CLASS PRESENTATION

ON

TONSILITIS

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 Introduction

Tonsillitis is an inflammation of the tonsils (two oval-shaped pads of tissue at the

back of the throat). It is generally known as strep throat. When the tonsils are affected,
it is called tonsillitis.If the throat is affected, it is called pharyngitis.but when both are

affected, it's calledpharyngotonsillitis.

Tonsillitis pharyngitis

Causes: Tonsillitis is most often caused by both viruses and bacteria. The most
common bacterium causing tonsillitis is Streptococcus pyogenes (group A
streptococcus).Viral causes of tonsilitis include ;Adenoviruses, Epstein-Barr virus,
which causes infectious mononucleosis, Herpes simplex virus, Cytomegalovirus,
Measles virus.

Mode of transmission

 Kissing or sharing utensils, food or drink

 Coming into close contact with someone who is sick
 Touching a contaminated surface and then touching your nose or mouth
 Inhaling tiny particles that become airborne when a sick person sneezes or
coughs

Pathophysiology

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 Tonsillitis is an inflammation of the tonsils. Tonsillitis develops when the
pathogen, viral or bacterial, infects the tonsils and elicits
an inflammatory response. It develops when the viruses infiltrate the tonsils and
cause an inflammatory response of up-regulated cytokines. Bacterial tonsillitis
considered acute is primarily caused by group A β-hemolytic streptococcus
(GABHS) streptococcus pyogenes infection. s. pyogenes and taxonomically-
similar bacteria infiltrate the tonsillar epithelium, successfully penetrating the
protective mucosal films in the oral and nasal cavity.
Recurrent bacterial tonsillitis is caused primarily by staphylococcus aureus.
Following invasion, S. aureus is internalized by non-phagocytic cells
through fibronectin-binding protein and beta-integrins. Invasion of non-
eukaryotic cells results in the up-regulation of cytokines, resulting in tonsillitis.
Affected persons display signs and symptoms like; sore throat, a high body
temperature, coughing, headache, ear ache. If tonsillitis is left untreated
complications like; Breathing difficulty, Swallowing difficulty, especially meats
and other chunky foods, An abscess that doesn't improve with antibiotic
treatment will arise and death may occur.
Clinical manifestation

The main signs and symptoms in children and adults are:

 a sore throat
 problems swallowing
 a high temperature of 38C or above
 coughing
 a headache
 feeling sick
 ear ache
 feeling tired

severe clinical manifestations include:

 swollen, painful glands in your neck (feels like a lump on the side of your
neck)
 white pus-filled spots on your tonsils
 bad breath

Medical management

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 1. Administration of anti-piuretic drugs like Aspirin, Phensic to reduce body
temperature.
2. Administration of analgestics to ease patient’s headache,. Eg: Duclophenac,
panadol
3. Administration of expectorants to dilate bronchioles and minimize or
eliminate the cough. E.g cough syrup, benylin
4. Administration of ear drops to relief patient of ear ache.
5. Administration of prescribed antibiotics to arrest the disease.

Diagnostic investigation

1. History taking
2. Physical examination:

 Examine your throat for redness, swelling or white spots on the tonsils
 Inspect the patient’s ears and nose for the presence of scarlatina rash
 Palpate the sides of the patient’s neck to see if the lymph nodes are swollen
and tender

3. Collection throat swab for laboratory investigation

4. Signs and symptoms of tonsillitis such as a fever, cough, runny nose, rash or
stomachache
5. Blood test

Nursing management

1. Encourage rest:Encourage the patient to get plenty of sleep.

2. Provide adequate fluids: Give your child plenty of water to keep his or her
throat moist and prevent dehydration.
3. Provide comforting foods and beverage: Warm liquids — broth, caffeine-free
tea or warm water with honey — and cold treats like ice pops can soothe a
sore throat.
4. Prepare a saltwater gargle: If your child can gargle, a saltwater gargle of 1/2
teaspoon (2.5 milliliters) of table salt to 8 ounces (237 milliliters) of warm
water can help soothe a sore throat. Have your child gargle the solution and
then spit it out.
5. Humidify the air: Use a cool-air humidifier to eliminate dry air that may
further irritate a sore throat, or sit with your child for several minutes in a
steamy bathroom.
6. Offer lozenges: Children older than age 4 can suck on lozenges to relieve a
sore throat.
7. Avoid irritants: Keep your home free from cigarette smoke and cleaning
products that can irritate the throat.

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 8. Treat pain and fever: Talk to your doctor about using ibuprofen (Advil,
Children's Motrin, others) or acetaminophen (Tylenol, others) to minimize
throat pain and control a fever. Low fevers without pain do not require
treatment. Unless aspirin is prescribed by a doctor to treat a particular disease,
the patient should not take aspirin.
Treatment

 Antibiotics: Penicillin and amoxicillin are the antibiotics that doctors prescribe
most often to adults with bacterial tonsillitis. People who are allergic to
penicillin antibiotics will receive a suitable substitute.

