Tonsillitis
| Classification according to ICD-10 | |
|---|---|
| J03 | Acute tonsillitis |
| J03.0 | Streptococcal tonsillitis |
| J03.8 | Acute tonsillitis caused by other specified pathogens |
| J03.9 | Acute tonsillitis, unspecified |
| J35.0 | Chronic tonsillitis |
| ICD-10 online (WHO version 2019) | |
As tonsillitis or tonsillitis refers to a painful inflammation of the tonsils . In practice, the term is reserved for the inflammation of the tonsils ( tonsilla palatina ) . The disease is contagious and can be transmitted through droplet infection . Acute streptococcal tonsillitis is no longer contagious 24 hours after starting antibiotic therapy . The incubation period is one to three days. Tonsillitis is one of the 20 most frequent consultation occasions in general medical practices.
Classification
According to the time course, a distinction is made between acute ( acute tonsillitis ), chronic (chronic tonsillitis ) and recurrent ( recurrent ) tonsillitis. If only one side is affected, one speaks of a unilateral tonsillitis; if both sides are affected, of bilateral tonsillitis.
According to the clinical aspect, a distinction is made:
- catarrhal angina ( angina catarrhalis ): redness and swelling of the tonsils
- follicular angina ( angina follicularis ): fibrinous coatings( Stipple ) on the crypts of the tonsils
- Lacunar angina ( angina lacunaris ): redness and confluent (confluent) fibrinous layers
Next forms are or were angina Diphtherica ( quinsy ) , angina lympho-monocytaria (Monocytic as accompanying angina during mononucleosis ) , acute necrotizing ulcerative gingivitis , angina herpetic (Herpes angina) , peritonsillar , hyperkeratosis , angina , syphilitic and angina agranulocytotica .
Causes (etiology)
Acute tonsillitis is mostly (70–95% of cases) caused by viruses , less often by bacteria . The typical pathogens in bacterial triggers are beta-hemolytic streptococci of Lancefield group A ( esp . Streptococcus pyogenes ). In addition, pneumococci , staphylococci , Haemophilus influenzae , Branhamella catarrhalis , Chlamydophila pneumoniae and Neisseria gonorrhoeae play a role. Many of these germs belong to the resident oral flora . However, the infection is usually triggered by new serotypes of the pathogen against which there is no immunity . A weakened general condition or an immune deficiency can also be additional factors .
Of the viral tonsillitis, the Pfeiffer glandular fever caused by the Epstein-Barr virus , in contrast to most viral tonsillitis, shows pronounced coatings.
Chronic tonsillitis is usually a mixed infection with anaerobic and aerobic pathogens.
Symptoms
With tonsillitis there is difficulty swallowing due to the narrowing of the throat . Lumpy language, bad breath ( foetor ex ore ) and a bitter aftertaste after eating and drinking are typical. Mucosal ulceration and swelling of the mandibular lymph nodes are possible. General symptoms such as fever , headache and fatigue often occur .
In angina catarrhalis , the tonsils are swollen and reddened. In angina follicularis , fibrin coatings (specks) appear, in angina lacunaris larger fibrin spots. When Scarlet -Angina rash (Scarlatiniformes is rash ) typical. With chronic tonsillitis, detritus accumulates on the tonsils.
Diagnosis
The diagnosis is usually made from the typical clinical picture (inspection). To estimate the likelihood of infection with beta-hemolytic streptococci, the Centor score (for patients> 15 years of age) or McIsaac score (for patients <15 years of age) can be calculated. To confirm the diagnosis, a rapid streptococcal test can also be carried out and a bacterial culture can be created from a throat swab . The antibody detection ( antistreptolysin -AK) shows an increase only after weeks.
therapy
The therapy depends on the cause and the course of the tonsillitis. Usually a combination of local and general treatment is used.
In the case of acute tonsillitis , rinsing the throat, gargling with disinfectants and brushing with Lugol's solution are effective. Mucosal anesthetics and analgesics can be used against pain . Neck wraps can be used to support this. In bacterial purulent tonsillitis, antibiotics are only indicated if certain bacteria, especially A-streptococci , have been identified as pathogens or are urgently suspected, as otherwise their disadvantages outweigh the disadvantages. Unjustified antibiotic therapy for a sore throat is one of the causes of antibiotic resistance . Penicillin V is the drug of choice; at penicillin intolerance are cephalosporins of the second generation or a macrolide antibiotic such as clarithromycin given.
If tonsillitis recurs (at least three episodes), removal of the tonsils ( tonsillectomy ) may reduce the number of episodes. However, the evidence on the effectiveness of this surgical treatment is only rated as “at best moderate”.
Differential diagnostics
Other bacterial diseases with tonsil involvement, such as Plaut-Vincent's angina (unilateral, necrotizing tonsillitis), diphtheria , scarlet fever , a syphilitic primary effect and tuberculosis should be clarified in the differential diagnosis .
Viral diseases such as Pfeiffer glandular fever ( mononucleosis infectiosa ) and herpangina can also manifest themselves on the tonsils.
Of the non-infectious diseases, agranulocytosis and tonsil carcinoma can be responsible for changes in the tonsils.
Complications
If a bacterial infection spreads to adjacent sections, a peritonsillar abscess , a retropharyngeal abscess or a neck phlegmon can occur. The latter can lead to jugular vein thrombosis by invading the great neck veins .
When pathogens are washed away into the bloodstream, blood poisoning and inflammation of other organs such as the heart ( endocarditis , myocarditis , pericarditis ) or kidneys ( post-infectious glomerulonephritis ) occur. Rheumatic fever can occur as a consequence of streptococcal tonsillitis . However, this systemic disease involving the skin, heart, joints and brain has become very rare in industrialized countries as a result of the use of antibiotics.
A tonsillitis can be used as a streptococcal infection psoriasis trigger (psoriasis), which can appear only after disappearance of tonsillitis.
literature
- S2k guideline for inflammatory diseases of the tonsils / tonsillitis, therapy of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery. In: AWMF online (as of 2015)
Web links
Individual evidence
- ↑ a b F. H. Kayser u. a .: Medical microbiology. 9th edition. Thieme, 1998, p. 231.
- ↑ According to W. Fink, G. Haidinger: The frequency of health disorders in 10 years of general practice . In: Z. Allg. Med. , 83 (200), pp. 102-108. Quoted from What family doctors mainly deal with . In: MMW update. Med. No. 16/2007 (149th year)
- ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 9-223, here: pp. 95-101.
- ↑ a b c Therapy of inflammatory diseases of the tonsils - tonsillitis. (PDF) AWMF, August 2015, accessed on September 27, 2016 .
- ↑ Robert M. Centor, John M. Witherspoon, Harry P. Dalton, Charles E. Brody, Kurt Link: The Diagnosis of Strep Throat in Adults in the Emergency Room . In: Medical Decision Making . tape 1 , no. 3 , August 1981, ISSN 0272-989X , p. 239-246 , doi : 10.1177 / 0272989x8100100304 .
