Tonsillitis; Angina tonsillarisTonsillitis is an inflammation of the palatine tonsils (tonsils). It is caused by viruses or bacteria. In most cases it is the pathogen “Streptococcus type A”.
This is mainly transmitted during the cold season by droplet infection. The affected person suffers from sore throat, fever and a general feeling of illness. The palatal tonsils are swollen and reddened.
If purulent coatings on the almonds are recognizable, an antibiotic should be prescribed. The most important differential diagnosis is Pfeiffer’s glandular fever. A chronic tonsillitis can be a complication.
In rare cases the purulent tonsillitis can lead to the development of rheumatic fever. However, these stages can also merge into one another.
- Angina catarrhalis: the palatal tonsils are merely reddened and swollen.
There are no coatings on them yet.
- Angina follicularis: the so-called stippling on the tonsils occurs. These are small whitish deposits.
- Angina lacunaris: the plaques enlarge and merge to form two-dimensional deposits.
The pathogens that cause tonsillitis are viruses on the one hand and bacteria on the other. Children suffer more often from viral, adults are more prone to bacterial tonsillitis.
The most common germ is the bacterium Streptococcus type A. This bacterium is round and prefers to line up in chains, hence the name “Streptos – winding, chain-like arranged” and “Kokkos – Kern”. However, a number of other bacteria can also be considered, e.g. staphylococci, haemophilus influenzae or pneumococci.
Children are significantly more frequently affected by acute tonsillitis than adults, as their immune system is still developing. Children can indeed contract tonsillitis several times a year. These disease-causing germs are already found in the normal flora of the mouth and throat.
If the immune system is weakened, e.g. by stress, cold, virus infestation and colds, these germs can multiply in the throat and lead to the development of tonsillitis. On the other hand, a sick person is contagious because there are masses of bacteria in his saliva, which are distributed in the form of tiny droplets when speaking or coughing. This is the principle of droplet infection.
The patient is contagious for two to three weeks without treatment, which can vary greatly depending on the pathogen. With an effective antibiotic, one is no longer contagious after one or two days in the case of bacterial tonsillitis. Typically, tonsillitis is caused by the spherical bacterium Streptococcus of group A.
These bacteria are transmitted via a so-called droplet infection. This means that the bacteria, which are found in saliva and mucus secretion, can be transmitted to other people by coughing or sneezing. In addition, the bacteria can first settle on the skin and then later, possibly by your own hands, come into contact with mucous membranes, which can lead to an infection, as is the case, for example, with a handshake.
Situations where many people are in confined spaces, such as buses or classrooms, are a great risk of infection with this type of transmission and should be strictly avoided if tonsillitis is known. For the same reason, strict hand hygiene should also be observed. Depending on the pathogen, tonsillitis can be contagious for different lengths of time.
In the case of streptococcal type A infection, the greatest number of pathogens are killed within 24 hours of starting antibiotic therapy, and the person affected is no longer infectious for others. However, a certain bacterial population is still present, so the antibiotic should be discontinued in any case to avoid bacterial resistance and other complications. Without antibiotic therapy, infection may be possible up to three weeks after the start of infection.
The incubation period, i.e. the time in which no typical symptoms of tonsillitis occur, but infection with the bacterium has already occurred, is about two to four days in the case of tonsillitis. During this period, despite the absence of symptoms, one is already contagious, as the bacteria are already in the saliva.If there is a suspicion of tonsillitis, it is important to consult a doctor and, if the diagnosis of a bacterially caused tonsillitis is confirmed, to start a therapy with antibiotics, because this way the bacteria can be destroyed and the time of infection can be minimized. Therefore, it is true that after about 24 hours after starting therapy with an antibiotic, the patient with tonsillitis is usually no longer infectious.
Chronic tonsillitis is a special form of tonsillitis, which is equally likely to be contagious. In this case, however, the response to antibacterial therapy is not guaranteed, which is why infection can also occur during therapy. It is important to note that in the case of an existing viral tonsillitis, treatment with antibiotics does not make sense and the period in which a sick person is contagious lasts longer.
In order to avoid infecting others, it is essential for a sick person to follow some instructions. Since infection is by droplets, a handkerchief or elbow should always be held in front of the mouth when sneezing or coughing. In addition, hands should be disinfected as often as possible to prevent contamination of surfaces that are used a lot (door handles, railings).
Rooms where large crowds of people are in a confined space (bus, school, office) should also be avoided. In the context of tonsillitis, sore throats are the most common symptoms. These can be moderate to severe.
The sore throat is typically bilateral, but can also be more pronounced on one side. Due to the swelling of the palatal tonsils, a clumsy speech is more frequent. The affected person may find speaking strenuous.
The inflammation in the throat area leads to pain and thus to difficulty swallowing, since the food has to pass exactly through the inflamed areas. The firmer and drier the food is, the more pronounced the swallowing difficulties are. This leads to increased salivation, which is less easy to swallow due to the difficulty in swallowing.
In addition, the neck lymph nodes swell, especially those in the jaw angle. This can cause a newly occurring painful swelling in the neck area, which can be palpated by the person affected and the doctor. The symptoms typically last three to seven days, depending on the pathogen and the patient’s immune system.
The typical signs of tonsillitis are primarily the local symptoms of the throat: frequently, severely reddened and swollen tonsils are visible in the mouth area, which can lead to difficulty swallowing (due to the painfulness) and even in some cases to breathing difficulties (due to the narrowing of the transition from the mouth to the throat area). In addition, the swollen tonsils usually lead to a speechless mouth as a further sign. There may also be noticeable suppurations on the tonsils, usually in the form of spots or even larger surface coatings, and isolated mucosal defects.
The optically altered tonsils can also be accompanied by swollen, pressure-painful, shifting lymph nodes in the neck and lower jaw area as well as bad breath, which is caused by the mostly bacterial colonization of the tonsils. Further, possibly parallel occurring general symptoms can be fever, headache and aching limbs, fatigue and tiredness. An accumulation of pus on the tonsils as part of tonsillitis always occurs when bacteria are involved.
Pus is an accumulation of lost tissue and defense cells (leukocytes) that have migrated into the inflamed area infected by bacteria and is therefore a sign of a running bacterial defense reaction. In a simple tonsillitis in its early stages (angina catarrhalis), the tonsils are merely swollen and reddened. In angina follicularis, a spotty yellowish-white pus can be seen in the furrows of the tonsils. In the case of so-called lacunar sore, even larger pus stains may be noticeable. However, if the coatings are so large that they cover the entire almonds or even extend beyond the almonds and differ in color from the classic pus color, various differential diagnoses should be considered, which require immediate, usually special therapy initiation (e.g. diphtheria, angina placenti, angina agranulocytotica, Pfeiffer’s glandular fever/mononononucleosis)
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