 Tonsillectomy: surgery to remove tonsils (tonsillectomy) may be used to treat

frequently recurring tonsillitis(At least seven episodes in the preceding year, At
least five episodes a year in the past two years, At least three episodes a year in
the past three years), chronic tonsillitis or bacterial tonsillitis that doesn't
respond to antibiotic treatment.
Complications

A collection of pus around your tonsil (peritonsillar abscess)


Middle ear infection

Breathing problems or breathing that stops and starts while you sleep (obstructive

sleep apnea)
 Tonsillar cellulitis, or infection that spreads and deeply penetrates nearby tissues
 P e r i t o n s i l l a r a b s c e s s ( " q u i n s y " ) :a peritonsillar abscess (pta) occurs
when infection spreads through the tonsil and and a collection of pus forms
around the outer edge. This collection of pus pushes the tonsil inwards. Patients
with this condition often cannot eat or drink at all. It is usually treated by
numbing the back of the throat, and inserting a needle or scalpel to drain the pus.
Whilst this doesn't sound like the most pleasant of experiences, most patients
experience a profound relief if pus is drained. O t h e r a b s c e s s e s :very
occasionally, abscess can form at the back of the throat, or spread through the
neck and into the chest.

 R h e u m a t i c f e v e r :rheumatic fever (rf) can occur when tonsillitis is caused by

a bacteria called group a streptococcus. It is an unusual complication that occurs
two to three weeks after the original infection. Rf can cause inflammation of the
joints (arthritis), heart (carditis) and valves of the heart (valvulitis), and also
affect the brain and nerves causing an unusual movement disorder called
'syndenham's chorea'. Sometimes the skin is affected, with nodule formation.

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  P o s t - s t r e p t o c o c c a l a r t h r i t i s : post-streptococcal arthritis is inflammation
of the joints that occurs within a month of tonsillitis caused by group a
streptococcus.

 P o s t - s t r e p t o c o c c a l g l o m e r u l o n e p h r i t i s :certain types of group a

streptococcus are more likely to affect the kidneys. Patients with tonsillitis due
to this variety of bacteria can have problems with inflammation of the kidneys.
This can give rise to blood in the urine, and rarely kidney failure. However, if
appropriately treated, the outcome is usually good.

 S c a r l e t f e v e r :scarlet fever is caused by a toxin released by group a

streptococci, which causes a bright red rash, with slightly raised areas, which
often gives the skin the appearance of sandpaper. It usually starts in the groins
and armpits. Children who have scarlet fever can usually return to school one or
two days after antibiotics have been started.

 T o x i c s h o c k s y n d r o m e :toxic shock syndrome is a rare, but very serious

complication of tonsillitis caused by gas. It causes a loss of blood pressure, and
organ failure, and can be a fatal condition in 30-60% of cases.

 E a r i n f e c t i o n s a n d s i n u s i t i s :infections of the tonsils can spread through

the eustachian tube to cause ear infections, or via the back of the nose into the
sinuses to cause sinus infections.

 M e n i n g i t i s a n d b r a i n a b s c e s s :infections from the tonsil can very rarely

spread to infect the lining of the brain (meningitis) or cause collections of pus
(abscesses) in the brain.

 J u g u l a r v e i n t h r o m b o p h l e b i t i s ( l e m i e r r e ' s s y n d r o m e ) :this occurs

when infection from the tonsil spreads to the jugular vein, which is a large blood
vessel that drains blood from the brain, head and neck region. It is a condition
that is more common in healthy young adults. The infection causes both
inflammation of the jugular vein, which can also be blocked by the formation of
a blood clot. It typically causes a high fever (more than 39 degrees celsius),
throat and/or neck pain, and breathing difficulty. Occasionally bits of the
infected clot ('septic emoboli') can break off and spread to other parts of the
body, typically the lungs.

 P a n d a s :pandas stands for 'paediatric autoimmune neuropsyhchiatric disorder

associated with group a streptococcus'. This is a controversial condition, that is
to say not all doctors agree it exists. It is believed to be a condition in which
children who have obsessive compulsive disorder and/or tic disorders that are
made worse following a group a streptococcal infection.

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  N e c r o t i z i n g f a s c i i t i s :this another very rare, but serious, complication of
tonsillitis caused by group A Streptococcus. This is an aggressive infection that
causes death of soft-tissue. The treatment is usually surgical removal of the
dead, infected tissue along with the administration of strong antibiotics put
directly into the blood stream.

Prevention

The best way to prevent tonsillitis is through good personal and environmental hygiene
which include:

 Washing your hands often

 Not sharing food, drink, utensils, or personal items like toothbrushes with anyone
 Staying away from someone who has a sore throat or tonsillitis

Conclusion

Tonsillitis is an inflammation of the tonsils. Tonsillitis most often affects children,

and tonsillitis caused by bacteria is most common in children ages 5 to 15. Frequent
exposure to germs. School-age children are in close contact with their peers and
frequently exposed to viruses or bacteria that can cause tonsillitis.

Reference

https://www.hopkinsmedicine.org/health/conditions-and-diseases/tonsillitis

https://www.wikidoc.org/index.php/Tonsillitis_pathophysiology#:~:text=Tonsillitis
%20develops%20when%20the%20pathogen,response%20of%20up%2Dregulated
%20cytokines.

https://www.nhs.uk/conditions/tonsillitis/

https://my.clevelandclinic.org/health/diseases/21146-tonsillitis#:~:text=To
%20diagnosis%20tonsillitis%2C%20your%20doctor,for%20other%20signs%20of
%20infection

https://www.webmd.com/oral-health/tonsillitis-symptoms-causes-and-treatments

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