Acute tonsillitis usually lasts for a few days until the patient has recovered. Usually it is completely cured after about one to two weeks. One speaks of chronic tonsillar angina if the symptoms persist for more than three months or even do not disappear at all. The degree of risk of infection for others depends on the type of pathogen: while bacterial angina tonsillaris, as mentioned above, is usually no longer infectious after just one day with the right antibiotic therapy, the risk of viral diseases is usually much longer. The point in time at which the patient is free of fever and symptoms serves as a good orientation for estimating the end of the disease.
Depending on the organ infestation, the internal treatment must take place with additional antibiotic protection and, if necessary, removal of the tonsils. Other possible complications: Abscesses in the neck or oral cavity (peritonsillar/retropharyngeal abscesses), heart inflammation (endocarditis, myocarditis, pericarditis), thrombosis of the jugular vein (jugular vein thrombosis), blood poisoning (sepsis). – Tongue base tonsillitis: The back end of the tongue, which is located towards the throat, is heavily swollen because the lymph nodes of the tongue are also affected.
The development of shortness of breath is possible due to the enormous narrowing of the throat, so that in-patient treatment may be necessary. – Streptococcal gingivostomatitis: The entire oral mucosa is inflamed and partly covered with painful abscesses, which can also spread to the lips. – Secondary diseases after streptococcal angina: After angina tonsillaris, this leads to a delayed antigen-antibody reaction, so that inflammation of the kidneys (acute glomerulonephritis), joints (acute rheumatic fever) or heart (endocarditis rheumatica) can occur.
Unfortunately, acute angina tonsillaris as a bacterial infection can rarely be sharply limited, resulting in some potential complications. Theoretically, it is always and at any time possible for the infection to spread to neighbouring structures. If such a transfer occurs, abscesses between the tonsils (peritonsillar abscess) or in the posterior pharyngeal area (retropharyngeal abscess) are the consequence, up to the cervical phlegmon.
This more serious complication is a rapidly spreading inflammation of all soft tissues of the neck. It represents an immediate surgical indication; intraoperatively the infected tissue is removed as completely as possible under antibiotic therapy and rinsed and disinfected. Without such a therapy, a cervical phlegmon spreads further and further and can eventually lead to death through generalized sepsis (blood poisoning).
A cervical phlegmon can also break into the jugular vein in the neck and cause a jugular vein thrombosis. However, the risk of the bacteria crossing over is not only local, but also systemic: if the entry port is suitable, the bacteria enter the bloodstream. This results in severe blood poisoning and/or inflammation of other organs into which they enter with the bloodstream.
Conceivable are, for example, inflammations of the heart (endocarditis, myocarditis…) or also of the kidney. In some rare cases, acute angina tonsillaris itself can also cause serious problems. For example, when the tonsils in the throat swell very strongly.
This can then lead to acute shortness of breath. Very rarely, a streptococcal infection can also trigger post-infectious rheumatic fever, which is accompanied by severe joint pain, fatigue and tiredness. This occurs because antibodies are formed against the bacteria that caused the original infection. In rare cases, these react with the body’s own structures. The skin, heart, joints and brain are then most likely to be affected by this severe complication.