Infant and Children | November 20, 2014 | Author: The Super Pharmacist
The immune system is the body’s defense against disease producing bacteria and viruses. It has many components. The tonsils are a part of the immune system. They are a pair of structures lying at the back of the throat, one on either side. They are quite strategically placed; at the entrance to the air and food passages. This emphasises their importance as guards, checking what is harmful for the body and what is not. Harmful viruses and bacteria are trapped and the immune system is alerted and activated against them. Sometimes during this fight against pathogens (disease producing agents) the tonsils themselves become infected and inflamed. The result is a condition known as tonsillitis. When it is of recent onset, it is termed acute tonsillitis. When it has been recurring or ongoing for some time, it is called chronic tonsillitis. Accumulation of pus next to the tonsil is known as peritonsillar abscess or quinsy.
The condition mostly affects children and young adults, as tonsils tend to regress with age.
Tonsillitis is normally the result of either a viral or bacterial infection, the former being more common. It can also start as a viral condition and then develop into a superadded bacterial infection. Commonly implicated viruses are adenovirus, rhinovirus, influenza virus and Epstein-Barr virus. There can be an associated common cold or flu. Commonly implicated bacteria include Group A β-hemolytic Streptococcus (GABHS), Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and others. Of these the most frequent is Streptococcus pyogenes, an example of a Group A β-hemolytic Streptococcus (GABHS). It is the organism behind 'strep throat'.
In young children, watch out for
Your doctor will make the diagnosis after noting a relevant history and performing a physical examination including a throat exam. A swab is taken from the throat and tonsils for testing. The rapid strep test yields results within minutes and indicates the presence or absence of strep throat. A culture report can take one to two days and is more sensitive than the rapid test. A rise in ASO titres (antibodies to the strep antigen) shows previous infection. Negative tests for bacterial infection point to viral tonsillitis.
Irrespective of the cause, the following measures will help in tonsillitis:
Antibiotics by definition are effective against bacteria and have no role against viruses. Since many cases of tonsillitis have a viral cause, antibiotics are not always necessary. The decision to start an antibiotic lies with your doctor.
A positive strep culture is a sure indication for an antibiotic such as penicillin or amoxycillin for approximately 10 days.
A narrow-spectrum oral cephalosporin such as cephalexin or a macrolide such as clarithromycin are penicillin alternatives for those sensitive or allergic to penicillins. Clindamycin is another effective choice. If your doctor prescribes an antibiotic, finish the full course to completely eradicate the organism.
While an acute attack of tonsillitis is managed conservatively, recurrent or persistent tonsillitis, also known as chronic tonsillitis, interfering with school and work, is an indication for a tonsillectomy. Tonsillectomy is the name of the surgical procedure to remove the tonsils. The following criteria have been developed to indicate the recommendation of a tonsillectomy:
Any of these would suggest chronicity and an indication for surgery. Also if the tonsils interfere with breathing and/or swallowing, surgery should be considered. In children another infected structure nearby is the adenoid which is usually removed with the tonsils.
The realisation that most cases are viral where antibiotics have no role, an overall decrease in unnecessary prescribing of antibiotics and a reduced incidence of strep throat and its complications, have all resulted in a continual decline in the use of antibiotics for tonsillitis.
Tonsillectomy is a very common surgical procedure. Traditionally done by blunt dissection and then use of ligatures or diathermy to stop the bleeding; new techniques utilise lasers and ultrasonic scalpels.
Most cases will resolve without antibiotics within a week or two. This is the time it takes for the body’s immune system to get rid of the infection on its own. However the supportive care measures outlined above including rest, rehydration and pain relief will improve patient comfort and hasten recovery.
Antibiotics do not markedly shorten the episode. Their main role is to prevent any complications and decrease the chances of transmission of infection. An untreated strep throat can give rise to complications including cardiovascular, joints or kidneys.
Most of the organisms that can infect the tonsils causing tonsillitis can infect the throat as well leading to pharyngitis. A tonsillectomy will eliminate future incidence of tonsillitis but pharyngitis can still occur. However there is a significant decrease in the frequency of recurrent throat infections. Also any breathing or swallowing difficulty due to the tonsils is taken care of for good. Generally speaking, people with repeated infections of the tonsils are better off without them.
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