Materiały źródłowe

• #1 Tonsillitis and Tonsilloliths: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/tonsillitis-tonsilloliths.html

  Tonsillitis, or inflammation of the tonsils, makes up approximately 0.4% of outpatient visits in the United States. Tonsillitis is caused by a viral infection in 70% to 95% of cases. […] It is important to differentiate group A beta-hemolytic streptococcus from other bacterial or viral causes of pharyngitis and tonsillitis because of the risk of progression to more systemic complications such as abscess, acute glomerulonephritis, rheumatic fever, and scarlet fever after infection with group A beta-hemolytic streptococcus. A variety of diagnostic tools are available, including symptom-based validated scoring systems (e.g., Centor score), and oropharyngeal and serum laboratory testing. […] The differential diagnosis of tonsillitis includes pharyngitis, retropharyngeal abscess, epiglottitis, peritonsillar abscess, and submandibular space infections (Ludwig angina). It is important to differentiate GABHS pharyngitis and tonsillitis from other bacterial and viral causes due to the risk of complications with GABHS. Physical examination of the oropharynx alone is not sufficient for this differentiation; therefore, a clinical scoring scale, such as the widely used Centor score, is recommended to guide diagnosis and treatment of GABHS oropharyngeal infections.

• #1 Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7087627/

  More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. […] To estimate the probability of tonsillitis caused by -hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. […] Routinely performed blood tests for acute tonsillitis are not indicated. […] The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. […] The diagnosis is much more based on the patients history and clinical symptoms. […] The term recurrent acute tonsillitis (RAT) means occurrence of repeated episodes of sore throat interrupted by intervals without or insignificant complaints.

• #1 Tonsillitis: Symptoms, Causes, Treatments, Surgery, and Remedies

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

  Your doctor will do a physical exam. Theyll look at your tonsils to see if theyre red or swollen or have pus in them. Theyll also check for a fever. They may look in your ears and nose for signs of infection and feel the sides of your neck for swelling and pain. […] You might need tests to find the cause of your tonsillitis. They include: […] A throat swab. Your doctor will test saliva and cells from your throat for strep bacteria. Theyll run a cotton swab along the back of your throat. This might be uncomfortable but wont hurt. Results are usually ready in 10-15 minutes. Sometimes, your doctor will also want a lab test that takes a couple of days. If these tests are negative, a virus is what caused your tonsillitis. […] A blood test. Your doctor may call this a complete blood cell count(CBC). It looks for high and low numbers of blood cells to show whether a virus or bacteria caused your tonsillitis. […] Rash. Your doctor will check for scarlatina, a rash linked to strep throat infections.

• #1 Tonsillitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.health.com/tonsillitis-overview-7494678

  A healthcare provider diagnoses tonsillitis through a physical exam, symptom and medical history evaluation, and diagnostic tests. […] During the physical exam, the provider will look for tonsillitis signs and symptoms, including swollen lymph nodes in the neck, red and swollen tonsils, and pus or white spots on the tonsils. […] Healthcare providers usually can’t tell whether a virus or bacteria is causing tonsillitis based on a physical exam alone. They may use diagnostic tests, such as a throat swab culture or rapid antigen test, to check for certain bacteria. […] For both tests, a sample of mucus is taken from the back of your throat with a swab. Rapid tests can quickly detect the presence of certain bacterial infections, such as strep throat. A throat swab sample may be sent to a lab to identify the type of bacteria causing the infection.

• #1 Treating Tonsillitis: What You Need to Know

  https://www.everydayhealth.com/tonsillitis/treatment/

  Diagnosing tonsillitis might also include these actions: (2) Using a lighted instrument to look in the ears and nose for other signs of infection. […] How is tonsillitis diagnosed? Tonsillitis is usually diagnosed based on signs and symptoms, along with a physical exam. A throat swab may also be done to test for strep throat.

• #1 Tonsillitis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/tonsillitis/treatment

  How is Tonsillitis Diagnosed? Diagnosis To diagnose tonsillitis, a healthcare provider will first conduct a physical examination. This involves examining your throat, reviewing your symptoms, examining the ears and nose, feeling the lymph nodes in the neck to check for swelling, and using a stethoscope to listen to your breathing. […] After confirming a tonsillitis diagnosis, the doctor will determine whether the infection is viral or bacterial. This can be done by performing a bacteria culture test, which involves swabbing the back of the throat to gather a sample which is then tested in a clinic or laboratory. Your doctor may also recommend a CBC (complete blood count) test, where a sample of blood is analyzed to help determine whether the infection is viral or bacterial.

