Aetiology

Tonsillitis is usually viral; it is most commonly caused by rhinovirus, coronavirus, and adenovirus infections.[4] Less commonly it is caused by the influenza virus, the parainfluenza virus, enteroviruses, or herpes viruses. In tonsillitis associated with infectious mononucleosis, the most common infective agent is the Epstein-Barr virus.[6]

Common bacterial pathogens include beta-haemolytic and other streptococci, with the most common being group A beta-haemolytic streptococci (GABHS). The prevalence of culture-positive GABHS in children (<20 years) is around 25%.[7] In adults, the prevalence of culture-positive GABHS is around 14%.[7] The frequency of patients with tonsillitis caused by group C or G streptococci is around one-fifth compared to patients with GABHS.[8] Rarer bacterial causes include Mycoplasma pneumoniae and Neisseria gonorrhoeae, which can be the cause in sexually active adolescents (particularly those engaging in oral-genital sex).[9]

Pathophysiology

Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema, and pain. Rarely, the swelling may progress to the soft palate and uvula (uvulitis), or inferiorly to the region of the supraglottis (supraglottitis).

Classification

Classification according to class of pathogen

  • Viral tonsillitis: most episodes are caused by viruses.

  • Bacterial tonsillitis: 5% to 30% of cases of tonsillitis are caused by GABHS bacteria.[1][2]

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