Tonsillitis is usually a euphemism for the acute form of tonsillitis, which is also called acute tonsillitis or acute angina tonsillaris. In this disease, the palatine tonsils (tonsils) are inflamed. These palatine tonsils are two elevations at the transition from the mouth to the throat and are part of the body’s immune system.

Children of school age in particular, but also infants and adults suffer from acute tonsillitis. In this case, it is transmitted via droplet infection, which means that it can be highly contagious, especially before treatment with antibiotics. Acute tonsillitis most frequently occurs in the winter months and in spring.

In addition to the acute form of tonsillitis, there is also the rarer chronic form of tonsillitis. In this case, the inflammation of the palatine tonsils has existed for more than 3 months. This chronic disease can occur after one or more tonsillitis and is characterized by a relocation of the depressions (crypts) of the tonsils. In chronic tonsillitis, the tonsils are often reduced in size, in contrast to those in acute tonsillitis. Also possible is a so-called lateral gangina, in which the lymphatic tissue in the throat area is affected.


Acute tonsillitis is transmitted via droplet infection, i.e. through saliva or sneezing. Mostly the pathogens of tonsillitis are viruses, but there is also bacterial tonsillitis, which is mainly caused by beta-hemolytic Group A Streptococci. In addition, other bacteria (e.g. pneumococci and haemophilus influenzae) or fungi may have caused the acute tonsillitis.

In most cases, only an already weakened immune system is susceptible to tonsillitis. Inflammation of the tonsils of the palate can also occur as an accompanying symptom to other diseases, such as scarlet fever. Other diseases that can accompany tonsillitis are

  • Pfeiffer’s glandular fever (Eppstein-Barr virus)
  • Herpangina (Coxackie A virus)
  • Soorangina (fungal infection by Candida albicans)
  • Specific angina for syphilis
  • Angina in the context of tuberculosis
  • Angina Plaut-Vincent
  • Angina agranulocytotica (lack of formation of granulocytes in the bone marrow)
  • Angina in the context of diphtheria
  • Angina in the context of leukemia

The typical symptoms of a disease of the palatine tonsils are sudden swallowing difficulties, high fever and reduced general condition.

The tonsils are swollen with inflammation, strongly reddened and have a whitish, greyish or yellowish coating. This coating can be stripy, punctiform or continuous. In most cases, the lymph nodes in the angle of the jaw and the lymph nodes in the neck are painfully swollen, the patient’s speech clotted / washed out. Bad breath is another typical symptom.


By looking closely at the tonsils, the doctor can identify the almond surface and the coating and thus roughly estimate the pathogen causing the disease. The appearance and colour, as well as the size and spread of the plaque on the palatal tonsils can be used to determine which pathogen is most likely: In practice, it is not relevant whether it is a so-called “purulent angina”, since pus is simply dead white blood cells that have been caused by a bacterial infection. However, even the white-yellowish coating in a viral infection can be understood as a purulent inflammation, so that the differentiation of the disease is not between purulent and non-purulent, but between bacterial and viral.

In order to determine this precisely, a throat swab is examined for bacteria. In addition, the laboratory findings can be helpful in differentiating between bacterial and viral tonsillitis. In a bacterial infection, there is an increase in white blood cells (granulocytes) and an increase in inflammation values (especially an increase in the CRP value) in the blood count. If an infection with group A streptococci is suspected, the doctor can carry out a rapid test with the throat swab or even a bacterial culture to arrive at a reliable diagnosis. – Streptococcal angina: whitish-yellowish, punctiform coating, then merging into a dense coating

  • Angina Plaut-Vincenti: unilateral small ulcer
  • Angina agranulocytotica: dirty, dead melts
  • Lues/Syphilis: small spots, possibly slightly lifted on almonds and oral mucosa
  • Tuberculosis: small ulcers with thickened edges
  • Scarlet changina: dark red almonds
  • Diphtheria: white-greyish coherent coating, when the coating is removed the underlying almond bleeds
  • Herpangina: small ulcers on the palatal arches
  • Pfeiffer’s glandular fever: confluent grey-white coatings