Tonsillitis is a common infectious disease of children and adults. It is in most cases treatable by antibiotics but untreated tonsillitis can lead to many complications including very serious ones.


The most common cause is streptococcus bacterial group. Tonsils consist of lymphoid tissue packed with lymphocytes and other immune defense cells that serve as an important line of defense against microorganisms entering our body with inspired air. Unfortunately, sometimes these microorganisms can attack directly the tissue of tonsils and cause an inflammation. To less common causes of tonsillitis belong viral or other than streptococci bacteria infections (for example staphylococcus, syphilis, gonorrhea.


Tonsillitis symptoms are well-known. Fever, fatigue, headache and muscle pain are present. In addition affected person feels an uncomfortable pain inside the neck that often worsens when swallowing. Sometimes the pain can be so severe that swallowing of food or fluids is almost impossible. The throat mucosa and affected tonsils are sick red, there are often visible white pins on the surface of tonsils. Painful and swollen lymph nodes may emerge in the neck area but this is not always present. The whole picture is very similar to infectious mononucleosis which is however much rarer compared to a streptococcus tonsillitis.




Scheme - open mouth of a person with tonsillitis



Angina has two possible complications that are related mainly to untreated tonsillitis. First possible complications is a spread of infection to deeper tissues of the pharynx and abscess (pus- filled cavity) development. Out of this location the inflammation may further spread into the chest which is a potentially fatal condition. It needs to be solved surgically. The second and nowadays luckily quite uncommon complication is so called rheumatic fever affecting heart and joints. You will find more information in an article dedicated to rheumatic fever.


The diagnosis is made of symptoms and finding in affected person’s mouth. If there is a need to differentiate viral inflammation of the upper respiratory tract from bacterial, we may investigate serum level of CRP (C – reactive protein), that is only slightly elevated in viral infections, but sharply increased by bacterial inflammations.


Symptoms leading to an abscess diagnosis are high fever, severe pain in the neck and symmetry of palatal arches by opened mouth, as well as a deviation of uvula. In that case a computed tomography of the neck could confirm and specify the diagnosis.


Recurrent tonsillitis can be further prevented by administering long-lasting depot form of penicillin (usually intramuscularly). People who have already had rheumatic fever should be treated preventively against tonsillitis recurrence and most of them use penicillin antibiotics regularly in a daily routine.


Penicillin is still the most effective antibiotic against streptococcal infections. It is very important to follow the dosage and duration of antibiotic treatment prescribed by a doctor. With a failure to comply or leaving a tonsillitis untreated there is also the risk of rheumatic fever development, together with all its complications. Bed rest and adequate fluid intake is very useful complementary means of therapy.


If a tonsil abscess originates in pharynx tissues, it must be surgically cut open with following pus evacuation and drainage.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources