Acute tonsillitis and its several complications

Acute tonsillitis

1. ACUTE TONSILLITIS

2. DEFINITION Acute tonsillitis is an inflammation of two oval shaped pads of tissue known as tonsils, at the back of the throat. It is infectious in nature and most commonly involves PALATINE TONSILS , but lingual and pharyngeal tonsil can also be involved.

3. WALDEYER'S RING The lymphoid tissue surrounding opening into respiratory and digestive systems form a ring. The lateral part is formed by Palatine tonsils and tubal tonsils (around auditory tube opening). The upper part is formed by Pharyngeal tonsil (on the roof of nasopharynx). The lower part is formed by Lingual tonsil ( on the posterior ⅓ of the tongue)

4. WALDEYER'S RING

5. ANATOMY OF PALANTINE TONSILS Situated bilaterally in the lateral wall of the oropharynx in the tonsillar recess bounded by the palatoglossal fold anteriorly and the palatopharyngeal fold posteriorly. Consists of two surfaces (lateral and medial) and two poles (upper and lower) Upper pole extends into soft palate and lower pole is attached to tongue .

6. FUNCTIONAL IMPORTANCE IN IMMUNE SYSTEM There are 12-15 tonsillar crypts on the medial surface that increase the surface area and the efficiency of protection against pathogens. Significant role in the defense against upper respiratory infections. One of the MALT of the upper respiratory tract, which has the ability to mount specific immune reactions in response to antigens. Activity is pronounced during childhood, when immunologic challenges from the environment induce hyperplasia. " Active phase " lasts until about 8 - 10 years of age.

7. ETIOLOGY Approximately 30-40% cases of tonsillitis can be attributed to Bacterial cause Generally caused by Group A beta- haemolytic streptococci ( GABHS) Haemophilus Influenzae Staphylococcus Aureus Streptococcus Pneumoniae E. Coli Diptheria , Syphillis , Neisseria Viruses { adenovirus, influenza A and B virus, Epstein Barr virus, Herpes Simplex virus, Enterovirus, Parainfluenzae virus}

8. ETIOLOGY

9. SIGNS AND SYMPTOMS High fever (38° – 40° C), may be associated with chills and rigors Severe pain on swallowing , which often radiates to the ear ( n.glossopharyngeus ) Swollen tonsillar lymph nodes (cervical adenopathy) Muffling of speech due to oropharyngeal swelling Dysphagia Erythematous tonsils with exudates Halitosis

10. General - headache, malaise, anorexia, abdominal pain, pain in the back and limbs Viral infections tend to have lower grade fevers and less exudative tonsils

11. CLASSIFICATION OF ACUTE TONSILLITIS ACUTE CATARRHAL (or) SUPERFICIAL TONSILLITIS- Here tonsillitis is a part of generalized pharyngitis and is mostly seen in viral infections. ACUTE FOLLICULAR TONSILLITIS - Infection spreads into the crypts become filled with purulent material. ACUTE PARENCHYMATOUS TONSILLITIS - Tonsil is affected and becomes uniformly large and red. ACUTE MEMBRANEOUS TONSILLITIS - It is a stage ahead of follicular tonsillitis when exudation from the crypts coalesces to form a membrane on surface of tonsil.

12. DIAGNOSIS Complaints and symptoms (History) Examination of the throat Inflammatory parameters – leukocytosis, ESR and CRP are elevated Thorat swab and culture (for pyogenic bacteria, Diptheria and candida infection). Bone marrow aspiration (or) Needle biopsy Rapid immunoassay

13. DIFFERENTIAL DIAGNOSIS Membraneous Tonsillitis Diptheria Infectious Mononucleosis Aganulocytosis Leukaemia Apthous Ulcers Candida infection of tonsils Traumatic ulcer Malignancy tonsils

14. TREATMENT For streptococcal tonsillitis is a 10 – 14 days course of penicillin V, amoxicillin + ẞ lactamase inhibitors (clavulanic acid). Macrolides or oral cephalosporin can be used in patients allergic to penicillin. Analgesics for pain relief, antipyretics to reduce fever (diclofenac, ibuprofen) Bed rest, hydration, oral hygiene

15. COMPLICATIONS Local/regional Recurrent tonsillitis (6 - 7 episodes in 1 year, 5 episodes per year for 2 consecutive years) Sinusitis Chronic tonsillitis (sore throat is present for at least 3 months with tonsillar inflammation) Peritonsillar abscess (several days after the onset of tonsillitis) Parapharyngeal abscess Retropharyngeal abscess Laryngitis

16. COMPLICATIONS Sequel of streptococcal tonsillitis - rarely, a delayed type antigen-antibody reaction can give rise to poststreptococcal diseases: Acute glomerulonephritis (1 to 2 weeks after infection) Acute rheumatic fever (1 to 4 weeks) Rheumatic endocarditis SYSTEMIC

17. Thank you