• #1 Tonsillitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/598?locale=fr

  Tonsillitis can be difficult to distinguish from viral pharyngitis as both present with similar clinical symptoms. […] Most cases resolve spontaneously within a few days and do not require antibiotics, although analgesia is recommended for symptom relief. Antibiotics are used to treat group A streptococcal infection that make up between 5% to 15% of cases of pharyngitis in adults and 15% to 30% of cases in children. […] Key diagnostic factors include pain on swallowing, fever (100.5F [38C]), and tonsillar exudate. […] 1st tests to order include throat culture and rapid streptococcal antigen test.

• #1 Tonsillitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/tonsillitis-pro

  It is recommended that throat swabs and rapid antigen tests should not be performed routinely. […] Rapid streptococcal antigen tests have the benefit of immediate results but sensitivity is lower than with culture. Their use has been recommended in adults and children aged over 3 years with a high probability of Group A beta-haemolytic streptococcus as assessed by at least three Centor criteria. […] Culture of Group A beta-haemolytic streptococcus (GABS) is inefficient as a diagnostic criterion, as it is too slow and may not differentiate between infection and carriage. There are four Centor Criteria that may be used: History of fever over 38C, Tonsillar exudate, No cough, Tender anterior cervical lymphadenopathy. […] Patients with one or none of these criteria are unlikely to have GABS. Consideration of antibiotic prescription should be limited to patients with three or four Centor criteria.

• #1 Tonsillitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/tonsillitis-pro

  The FeverPAIN criteria is an alternative score used for prediction of streptococcal infection. Each criterion scores one point. For children with a FeverPAIN score of 3 or more, prescribe antibiotics. For adults with a FeverPAIN score of 4 or 5, consider antibiotic prescription. For adults with a FeverPAIN score of 2 or 3, no severe symptoms and not in a vulnerable group; consider a delayed antibiotic prescription.

• #1 Tonsillitis and Tonsilloliths: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/tonsillitis-tonsilloliths.html

  The Centor score is helpful in ruling out streptococcal pharyngitis and has limited positive predictive value for determining when GABHS infection is present. […] There are several laboratory tests that may be used in the evaluation of pharyngitis and tonsillitis to help differentiate GABHS infection from other causes. Rapid antigen detection testing has three features that make it the recommended first-line test for detecting GABHS infection. […] A throat culture is considered the diagnostic standard for GABHS tonsillitis. This test is performed using a swab of the posterior oropharynx and tonsils. […] Nucleic acid amplification tests can also be used to diagnose GABHS infections. […] Antistreptococcal antibody titers, which are obtained from a peripheral blood sample, are another diagnostic approach.

• #1 Tonsillitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21146-tonsillitis

  To diagnose tonsillitis, your healthcare provider will: […] After confirming a tonsillitis diagnosis, your provider will need to determine whether the infection is viral or bacterial. To do this, they may request a bacteria culture test. […] During this procedure, your provider will swipe the back of your throat with a long cotton swab to gather cells and saliva. Then, theyll check the sample to see if it tests positive for Group A Streptococcus bacteria. If your results are positive, you have strep throat. If your results are negative, you have viral tonsillitis.

• #1 Tonsillitis: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/tonsillitis/?srsltid=AfmBOopEHC3x-q3xSPFjpyI3f6lqw5IPrpa8T7LSJBZchdL5JQeuJmrj

  Tonsillitis is diagnosed by completing a review of the presenting signs and symptoms, performing rapid antigen testing, and/or obtaining a throat culture. A Centor Score may be used to assess the severity of symptoms and decide the next steps of treatment (Windfuhr, et al., 2016). Centor scoring involves assigning one point for each of the following four signs: […] GABHS testing is specific (88% to 100%) but not sensitive (61% to 95%), making false negatives possible (Anderson Paterek, 2021). […] Five or more episodes of tonsillitis in a year is considered chronic or recurrent tonsillitis. This frequency is arbitrary but warrants further clinical investigation (Anderson Paterek, 2021). […] The differential diagnosis for tonsillitis includes: Pharyngitis, Retropharyngeal abscess, Epiglottitis, Ludwig angina, Dental abscess, Kawasaki disease, Primary HIV, Coxsackie virus, Epstein-Barr virus, Oral candidiasis.

