Tonsillitis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
* Tonsillitis | *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. | |||
*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]] where 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> | |||
**Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications. | |||
* 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]]). | * 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]]). | ||
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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.
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 where indicated.[2]
- Left untreated, recurrent tonsillitis may persist and recur over periods of time and can lead to infectious complications.
- 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).
- 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),[3][4][5] 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.
- 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 tonsilloliths. These may emit an odor due to the presence of volatile sulfur compounds.
Complications
The complications can be listed as:
- Blocked airway from swollen tonsils
- Dehydration from difficulty swallowing fluids
- Peritonsillar abscess in other parts of the throat behind the tonsils
- Post-streptococcal glomerulonephritis
- Rheumatic fever and other heart problems
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.
References
- ↑ "Tonsillitis - NHS Choices".
- ↑ 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.
- ↑ "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. 1999. ISBN 1-899893-66-0. Unknown parameter
|month=ignored (help); External link in|publisher=(help) - notes though that these criteria "have been arrived at arbitrarily" from:
Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. - ↑ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics. 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941. - 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"
- ↑ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]". Ther Umsch (in German). 61 (5): 325–8. PMID 15195718. - 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"