Symptoms

The symptoms vary with severity of infection. The predominant symptoms are:

1. Sore throat.

2. Difficulty in swallowing. The child may refuse to eatanything due to local pain.

3. Fever. It may vary from 38 to 40°C and may be associatedwith chills and rigors. Sometimes, a child presents with anunexplained fever and it is only on examination that anacute tonsillitis is discovered.

4. Earache. It is either referred pain from the tonsil or theresult of acute otitis media which may occur as acomplication.

5. Constitutional symptoms. They are usually more markedthan seen in simple pharyngitis and may include headache,general body aches, malaise and constipation. There maybe abdominal pain due to mesenteric lymphadenitissimulating a clinical picture of acute appendicitis.

Signs

1. Often the breath is foetid and tongue is coasted.

2. There is hyperaemia of pillars, soft palate and uvula.

3. Tonsils are red and swollen with yellowish spots of purulentmaterial presenting at
the opening of crypts (acutefollicular tonsillitis) or there may be a whitish membraneon the medial surface of tonsil which can be easily wipedaway with a swab (acute membranous tonsillitis). Thetonsils may be enlarged and congested so much so thatthey almost meet in the midline along with some oedemaof the uvula and soft palate (acute parenchymatoustonsillitis).


4. The jugulodigastric lymph nodes are enlarged and tender. Treatment

1. Patient is put to bed and encouraged to take plenty of fluids.


2. Analgesics (Aspirin or paracetamol) are given accordingto the age of the patient to relieve local pain and bringdown the fever.

3. Antimicrobial therapy. Most of the infections are due tostreptococcus, and penicillin is the drug of choice. Patientsallergic to penicillin can be treated with' erythromycin.Antibiotics should be continued for 7-10 days.

Complications

1. Chronic tonsillitis with recurrent acute attacks. This isdue to incomplete resolution of acute infection. Chronicinfection may persist in lymphoid follicles of the tonsil inthe form of microabscesses.

2. Peritonsillar abscess.

3. Parapharyngeal abscess.

4. Cervical abscess due to suppuration of jugulodigastriclymph nodes.

5. Acute otitis media. Recurrent attacks of acute otitis mediamay coincide with recurrent tonsillitis.

6. Rheumatic fever. Often seen in association with tonsillitisdue to Group A beta-haemolytic streptococci.

7. Acute glomerulonephritis. Rare these days.Subacute bacterial endocarditis. Acute tonsillitis in apatient with valvular heart disease may be complicated byendocarditis. It is usually due to streptococcus viridans