• #1 What Is Tonsillitis Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/tonsillitis/guide/

  A rapid strep test can be administered in the doctor’s office and yields results in just a few minutes. The test is not perfect, since it only detects one strain (or type) of strep and sometimes comes back negative even when strep bacteria are present. The doctor may order a throat culture which also involves swabbing the back of the throat to see if strep grows from the sample collected. It’s more reliable than the rapid strep test, but the results can take a day or two.

• #1 Acute tonsillitis and pharyngitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-tonsillitis-and-pharyngitis/

  Recommendations in this section are consistent with the 2012 Infectious Disease Society of America (IDSA) and the 2009 American Heart Association (AHA)/American Academy of Pediatrics (AAP) guidelines on GAS pharyngitis. […] Obtain a rapid strep test if indicated, e.g., symptomatic patient 3 years old. […] Positive rapid strep test: GAS infection likely; proceed to treatment. […] Negative rapid strep test: Obtain a throat culture in children 3 years old and consider obtaining in younger children (not routinely required in adults). […] Indications: Confirmatory test to definitively rule out GAS infection in symptomatic children and adolescents with a negative RADT. […] Lack of clinical improvement after 34 days despite antibiotic treatment. […] Recurrent or chronic tonsillitis. […] Consider in adults with risk factors for invasive GAS infection. […] The diagnosis of acute tonsillitis or acute pharyngitis is primarily clinical.

• #1 Tonsillitis – Wikipedia

  https://en.wikipedia.org/wiki/Tonsillitis

  Tonsillitis is most commonly caused by a viral infection and about 5% to 40% of cases are caused by a bacterial infection. […] Confirmation may be by a throat swab or rapid strep test. […] In primary care settings, the Centor criteria are used to determine the likelihood of group A beta-hemolytic streptococcus (GABHS) infection in an acute tonsillitis and the need of antibiotics for tonsillitis treatment. […] The diagnosis of GABHS tonsillitis can be confirmed by culture of samples obtained by swabbing the throat and plating them on blood agar medium. […] Bacterial culture may need to be performed in cases of a negative rapid streptococcal test. […] Epstein Barr virus serology can be tested for those who may have infectious mononucleosis with a typical lymphocyte count in full blood count result. […] Nasoendoscopy can be used for those with severe neck pain and inability to swallow any fluids to rule out masked epiglotitis and supraglotitis.

• #1 Tonsillitis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/tonsillitis.html

  How Is Tonsillitis Diagnosed? Doctors will ask about symptoms and do an exam. They’ll check the inside of the mouth, the back of the throat, and the neck. […] A health care provider may use a soft cotton swab to gently collect a sample from the tonsils and back of the throat. This can be: tested quickly with a rapid strep test that gives an answer within minutes […] sent to a lab for a throat culture, which takes a few days. […] If the rapid strep test doesn’t show signs of strep, the health care provider will depend on the culture for a final diagnosis.

• #1 Tonsillitis – Swollen Tonsils – Symptoms | familydoctor.org

  https://familydoctor.org/condition/tonsillitis/

  Tonsillitis is an inflammatory disease. It occurs when your tonsils become infected by a virus or bacteria. Tonsillitis is more common in children than adults. […] Contact your doctor if you or your child has symptoms of tonsillitis. Your doctor will ask about symptoms. They will also check your ears, nose, and throat for swelling and signs of infection. […] Your doctor will use a swab to take a sample from the back of your throat. The sample may be used for a rapid strep test or a throat culture. Both tests can show if your infection is caused by strep or another kind of bacteria. A rapid strep test only takes a few minutes to show results. However, a throat culture must be sent to a lab and takes 24 hours or more. It is more reliable than a rapid stress test, which can give a false negative result. The doctor may order both tests to ensure a diagnosis. […] In some cases, your doctor may do a blood test to determine the cause. For example, a blood test can check for mono.

• #1 Tonsillitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tonsillitis/diagnosis-treatment/drc-20378483

  Your child’s doctor will start with a physical exam that will include: […] With this simple test, the doctor rubs a sterile swab over the back of your child’s throat to get a sample of secretions. The sample will be checked in the clinic or in a lab for streptococcal bacteria. […] If the rapid in-clinic test comes back positive, then your child almost certainly has a bacterial infection. If the test comes back negative, then your child likely has a viral infection. Your doctor will wait, however, for the more reliable out-of-clinic lab test to determine the cause of the infection. […] Your doctor may order a complete blood cell count (CBC) with a small sample of your child’s blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what’s elevated, what’s normal or what’s below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.

