Acute Tonsillitis - Causes (Viral, Bacterial), Pathophysiology, Treatment, Tonsillectomy

The tonsils are part of what is called Waldeyer’s ring. Generally when talking about tonsils we are talking about the palatine tonsils situated on both sides of the throat. The tonsils are important in the early years of life because the lymphoid tissues containing the immune cells are continuously exposed to many antigens. That is why until the age of 6 tonsils are typically hyperplastic and tend to regress by 12 years of age. The palatine tonsils have a strong blood supply from five different vessels, that is why there is a risk of a lot of bleeding with tonsillectomy. Zooming to the tonsils, we can see they have deep crypts and lymph nodules. The crypts are normally colonised by many species of bacteria and also exposed to many viral organisms. Many viral and bacterial organisms can cause tonsillitis, which is inflammation of the tonsils causing tonsillar oedema, hypertrophy, erythema and pain. The inflammation may affect other areas of the back of the throat, including the adenoids and the lingual tonsils. This inflammatory response produces exudate either white, grey, or yellow discharge. Cultures are not often useful in distinguishing the offending pathogen because even you grow something they are probably commensal organisms anyway. Generally with acute tonsillitis the pharynx is also inflamed and so a better definition is pharyngotonsillitis rather than acute tonsillitis. Majority of the cases of tonsillitis are usually from viruses. Common viral organisms that cause tonsillitis include epstein barr virus (EBV), adenovirus, rhinovirus, RSV, influenza and parainfluenza. The most common bacterial cause of acute tonsillitis is Group A Streptococcus (GAS). We will focus on a the two clinically important causes of acute tonsillitis: EBV and GAS