Pathogenesis (development of disease)
Tonsillitis causes inflammation of the palatine tonsils (tonsilla palatina). The pharyngeal tonsils (tonsilla pharyngealis) and lingual tonsils (tonsilla lingualis) of the lymphatic pharyngeal ring (Waldeyer’s pharyngeal ring) may also be affected.Viral tonsillitis typically causes a lymphocytic inflammatory response in this setting, whereas bacterial tonsillitis causes granulocytic inflammation (inflammation by granulocytes/white blood cells).
Acute tonsillitis is predominantly caused by viral pathogens (70-95% of cases), less commonly by bacterial pathogens.
Acute tonsillitis or pharyngotonsillitis is caused by the following viruses:
Double-stranded DNA viruses
- Human adenoviruses
- Epstein-Barr virus (HHV-4)
Single-stranded DNA viruses
- Human bocavirus single-stranded RNA viruses:
- Influenza and parainfluenza viruses.
- Rhinoviruses
- Enteroviruses; including coxsackie viruses (see below Herpangina Zahorsky).
- Coronaviruses
- Respiratory syncytial virus (RSV), human metapneumovirus.
Retroviruses
- Human immunodeficiency viruses (HIV; acute HIV disease with generalized lymphadenopathy and tonsillitis).
Coxsackie A viruses, which are classified as enteroviruses, cause a clinical picture known as “herpangina Zahorsky” that can be confused with acute bacterial tonsillitis.
Acute bacterial tonsillitis is caused by the following bacteria:
GABHS (= group A beta-hemolytic streptococci): Streptococcus pyogenes = Lancefield group A ß-hemolytic streptococci (GAS (group A streptococci); 15-30% of acute tonsillitis in children; for 5-10% of acute tonsillitis in adults).
- Group C and G streptococci.
- Haemophilus influenzae
- Nocardia
- Corynebacteria
- Neisseria gonorrhoeae
The bacterial symbiosis of Fusobacterium nucleatum and Borrelia vincentii causes a clinical picture known as Angina Plaut-Vincentii, the characteristic of which is a usually unilateral ulcerative tonsillitis (tonsillitis associated with ulcers) with a pronounced foul foetor ex ore (bad breath).
The cause of recurrent (acute) tonsillitis is usually a mixed infection with aerobic and anaerobic pathogens with simultaneous infection with group A beta-hemolytic streptococci. It usually runs its course without more severe inflammation.
Etiology (causes)
Biographic causes
- Age – children are more likely to be affected because they are more easily infected, e.g., at school and nursery school
Behavioral causes
- Nutrition
- Malnutrition and undernutrition – weakens the immune system.
- Micronutrient deficiency (vital substances) – see prevention with micronutrients.
- Consumption of stimulants
- Tobacco (smoking) – favors upper respiratory tract infections.
- Psycho-social situation
- Stress (due toweakening of the immune system).
- Lack of hygiene – simple hand washing with soap can already help to reduce the rate of infection.
Causes related to disease
- Immunodeficiencies
- Local immunodeficiency – there are fewer T helper cells and fewer B cells in the germinal centers of the tonsils; immune response to SpeA (pyrogenic streptococcal exotoxin) was weakened in children with recurrent tonsillitis (→ recurrent tonsillitis)
Medication
- Cytostatics (substances that inhibit cell growth or cell division).
X-rays
- Radiatio (radiotherapy)
Other causes
- Operations