• #1 Acute Tonsillitis – Clinical presentation and Treatment – Dr Sanu P Moideen

  https://drsanu.com/articles/acute-tonsillitis-clinical-presentation-and-treatment/

  Acute tonsillitis is an inflammatory condition of tonsil lasting less than 3 weeks duration. […] Acute tonsillitis is a clinical diagnosis. […] Diagnosis of causative agent has little role in management as both bacterial and viral tonsillitis tend to resolve quickly without treatment in most cases. Hence throat swab and culture is usually indicated in severe cases only. […] Throat swab may yield positive culture for GABHS. But this may be false positive as positive culture is seen in upto 40% of asymptomatic carriers. […] Rapid Antigen Test (RAT) is an office procedure with high speed in reporting results obtained usually within 10 minutes. […] A mononucleosis spot test can be a consideration when the Ebstein-Barr virus is suspected (usually will have kissing tonsils). […] Imaging and other lab investigations are rarely necessary for uncomplicated infections. […] CT imaging of the neck with intravenous contrast to exclude dangerous causes such as abscess, Lemierre disease, and epiglottitis. […] Complete blood count and basic metabolic panel to assess renal function, etc. also to be considered accordingly.

• #1 Tonsillitis and Tonsilloliths: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/tonsillitis-tonsilloliths.html

  In patients with more severe infection, including those with unstable vital signs, toxic appearance, difficulty swallowing, inability to tolerate oral intake, or trismus, imaging may be required. Contrast-enhanced computed tomography is the preferred imaging modality to evaluate for serious complications such as abscesses, epiglottitis, or Lemierre syndrome (a rare complication of tonsillitis with septic thrombophlebitis of the tonsillar and internal jugular veins).

• #1 Tonsillitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544342/

  Testing for GABHS can occur via throat culture alone or in conjunction with rapid antigen testing. […] In complicated infections, including patients with unstable vital signs, toxic appearance, inability to swallow, inability to tolerate oral intake, or trismus, a more extensive evaluation may be required. […] For the majority of patients, tonsilitis is a self-limiting disease. Given the frequency of viral etiologies, the mainstay of treatment of acute tonsillitis is supportive care, including analgesia and hydration; patients rarely require hospitalization. […] For patients at high risk of bacterial pharyngitis based on Centor criteria and antigen testing or throat culture, antibiotics are often used in treatment. […] Recurrent tonsillitis is arbitrarily defined but generally identified as five or more tonsillitis episodes in one year.

• #1 Tonsillitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544342/

  The differential diagnosis for tonsillitis is broad and includes pharyngitis, retropharyngeal abscess, epiglottitis, and Ludwig angina. […] Acute tonsillitis treatment is usually via outpatient supportive management, including analgesia and oral hydration; hospital admission is rarely necessary. […] The prognosis of acute tonsillitis in the absence of complications is excellent. Most cases are self-limiting infections in healthy patient populations who improve and have minimal sequela. […] While tonsillitis is typically symptomatically managed with good clinical outcomes, complications do occur.

• #1 Tonsillitis and Peritonsillar Abscess: Practice Essentials, Background, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/871977-overview

  Tonsillitis and PTA are clinical diagnoses. Testing is indicated when GABHS infection is suspected. Throat cultures are the criterion standard for detecting GABHS. For patients in whom acute tonsillitis is suspected to have spread to deep neck structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using plain films of the lateral neck or computed tomography (CT) scanning with contrast is warranted. In cases of PTA, CT scanning with contrast is indicated. […] Treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate hydration and caloric intake and controlling pain and fever. […] GABHS infection obligates antibiotic coverage.

• #1 Tonsillitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544342/

  Tonsillitis, or inflammation of the tonsils, is a common disease and makes up approximately 1.3% of outpatient visits. […] Acute tonsillitis is a clinical diagnosis. Differentiation between bacterial and viral causes can be difficult; however, this is crucial to prevent the overuse of antibiotics. This activity reviews the etiology, presentation, evaluation, and management of tonsillitis, and examines the role of the interprofessional team in evaluating, diagnosing, and managing the condition. […] For the majority of patients, evaluation for tonsillitis includes physical examination, risk stratification by scoring systems, and consideration of rapid antigen testing and/or throat culture. Imaging is rarely necessary for uncomplicated infections. Evaluation should begin with a thorough history and physical exam, and this information can be used to calculate a Centor Score.

