Causes of tonsillitis in adults

Tonsillitis - Overview

The tonsils are two clumps of tissue, on either side of the throat, embedded in a pocket at the side of the palate. They form a part of the body’s immune system. Tonsillitis is an inflammatory disease affecting the tonsils. This means that they get inflamed, and then further this causes various symptoms such as a sore throat or a fever.

In tonsillitis, the tonsils are enlarged, red, and often coated (either partially or entirely) by a substance that is white, yellow, or, sometimes, gray. It happens mostly to children and young people but can affect people at any age.

Symptoms of this disease include: red or swollen tonsils, sore throat, fever, sore eyes, cough, white or yellow patches on the tonsils, difficulty at swallowing, headache, stiffness in the neck, enlarged lymph nodes in the neck, chills, changes in the voice of the person (the voice sounds scratchy or muffled), etc.

People in close contact with young children (teachers and parents), are more likely to contract this disease. It is easy for children, being surrounded by other children, and therefore exposed to various bacteria and viruses, to transfer it to adults. The infection is generally spread from person to person by airborne droplets, hand contact, or kissing.

The most common causes of tonsillitis are the viruses that also cause the common cold, such as influenza, coronavirus, rhinovirus, Epstein-Barr virus, or herpes simplex virus, etc.

The other reason for tonsillitis may be bacterial. And the most common virus that can bring about this disease is Group A ?-hemolytic streptococcus (which causes strep throat). Also, diphtheria, syphilis, and gonorrhea may be the underlined cause, but this happens very seldom.

Whether it be the bacterial or viral cause, the incubation period is usually about two or three days from picking the infection up and the actual disease first appearing in the form of some symptom.

More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life.

The incidence peak of acute tonsillitis is observed in children of school age, but it may generally occur at any age. It can only be assumed that (pharyngo-)tonsillitis caused by group A ?-hemolytic streptococci (GABHS) or Streptococcus pyogenes is responsible for about 5 % of acute medical consultations.
In 2010, approximately 127,000 tonsillectomies including tonsillotomies were performed in Germany on an inpatient basis. Further details, not relevant for this clinical guideline, are provided in the literature. Histopathological examination of the tonsils alone is not capable to establish the diagnosis of tonsillitis. The diagnosis is much more based on the patient’s history and clinical symptoms. Bathala and Eccles described the mechanism of pain secondary to tonsillitis.
Acute tonsillitis is mainly caused by viruses, such as double-stranded DNA viruses (human adenoviruses, Epstein Barr Virus), single-stranded DNA viruses (Human Boca Virus), single-stranded RNA viruses (influenza and para-influenza viruses; rhino-viruses; entero-viruses including Coxsackie viruses; corona viruses; respiratory syncytial virus (RSV); human meta-pneumo-virus), retro-viruses [human immunodeficiency viruses (HIV)].
The most important pathogens that cause bacterial tonsillitis are GABHS, i.e. Streptococcus pyogenes. The disease transmission generally occurs via droplet infection transmitted by other patients with acute GABHS tonsillitis, very rarely by asymptomatic carriers. However, even autoinfection via the normal flora of the mouth and the pharynx is possible. Other pathogen reservoirs may be pets, farm animals, but also articles of daily use such as tooth brushes.
More rarely, other bacteria must be considered such as e.g. Streptococci of group C and G, Haemophilus influenzae, Nocardia, Corynebacteria and Neisseria gonorrhoeae. The bacterial symbiosis of Fusobacterium nucleatum and Borrelia vincentii leads to a disease known as Vincent’s angina, which is characterized by a mostly unilateral, ulcerating tonsillitis with intensively putrid halitosis.
To estimate the probability of tonsillitis caused by ?-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ?3 should lead to pharyngeal swab or rapid test or culture in order to identify ?-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG.

Acute tonsillitis is to be a clinical diagnosis. Furthermore, parameters like the patient´s history, clinical symptoms, and laboratory values are required to distinguish between viral and bacterial origin of tonsillitis. It should be emphasized, that even positive results in laboratory tests such as C-reactive protein (CRP), serological parameters like positive anti-streptolysin-O titers (ASLO) or tonsil swabs (rapid antigen detection or microbiological culturing) do not prove a tonsillitis in asymptomatic patients

✓ Fact confirmed: Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management Jochen P. Windfuhr, Nicole Toepfner, Gregor Steffen, Frank Waldfahrer & Reinhard Berner; 11 January 2016

Treatment

Usually, tonsillitis goes away on itself, but it is advisable that the person affected consult a doctor to avoid such complications as, for instance: dehydration, kidney failure, pharyngitis, blocked airways, rash, secondary infections (in the middle ear or sinuses), etc.

Treatment for tonsillitis depends on whether it was caused by a virus or bacteria. If it’s caused by a bacteria, the doctor will prescribe a course of antibiotics, usually penicillin, or, if someone is allergic to it, another antibiotic, such as erythromycin. If, however, it was caused by a virus, it is usually treated with paracetamol or Aspirin (but this is not for children under 16).

If someone suffers from repeated cases of tonsillitis, a tonsillectomy (an operation in which the tonsils are completely removed) may be performed. However, this is rarely done.