From the Guidelines
Bacterial tonsillitis is typically characterized by severe sore throat, difficulty swallowing, swollen and red tonsils with white or yellow patches or pus, tender and swollen lymph nodes in the neck, fever above 100.4°F (38°C), and other symptoms such as headache, loss of appetite, and general malaise, as noted in the study by 1. The presence of these symptoms, particularly the combination of fever, tonsillar exudates, and absence of cough, suggests a bacterial cause, with Group A Streptococcus being the most common bacterial pathogen, as indicated by 1. Key signs that distinguish bacterial from viral tonsillitis include:
- Severe sore throat
- Difficulty swallowing
- Swollen and red tonsils with exudates
- Tender and swollen lymph nodes in the neck
- Fever above 100.4°F (38°C)
- Absence of cough It's crucial to seek medical attention if bacterial tonsillitis is suspected, as it typically requires antibiotic treatment to prevent complications, according to 1. While waiting for medical care, managing symptoms with rest, fluids, warm salt water gargles, and over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate discomfort, as suggested by general medical practice and supported by the principles outlined in 1. The modified Centor criteria, which include fever, tonsillar exudates, tender anterior cervical adenopathy, and absence of cough, can be used to determine the likelihood of a bacterial cause, as mentioned in 1. However, given the potential for serious complications, a definitive diagnosis and treatment plan should be made under the guidance of a healthcare professional, emphasizing the importance of prompt medical evaluation and appropriate antibiotic therapy, as highlighted by 1 and 1.
From the Research
Signs of Bacterial Tonsillitis
- The signs of bacterial tonsillitis are not explicitly stated in the provided studies, but the diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections 2.
- A scoring system (Centor, McIssac, FeverPAIN score) can be used to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS) 3.
- In ambiguous cases, a point-of-care test GAS swab test is helpful in diagnosing bacterial tonsillitis 3.
- Bacterial tonsillitis is often caused by group A beta-hemolytic streptococci, and prevention of acute rheumatic fever is the principal goal of treatment 4.
Diagnosis and Treatment
- Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results 2.
- Bacteria are cultured from few people with tonsillitis, and other causes of tonsillitis include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella 2.
- Antibiotic treatment is an option in patients with recurrent acute pharyngo-tonsillitis (RAPT), who have contraindications for tonsillectomy, and clindamycin and amoxicillin with clavulanate are superior to penicillin with preferable effects on the microbiological flora and the number of future attacks of APT in patients with RAPT 5.
- Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years 3.