Acute tonsillitis

Synonyms in a broader sense

Medical: Angina tonsillaris

  • Acute tonsillitis
  • Purulent tonsillitis


Acute tonsillitis is an infection of the tonsils of the throat. It can occur at any age and in any season. In children, viruses can cause an inflammation, in adults it is more likely to be caused by bacteria.

Mostly streptococci, in older patients also pneumococci or the germ Haemophilus influenza (HiB). Acute tonsillitis can be treated well with medication and usually heals without consequences. In some cases, however, the inflammation lasts longer than three months. In these cases, the tonsils are chronically inflamed (chronic tonsillitis) and require more complex therapy. In rare cases, the germs that cause the infection of the tonsils can also affect other organs in our body and cause complications.


What causes tonsillitis? Acute tonsillitis is usually triggered by pathogenic germs (pathogenic bacteria). These germs are either present in our oral flora in small quantities and have been able to multiply or they have been introduced from outside (droplet infection).

The bacteria that are already present have a great chance of multiplying when the general condition of our body is weakened. favour an infection of the tonsils. Especially in the first years of life (“immunological learning phase”) the tonsils have a lot to do, because every foreign substance in the oral cavity is initially regarded as an “enemy”. Diseases of the tonsils are therefore very common in early childhood. – Colds /Sniffles

  • Mental, psychological and physical stress
  • Immunodeficiency (e.g. AIDS) and
  • Cancer


Acute tonsillitis is highly contagious. Through simple droplet infections, for example when coughing or sneezing, finely nebulized water droplets including pathogens are released from the throat into the environment. Another possibility of infection is the indirect route via contaminated objects, whereby the classic example is the contaminated door handle that is touched.

If taken up by other people, the pathogens can multiply in the respiratory tract and throat and thus have an infectious effect. So it is understandable that kissing is also contagious, just like sharing a drinking bottle. In order to reduce the danger of infection, the above-mentioned should be avoided.

It is obligatory for people suffering from acute tonsillitis to hold their hand in front of their mouth when coughing and sneezing and to wash if necessary. It is also advisable to avoid large gatherings of people, such as at school or in the office, as other people are exposed to an unnecessary risk of infection. It is difficult to say how long one is contagious.

However, it should not be assumed that the contagious potential has disappeared when symptoms such as sore throats and difficulty swallowing disappear. Even if the tonsils look swollen and healthy, there is still evidence of infectious agents in the person. If one is infected, the incubation period until the first symptoms appear is about 2-4 days.

It is important to see a doctor immediately and to take antibiotics. On the one hand, not only the disease, but especially the rare but severe complications of an acute tonsillitis are combated or prevented. On the other hand, as a rule, people are no longer infectious 24 hours after the start of therapy, if bacterial pathogens are involved.

An acute tonsillitis develops in 50-80% of cases on the basis of a viral infection. These include the respiratory tract infection colloquially known as the “common cold“, but rhinitis or pharyngitis can also develop into an acute tonsillitis. Typical viral pathogens are the influenza viruses, the parainfluenza viruses, and the corona viruses.

In the remaining 20-30% of cases, the infection is caused by bacteria, mainly streptococci, and to a lesser extent staphylococci and pneumococci. These viruses and bacteria are mainly transmitted via the air, by means of droplet infection. This means that a “coughing up” of the pathogens by another person, followed by inhalation, is in principle sufficient to become infected.

Now one sees someone coughing all the time, especially in public transport, and yet it is extremely rare to have an acute tonsillitis. How can this happen? On the one hand, a certain amount of pathogens is of course necessary to really infect the organism.

On the other hand, we normally have a very strong immune system, which makes life difficult for viruses or bacteria as soon as they enter the body. However, our immune system is impaired in its function in case of chronic diseases, certain medications, or simple stress, and is less able to do its job. So if you already feel weakened anyway and are perhaps under physical or mental stress, the pathogens are particularly dangerous for the body.

Physical stress also includes excessive exertion during sports: If you overexert yourself excessively, your immune system is demonstrably weakened within the next four hours after exercise. Therefore, in such situations, it is important to pay close attention to sufficient heat, vitamins and physical recovery. Acute tonsillitis is highly contagious and is transmitted via the so-called droplet infection.

A droplet infection is the spread of a pathogen via tiny droplets from the mouth and throat of the patient, for example when sneezing. These droplets, which contain the infectious bacteria, reach the mucous membranes of another person either directly through the air or via skin contact, where they lead to infection. After initial contact with the pathogen, it takes between two and four days before the acute tonsillitis breaks out.

This period is also known as the incubation period. Already in the time until the outbreak of the disease an infection can occur. About 24 hours after the start of antibiotic therapy, there is no longer any risk of infection in the case of streptococcal tonsillitis, although the symptoms of acute tonsillitis are still present.

For other pathogens of acute tonsillitis, the risk of infection can last several days. Because of the high risk of infection, group facilities such as kindergartens and schools or, in the case of adults, the workplace should be avoided. What are the symptoms of tonsillitis?

Acute tonsillitis causes increasing difficulty in swallowing. It is the swallowing difficulties that cause the most stress in acute tonsillitis, as increased salivation forces us to swallow a lot and often. In particularly severe cases, even the attempt to open the mouth can cause severe tonsils pain.

When swallowing, unpleasant stings can occur in the ear. Smaller neck movements can also be painful because the neck lymph nodes are swollen. In addition to a general feeling of illness with headache and fatigue, fever also occurs.

The fever is usually higher in children than in adults. The palatine tonsils, which are located at the transition from the oral cavity to the throat between the front and rear palatal arches (mucous membrane folds) on both sides, are part of the so-called Waldeyer’s pharyngeal ring – a defence system of the body against bacteria and viruses. Pathogens ingested with air, saliva or food first pass through these important guard stations and are recognised and fought by the numerous defence cells in the tonsils.

The surface of the palatine tonsil is heavily furrowed, so that on the one hand the surface is enlarged and many defence cells can settle there, on the other hand, even light pathogens can “get caught” in this furrowed surface. If a defensive reaction occurs, the almonds swell reactively and they turn inflammatory red – it is therefore a sign that the immune system has been activated. Depending on how much the tonsils swell, the limited spatial capacity in the mouth-throat area can lead to characteristic symptoms: these include difficulty swallowing, sore throat, impaired breathing through the nose and dumpy speech.

Acute tonsillitis usually begins with sudden severe sore throat, which can radiate into the ears and the entire head area, and is accompanied by fever and sometimes chills. In addition, there is a strong tiredness and exhaustion. The throat swells within a very short time, which is not only very unpleasant but can also lead to swallowing and speech problems.

In very pronounced forms, the swelling can even hinder breathing. In the further course this swelling can increase, which in combination with the strong pain, especially in children, leads to a cessation of food intake. A typical symptom of acute tonsillitis is bad breath, which often increases during the course of the disease.

If the tonsillitis is treated correctly, a significant improvement of the symptoms occurs after only a few days. After about one to a maximum of two weeks, the acute tonsillitis has healed. If symptoms are still present after more than three weeks, there is a risk of chronic tonsillitis.