillitis are not indicated.
Tonsillitis is inflammation due to infection of the tonsils. Pharyngitis is inflammation of the oropharynx but not the tonsils. The tonsils tend to.
Tonsillitis is the second most common presenting condition in general practice for the age group and the eighth most common overall in the UK. Signs and symptoms Confusion exists over the term 'tonsillitis' as, although it is a parenchymal infection of the palatine tonsils, it can occur in isolation or as part of a generalised pharyngitis. In general practice, the usual presenting symptom of tonsillitis is a sudden-onset sore throat with associated features of odynophagia, pyrexia and tonsillar exudates, and is more common in year olds. Other symptoms are tonsillar erythema, enlargement, anterior cervical lymphadenopathy and referred otalgia, in addition to headache, halitosis and vomiting.
Background and Objective Acute tonsillitis is one of the most common reasons for application to otorhinolaryngology clinics. In the treatment of acute tonsillitis, supportive therapies are mostly used. As antibiotic therapy, penicillin or erythromycin can be used.
A prospective randomized clinical study comparing the efficacy of penicillin-V potassium with amoxycillin plus clavulanate potassium Augmentin in the treatment of acute episodes of recurrent streptococcal tonsillitis was conducted.
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