tonsillitis, acute tonsillitis, streptococcal angina
Angina tonsillaris is a mostly bacterial inflammation of the palatine tonsils (lat. Tonsillae palatinae). The colloquial form “angina” should not be confused with other clinical pictures with similar names, e.g. angina pectoris in the acute coronary syndrome. In both cases, angina stands for the noticeable tightness in the throat (angina tonsillaris) or chest (angina pectoralis). The tonsils are a special type of lymph node, which explains why other lymph nodes in the neck drainage area can also be affected or swollen to a certain extent.
As already mentioned, angina tonsillaris is most often caused by an infection with bacteria. These bacteria are advanced types of the inhabitants of our normal oral flora. This means that the same bacteria (by name) are present in our mouth at all times, but do not cause disease.
If mutations occur within the bacteria, so that they become more aggressive for us, disease can occur, which is transmitted from person to person. The most common cause of angina tonsillaris is streptococci, or more precisely: Streptococcus pyogenes (beta-hemolytic group A streptococci). More rarely, staphylococci, Haemophilus influenzae, pneumococci or even viruses (e.g. Epstein-Barr virus) are triggers of angina tonsillaris.
In the case of chronic angina tonsillaris, a mixed infection with different bacteria is most likely to be present. Immunocompromised persons can also develop angina tonsillaris due to a fungal infection. Since bacteria are the most common cause of angina tonsillaris (approx.
99%), the details of this clinical picture will be discussed below, unless otherwise noted. Angina tonsillaris is most likely to be transmitted via saliva by coughing, sneezing, unclean hands as a droplet infection. Children and adolescents are most frequently affected by angina tonsillaris, which is partly explained by the fact that they have a lot of contact with other children (kindergarten, school).
On the other hand, the body’s own immune system can remember a group of bacteria that it has once infected and build up a lifelong defence against precisely this group. After every episode of angina tonsillaris, the theoretical possibility of re-infection decreases because the defence has become stronger. After contact with the pathogen, it takes about 1-3 days until angina tonsillaris becomes noticeable as a disease (incubation period).
If the bacterial angina tonsillaris is successfully treated with antibiotics, it can be assumed that the patient is no longer infectious 24 hours after the first antibiotic is taken. Acute tonsillar angina is transmitted via a droplet infection. This means that the infection occurs via tiny particles dissolved in the ambient air.
This air-particle-pathogen mixture (aerosol) is produced when patients speak via escaping saliva or sneeze and cough. The pathogens are then spread directly through the air. Contact persons of the patient breathe in the ambient air with aerosol.
The pathogen is absorbed through the mucous membranes in the mouth, nose and throat and then, in the event of a poor immune status or increased stress, the disease breaks out. Since the pathogens are transported in the air, their radius of distribution is relatively limited: anyone standing more than about three metres away from the patient has already exceeded the maximum transmission distance and will normally no longer be infected. The typical bacterial pathogen of acute angina tonsillaris, the group A streptococci, reaches the next patient in the same way.
However, if a suitable antibiotic therapy is started after diagnosis, the patient is no longer contagious after 24 hours. Even people who do not show any symptoms themselves can already be contagious for others: it usually takes some time until certain pathogens have multiplied strongly enough to trigger the full picture of the infection (incubation period). Nevertheless, potentially contagious pathogens are already present and can be transmitted. This incubation period is one to three days for most forms of acute angina tonsillaris.