History and exam

Key diagnostic factors

common

presence of risk factors

Acute tonsillitis is most common between the ages of 5 and 15 years but can occur at any age.[1][5] Predominantly but not exclusively a disease of school children.[18] Tonsillitis, whether viral or bacterial, is an infectious condition and can be spread by exposure to an infected person.

pain on swallowing

Usually not severe, but on occasion may result in significantly reduced intake, which may necessitate admission to hospital.[18]

fever (>38°C [>100.5°F])

Many patients with acute tonsillitis have a high temperature.[20] One of the Centor criteria is history of fever over 38°C (100.5°F).[19] Three of four Centor criteria make bacterial infection more likely.

tonsillar exudate

Patients with acute tonsillitis, particularly when it is caused by group A beta-haemolytic streptococci, often have purulent exudate on the tonsillar surface.[1][5] Tonsillar exudate is one of the Centor criteria.[19] Three of four Centor criteria make bacterial infection more likely. However, tonsillar exudates are also prominent in infectious mononucleosis.[Figure caption and citation for the preceding image starts]: Tonsillitis caused by group A beta-haemolytic streptococcusFrom the collection of Dr Eleftherios Margaritis [Citation ends].com.bmj.content.model.Caption@1ad2fa45

Other diagnostic factors

common

sudden onset of sore throat

A sudden onset of sore throat is suggestive of an infectious process.[18]

headache

A non-specific symptom of the acute infective process.

abdominal pain

May lead occasionally to the false diagnosis of gastroenteritis and (rarely) may even mimic an acute abdomen.[18]

nausea and vomiting

A non-specific symptom but one that may lead to a false diagnosis of gastroenteritis, if very prominent.[18]

presence of cough or runny nose

Suggests viral upper respiratory infection. Absence of cough is a Centor criteria.[19] Three of four Centor criteria make bacterial infection more likely.

tonsillar erythema

Common sign on presentation.

tonsillar enlargement

Common sign on presentation.

enlarged anterior cervical lymph nodes

Swollen, painful anterior cervical lymph nodes are common in acute tonsillitis (particularly in acute bacterial group A beta-haemolytic streptococcal tonsillitis).[5] Cervical adenopathy is one of the Centor criteria.[19] Three of four Centor criteria make bacterial infection more likely.

Risk factors

weak

age between 5 and 15 years

Acute tonsillitis is most common between the ages of 5 and 15 years but can occur at any age.[1][5]

contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)

Tonsillitis, whether viral or bacterial, is an infectious condition and can be spread by exposure to an infected person.

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