Acute tonsillitis is an infection of the tonsils caused by several possible types of bacteria or viruses.

Viral tonsillitis is often present along with other symptoms of an upper respiratory tract infection (cough, runny nose, sneezing). Herpes simplex virus infection may demonstrate painful vesicular lesions, as will herpangina (coxsackievirus).

Pharyngitis caused by Epstein-Barr virus can be part of complex symptoms known as infectious mononucleosis. The marked tonsillar enlargement seen in mononucleosis may lead to airway compromise.

In comparison with viral infections, bacterial (streptococcal) tonsillitis tends to present with a more abrupt onset and high fevers.

Acute bacterial tonsillitis is generally caused by group A

• Young age: most often it occurs in children.
• Close contact with an infected person
• Compromised immunity
• Military and closed communities

The palatine tonsils are located in the tonsillar fossa defined by the palatoglossal muscle anteriorly and the palatopharyngeal muscle posteriorly. They are covered with epithelium that extends into deep and partly branched tonsillar crypts. The crypts greatly increase the contact surface. Disruption in the crypt epithelium allows for interaction of antigenic stimuli with tonsillar lymphocytes.

A virulent organism that enters the tonsillar crypt and fails to be expelled can proliferate in the base and lead to localized edema and influx of neutrophils: clinically presenting as a red swollen tonsil with exudate.

• High fever
• Both tonsils are swollen, bright red and coated
• A white or yellow coating on the tonsils
• Severe pain on swallowing, which often radiates to the ear
• Swollen neck lymph nodes
• Muffing of speech due to oropharyngeal swelling
• Painful blisters or ulcers on the throat
• Headache
• Loss of appetite
• Swollen glands in the neck or jaw area
• Bad breath

In children, symptoms may also include:

• Nausea
• Vomiting
• Abdominal pain

Infected tonsils are normally visible—diagnosis is possible without tests. The blood count shows leukocytosis, erythrocyte sedimentation rate or C-reactive protein are elevated.

Rapid Streptococcus group A antigen test can identify the causative organism in just 10 minutes if negative, throat swab can be ordered.

Bacterial culture is rarely taken from throat smears because it usually takes 2—3 days to obtain a definitive result.

Computed tomography of the neck and oropharyngeal structures may be needed to exclude formation of an abscess. Magnetic resonance imaging may be used as well.

Here are some suggestions, which will make you feel better:

• Get enough rest
• Drink warm or very cold fluids to east throat pain (ice-cream may be useful as well)
• Eat smooth foods
• Suck on lozenges containing anesthetics

In the case of viral tonsillitis, spontaneous recovery is expected.

Standard treatment for streptococcal tonsillitis is a 10—14 days course of penicillin or amoxicillin. In the case of penicillin allergy, macrolides or oral cephalosporins can be used.

Analgesics are administered for pain relief, antipyretics may be considered.

In the case of complication development, surgical procedures must be carried out. Usually, it is tonsillectomy (removal of both palatine tonsils).

Airway obstruction—is very rare, but may occur in tonsillitis due to glandular fever. Clinically, it can be seen as severe snoring and acute sleep apnea (partial or total closure of upper airway during sleep), which may require rapid intervention.

Peritonsillar abscess (also called Quinsy)—appears as a swelling of the soft palate and tissues lateral to the tonsil. There is a pus collection in the potential space between the capsule and the surrounding pharyngeal musculature. Displacement of uvula towards the opposite site also is seen. Symptoms include bad breath, lockjaw (reduced opening of the jaws) and drooling.

Parapharyngeal abscess—it usually presents as a diffuse swelling in the neck and is a serious condition.

If the underlying bacterial infection is left untreated, there is a possibility of complication development, such as:

• Scarlet fever. It is most common in children 5 to 15 years of age. Clinically it appears as sore throat, high fever and a bright red rash that covers the body.
• Rheumatic fever. It is also most frequently seen in children 5 to 15 years of age. Clinically it appears as a painful and swollen joint accompanied by fever, sometimes even chest pain and a heart murmur.

Glomerulonephritis. The streptococcal infection causes the tiny blood vessels in the filtering units of the kidneys to be inflamed. This makes kidneys less able to filter the urine. Clinically it may appear as decreased urine output, rust-colored urine, general swelling.

The bacteria and viruses causing tonsillitis are spread through contact with other people. You can prevent the spread of the etiological agents by washing your hands. Don't share glasses or utensils. Avoid close contact (such as handshaking, hugging, kissing) with people who are sick.

Tonsillectomy eliminates the risk of recurrent tonsillitis. There are some preventive activities to reduce the possibility of getting tonsillitis:

• Smoking cessation
• Avoidance of extensive alcohol intake
• Don't use antibiotics without a doctor's prescription

The average duration of tonsillitis is one week. Viral tonsillitis is self-limiting and overall prognosis is good.  Some of the patients suffer from recurrent tonsillitis—prolonged or frequent episodes of swollen tonsils. Failure to treat group A streptococcus infection may lead to serious short-term or long-term difficulties.

Tonsillitis affects both genders equally. Peak incidence is seen in winter and early spring. As mentioned in the publication by the American Academy of Family Physicians in 2003, it occurs mainly in children 5 to 15 years of age. According to the National Center for Health Statistics, sore throat accounts for 2.1% of ambulatory visits in the U.S.