From the Research
Yes, a patient without tonsils can develop posterior pharyngeal exudates with strep throat. Even after tonsillectomy, streptococcal bacteria can still infect the remaining pharyngeal tissue, including the posterior pharyngeal wall. The exudates, which are patches of white or yellow pus, can form on any inflamed pharyngeal surface where the bacteria colonize. While tonsillectomy may reduce the frequency of strep throat infections, it doesn't provide complete immunity since the bacteria can affect other lymphoid tissue in the throat. Patients without tonsils who develop symptoms like sore throat, fever, and visible posterior pharyngeal exudates should still be evaluated for strep throat. Diagnosis typically involves rapid strep testing or throat culture, and treatment remains the same: antibiotics such as penicillin V (500 mg twice daily for 10 days), amoxicillin (500 mg twice daily for 10 days), or macrolides like azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) for those with penicillin allergies, as recommended by studies such as 1. Complete antibiotic treatment is essential even if symptoms improve quickly to prevent complications like rheumatic fever. Key points to consider in the diagnosis and treatment of strep throat include:
- The use of rapid antigen detection tests or throat cultures for diagnosis, as outlined in 2 and 3
- The importance of considering the modified Centor score in determining the need for testing or empiric antibiotic therapy, as discussed in 3 and 1
- The role of antibiotics in reducing the duration of symptoms and preventing complications, as emphasized in 4 and 5
- The need for complete antibiotic treatment, even in patients who experience rapid improvement of symptoms, to prevent complications like rheumatic fever, as highlighted in 2, 3, and 1.