Pharyngitis and tonsillitis are inflammations of the throat and tonsils, respectively, often caused by infections. These conditions are common in Ghana, especially among children and during seasonal changes, potentially leading to complications like abscesses or rheumatic fever if untreated. Prompt management is key to alleviating symptoms and preventing spread.
🦠 Overview and Pathophysiology
These conditions arise when pathogens invade the throat or tonsils, triggering inflammation. The immune response can sometimes lead to pus formation or spread to nearby tissues if not addressed.
Causes
- Bacterial: Group A Streptococcus (Streptococcus pyogenes) is a leading cause, especially in tonsillitis; other bacteria like Streptococcus pneumoniae or Staphylococcus aureus may contribute.
- Viral: Common culprits include rhinovirus, adenovirus, influenza, and Epstein-Barr virus (linked to infectious mononucleosis).
- Other: Allergies, irritants (e.g., smoke), or trauma can mimic symptoms.
Risk Factors
- Close contact in schools or crowded settings.
- Weakened immunity or recent respiratory infections.
- Seasonal peaks, particularly in cooler months.
🔍 Clinical Presentation
Symptoms vary by cause and severity, often overlapping between pharyngitis and tonsillitis.
Symptoms
Common: Sore throat, difficulty swallowing, fever, hoarse voice.
Tonsillitis-Specific: Swollen tonsils, white patches or pus, bad breath.
Severe: Fatigue, swollen lymph nodes in the neck, body aches.
Signs
Physical: Red, inflamed throat or tonsils, possible exudate (pus) on tonsils.
Systemic: Elevated temperature, tender neck glands.
Complications: Difficulty breathing or drooling (peritonsillar abscess).
- High fever (>38.5°C) persisting beyond 48 hours.
- Difficulty breathing or swallowing.
- Rash with fever (possible streptococcal complications).
🧪 Diagnosis
Diagnosis combines clinical assessment with targeted tests to guide treatment.
Investigations
First-Line: Throat swab for rapid antigen test or culture (to detect Group A Streptococcus).
Supportive: Complete blood count (elevated white cells in bacterial cases), monospot test for Epstein-Barr.
Imaging: Consider X-ray or CT if abscess is suspected.
💊 Treatment
Management focuses on symptom relief for viral cases and targeted antibiotics for bacterial infections.
Non-Pharmacological
Rest the voice, stay hydrated with warm fluids or lozenges, use a humidifier, and avoid irritants like smoke. Gargling with salt water can soothe discomfort.
Viral Pharyngitis/Tonsillitis
- Paracetamol: 500-1000 mg every 6-8 hours (max 4 g/day) for pain and fever.
- Ibuprofen: 200-400 mg every 6-8 hours (max 3200 mg/day) if tolerated.
Bacterial (Streptococcal) Treatment
- Penicillin V: 500 mg orally twice daily for 10 days (adults); children 25-50 mg/kg/day in 2 doses.
- Alternative (Penicillin-Allergic): Azithromycin 500 mg on day 1, then 250 mg daily for 4 days.
Complications (e.g., Abscess)
- Amoxicillin-Clavulanate: 875 mg/125 mg twice daily for 7-10 days.
- Drainage: Surgical intervention if abscess confirmed.
- Complete the full antibiotic course to prevent rheumatic fever or glomerulonephritis.
- Avoid antibiotics for viral cases unless secondary bacterial infection is suspected.
- Monitor for allergic reactions or worsening symptoms.
🤰 Special Populations
Adjust care based on age and condition:
Children
Use weight-based dosing (e.g., penicillin 25-50 mg/kg/day); watch for breathing issues.
Pregnancy
Prefer penicillin or cephalosporins; avoid tetracyclines. Consult obstetrician if severe.
🚨 Referral Criteria
- Suspected peritonsillar or retropharyngeal abscess.
- Persistent fever or worsening respiratory distress.
- Signs of rheumatic fever (e.g., joint pain, rash).
Transfer to a facility with ENT or pediatric expertise.
🧠 Key Takeaways
- ✅ Assess Cause: Test for Streptococcus if bacterial suspected.
- ✅ Treat Viral: Symptomatic relief with paracetamol.
- ✅ Treat Bacterial: Penicillin for 10 days.
- ✅ Monitor: Watch for complications like abscess.
- ✅ Special Care: Adjust for children and pregnancy.
- ✅ Refer: For severe cases or complications.