Bacterial tonsillitis is an infection of the tonsils caused by bacteria. Symptoms include sore throat, difficulty swallowing, fever and sometimes a general feeling of being unwell. Bacterial tonsillitis is treated with antibiotics.
Aetiology
Bacterial tonsillitis is mainly caused by the bacteria Streptococcus pyogenes (group A beta-hemolytic streptococcus ) and Streptococcus anginosus. Other less common bacteria that can cause bacterial tonsillitis include Haemophilus influenzae, Neisseria gonorrhoeae, and Streptococcus pneumoniae.
Bacterial tonsillitis is usually contagious and can be spread through respiratory droplets by talking, coughing, or sneezing around other people. It can also spread through close contact with objects or surfaces that have been touched by someone with the infection.
Epidemiology
Bacterial tonsillitis is a common infection in childhood and adolescence, and is less common in adults. Although it can occur at any time of the year, an increase in incidence is observed during the autumn and winter months. Bacterial tonsillitis is most often diagnosed in children 5 to 15 years of age.
Bacterial tonsillitis is more common in regions with temperate and humid climates, and in areas with high population density. The incidence rate varies in different countries and regions of the world, but is estimated to affect about 10% of children in the United States.
In addition, some risk factors for developing bacterial tonsillitis include having a weakened immune system, having a chronic illness such as asthma, and having close contact with someone who has a tonsil infection.
Clinical picture
Symptoms of bacterial tonsillitis usually come on suddenly and may include:
- Severe sore throat, especially when swallowing.
- Fever and chills.
- Headache.
- Malaise.
- Ear pain.
- Jaw pain.
- Rash.
- Enlargement of the tonsils.
- Redness and swelling of the tonsils.
- Pus or white spots on the tonsils.
- Nausea or vomiting.
- Abdominal pain.
- White or spotted tongue.
- Cervical lymphadenopathy.
In some cases, bacterial tonsillitis can cause complications, such as tonsil abscesses, cellulitis, sepsis, and rheumatic disease.
It is important for a doctor to examine the person and perform tests to confirm the diagnosis of bacterial tonsillitis and determine the underlying cause.
Diagnosis of Bacterial Tonsillitis
The diagnosis of bacterial tonsillitis is based on medical history, symptoms, and physical findings. The doctor will usually do a physical exam of the throat, including looking at the tonsils for signs of swelling, redness, and the presence of pus or white patches.
In addition, a throat smear is usually performed to detect the bacteria causing the infection and determine their type. The result of this smear can be known in a few hours.
Other tests that can help confirm the diagnosis include:
Blood tests to measure C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR)
Throat culture: This involves taking a sample from the throat and growing it in a specific medium to detect the bacteria causing the infection.
Antibody screening studies to detect the presence of antibodies to group A beta-hemolytic streptococcus (ASO, Anti-DNase B)
In case of suspected complications or serious illness, other tests such as an ultrasound, CT scan, or puncture may be necessary to obtain a tissue sample.
It is important to note that bacterial tonsillitis must be differentiated from other causes of sore throat, such as viral tonsillitis or strep throat, as their treatment may vary.
Treatment for Bacterial Tonsillitis
Treatment of bacterial tonsillitis usually includes the use of antibiotics. Recommended antibiotics for the treatment of bacterial tonsillitis caused by group A beta-hemolytic strep are penicillin and penicillin-class antibiotics such as amoxicillin and ampicillin. Other antibiotics such as clindamycin, azithromycin or clarithromycin are alternatives in case of penicillin allergy.
It is important to take antibiotics as directed, even if symptoms go away before treatment ends. This will help prevent the infection from coming back and prevent the bacteria from spreading to others.
In addition, it is advisable to follow a series of measures to relieve symptoms and aid in recovery:
- Rest: It is important to rest to help the body fight the infection.
- Fluids: Drink enough fluids to stay hydrated.
- Painkillers: Paracetamol or ibuprofen can help relieve a sore throat and fever.
- Gargles: Gargling with warm salt water can help relieve a sore throat.
- Humidity: Keeping the environment comfortable and moist can help relieve symptoms.
In case of complications such as tonsil abscess or cellulitis, more specific treatment may be necessary and may require hospitalization.
It is important to note that bacterial tonsillitis is contagious and close contact with others should be avoided until symptoms disappear and antibiotic treatment has been completed.
Prevention of Bacterial Tonsillitis
The best way to prevent bacterial tonsillitis is to avoid contact with people who have the infection and practice good hygiene measures. Some preventive measures include:
- Wash your hands often with soap and water, especially after coughing or sneezing, and before cooking or eating.
- Avoid sharing personal items such as towels, toothbrushes or kitchen utensils.
- Cover your mouth and nose when coughing or sneezing with a tissue or elbow, and don’t touch your face with your hands.
- Maintain good ventilation in your home and in places where you spend a lot of time.
- Avoid being around people with acute respiratory infections, especially if you have a weakened immune system.
- Vaccines: The pneumococcal vaccine can help prevent bacterial tonsillitis caused by pneumococcus.
In addition, it is important for people with symptoms of bacterial tonsillitis to isolate themselves to prevent spreading the infection to others, and seek medical attention to receive proper diagnosis and treatment.
Criteria for tonsillectomy
Tonsillectomy is the surgical removal of the tonsils. Although it is a common procedure, it is reserved for cases in which other treatments have not been effective or in which there are recurrent complications. Criteria used to determine whether a patient should undergo a tonsillectomy include:
- Recurrent tonsil infections: If a patient has more than six tonsil infections a year or if they have more than three infections in the past three years.
- Recurrent tonsil abscesses: If a patient has frequent tonsil abscesses.
- Recurrent sore throat: If a patient has a recurrent sore throat and no other causes can be identified.
- Difficulty swallowing: If a patient has difficulty swallowing due to swelling of the tonsils.
- Airway obstruction: If the tonsils are obstructing the patient’s airway, especially at night.
- Sleep apnea: If a patient has sleep apnea due to airway obstruction caused by swollen tonsils.
- Other problems: If the tonsils are causing other problems such as hearing problems, dental problems, or cosmetic problems.
It is important to note that tonsillectomy is not recommended to treat bacterial tonsillitis, as antibiotics are effective in most cases.
It is important to consult with an otolaryngology physician to determine if a tonsillectomy is appropriate for a specific patient and discuss the risks and benefits of the procedure.
