From the Guidelines
Yes, viruses can cause exudative tonsillitis. Viral tonsillitis, particularly that caused by Epstein-Barr virus (infectious mononucleosis), adenovirus, and occasionally influenza viruses, can present with white or yellow exudates on the tonsils similar to bacterial infections 1. While bacterial tonsillitis (especially group A Streptococcus) is often associated with exudates, viral causes account for approximately 70-85% of all tonsillitis cases. Distinguishing between viral and bacterial causes can be challenging based on appearance alone, though viral tonsillitis often presents with additional symptoms like conjunctivitis, cough, rhinorrhea, and lack of high fever. Some key points to consider in the diagnosis and management of tonsillitis include:
- The presence of symptoms such as persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates may suggest a bacterial cause, but these can also be present in viral infections 1.
- The use of rapid antigen detection tests and/or throat cultures can help confirm the presence of group A Streptococcus, but these tests are not always necessary for diagnosis 1.
- Treatment for viral tonsillitis is primarily supportive, including adequate hydration, rest, and pain management with acetaminophen or ibuprofen 1.
- Antibiotics are not effective against viral infections and should be avoided unless there is confirmed bacterial co-infection.
- Viral tonsillitis typically resolves within 7-10 days as the body's immune system clears the infection. It's essential to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions, and to use the most recent and highest-quality evidence available to guide these decisions 1.
From the Research
Causes of Exudative Tonsillitis
- Viruses are a common cause of exudative tonsillitis, with studies showing that they are responsible for a significant proportion of cases 2, 3, 4, 5, 6.
- Specific viruses that have been implicated in exudative tonsillitis include:
- Bacteria, such as group A streptococci (GAS), can also cause exudative tonsillitis, but they are less common than viral causes 2, 3, 4, 5.
Diagnosis and Treatment
- The diagnosis of exudative tonsillitis is often based on clinical presentation, and laboratory tests may not always be able to distinguish between viral and bacterial causes 2, 3, 5.
- Treatment for exudative tonsillitis is typically supportive, with analgesia and hydration for viral cases, and antibiotic therapy for bacterial cases 4, 5.
- Routine or immediate antibiotic therapy for acute exudative tonsillitis in children is not necessary, as the majority of cases are caused by viruses 3, 4.