- Clinical science
Acute tonsillitis is an inflammation of the pharyngeal tonsils that frequently arises in combination with an inflammation of the pharynx (tonsillopharyngitis). It is particularly common in children and young adults and is primarily caused by viruses and group A streptococci (GAS). Acute tonsillitis is characterized by a sudden onset of fever, sore throat, and painful swallowing. Tender, swollen cervical lymph nodes and tonsillar exudates may occur. Normally, the disease is self-limiting. However, if group A streptococcal infection is confirmed with rapid antigen detection test and/or throat culture, treatment with antibiotics (penicillin) should be initiated to prevent and . Tonsillectomy is an option in recurrent and chronic tonsillitis, although the procedure is associated with a high risk of postoperative bleeding. and are serious suppurative complications of acute bacterial tonsillitis and require immediate treatment.
- Peak incidence
- Viral tonsillitis: children < 5 years and young adults 
- Streptococcal tonsillitis: children aged 5–15 years; rare in children < 2 years
Epidemiological data refers to the US, unless otherwise specified.
- Acute tonsillitis
- Recurrent tonsillitis and chronic tonsillitis: polymicrobial infections with aerobic bacteria (typically streptococci, staphylococci, Haemophilus influenzae) and anaerobic bacteria 
- Sudden onset of symptoms
- Red and swollen pharynx, tonsillar exudates 
- Fever, sore throat, dysphagia
- Painful, swollen cervical lymph nodes
- Foul breath
- If viral: headache, earache, nasal congestion, and cough 
Acute tonsillitis is primarily a clinical diagnosis that may be supported by blood tests and confirmed via microbiological testing.validated clinical decision rule (e.g., modified Centor score, FeverPAIN score) with selective use of rapid antigen detection testing
Modified Centor score: 
Microbiologic testing 
Confirmatory tests: rapid antigen detection test and/or throat culture
Rapid GAS antigen detection test
- Throat swab allows simple and quick detection of group A streptococcal infection (highly specific, sensitivity 59–96%) 
- A negative test should be confirmed by throat culture in children and adolescents.
- Throat culture: to identify pathogen and determine antibiotic sensitivity 
- Rapid GAS antigen detection test
- Confirmatory tests: rapid antigen detection test and/or throat culture
- Blood tests
| || |
| || |
|Vincent angina|| || |
|(fungal tonsillitis)|| || |
|Pharyngeal syphilis|| |
|Tonsillitis in (diphtheric croup)|| || |
|Agranulocytic angina|| |
The differential diagnoses listed here are not exhaustive.
Acute tonsillitis is usually self-limiting (symptoms usually resolve within 3–4 days without treatment). However, antibiotic therapy is indicated for bacterial infections.
- Symptom relief: rest, sufficient fluid intake, analgesics, salt-water gargles
- Antibiotic treatment if infection with group A Streptococcus has been confirmed
Subtotal tonsillectomy: tonsils are partially removed, while the capsule remains
- Advantage: Low rate of postoperative bleeding
- Disadvantage: relapse is possible 
Total tonsillectomy: removal of the entire tonsils and capsule
- Postoperative hemorrhage is a serious complication (occurs in ∼ 5%)
- Subtotal tonsillectomy: tonsils are partially removed, while the capsule remains
We list the most important complications. The selection is not exhaustive.