• #1 Tonsillitis and Tonsilloliths: Diagnosis and Management – Department of Family Medicine

  https://www.med.unc.edu/fammed/research/publications-2/tonsillitis-and-tonsilloliths-diagnosis-and-management/

  Tonsillitis, or inflammation of the tonsils, makes up approximately 0.4% of outpatient visits in the United States. […] A variety of diagnostic tools are available, including symptom-based validated scoring systems (e.g., Centor score), and oropharyngeal and serum laboratory testing. […] It is important to differentiate group A beta-hemolytic streptococcus from other bacterial or viral causes of pharyngitis and tonsillitis because of the risk of progression to more systemic complications such as abscess, acute glomerulonephritis, rheumatic fever, and scarlet fever after infection with group A beta-hemolytic streptococcus.

• #1 Tonsillitis and Peritonsillar Abscess Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/871977-workup

  A rapid antigen detection test (RADT), also known as the rapid streptococcal test, detects the presence of GABHS cell wall carbohydrate from swabbed material and is considered less sensitive than throat cultures; however, the test has a specificity of 95% or more and produces a result in significantly less time than that required for throat cultures. A negative RADT requires that a throat culture be obtained before excluding GABHS infection. […] Laboratory evaluation in chronic tonsillitis relies upon documentation of results of pharyngeal swabs or cultures taken during prior episodes of tonsillitis. […] For patients in whom acute tonsillitis is suspected to have spread to deep neck structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using plain films of the lateral neck or CT scans with contrast is warranted. […] In cases of peritonsillar abscess (PTA), CT scanning with contrast is indicated in general for unusual presentations (eg, an inferior pole abscess) and for patients at high risk for drainage procedures (eg, patients with coagulopathy or anesthetic risk).

• #1 Tonsillitis: Diagnosis, Treatment, Medicines, and More

  https://www.webmd.com/oral-health/understanding-tonsillitis-treatment

  To check your child’s tonsils, gently place the handle of a spoon, if possible, on their tongue and ask the child to say „aaahhh” while you shine a light on the back of the throat. If the tonsils look bright red and swollen, see your pediatrician or family doctor. […] Your pediatrician will examine your child’s tonsils and take a throat swab to check for strep throat. The test can be done with results available during the office visit. This is the rapid strep test. If this is negative a culture is done for confirmation which takes 24-48 hours. […] If your doctor discovers or suspects an abscess, you may need to be seen by an ear, nose, and throat doctor (called an ENT or otolaryngologist) to be evaluated for possible drainage of pus. […] Frequent cases of tonsillitis that affect your child’s general health, interfere with school attendance, cause breathing problems (snoring), snoring, or difficulty swallowing may warrant surgical removal of the tonsils (tonsillectomy).

• #1 Tonsillitis – Quinsy – Abscess – Antibiotics – TeachMeSurgery

  https://teachmesurgery.com/ent/throat/tonsillitis/

  Important differentials to consider include head and neck malignancy, haematological malignancies, or deep space neck abscess, especially in chronic cases. […] Consider a CT neck scan with intravenous contrast if a deep neck space infection is suspected, or if there are signs of parapharyngeal swelling during flexible nasoendoscopy. […] The definitive management for patients with recurrent tonsillitis is with surgical tonsillectomy. […] Typical indications for surgical excision of the tonsils include: 7 episodes in the preceding year, or 5 episodes in each of preceding 2 years, or 3 episodes in each of preceding 3 years. […] Peritonsillar abscess and deep space neck infections are rare complications of tonsillitis that should be assessed for in any prolonged, severe, or atypical case.

• #1 Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7087627/

  The diagnosis of tonsillitis is established based on clinical symptoms and patient history rather than histopathological examination. […] Acute tonsillitis is to be a clinical diagnosis. […] Parameters like the patients history, clinical symptoms, and laboratory values are required to distinguish between viral and bacterial origin of tonsillitis. […] The immune response against streptococci does not lead to a complete immune protection so that streptococcal infection might re-occur. […] The detection of bacterial commensals does not confirm a bacterial infection in symptomatic patients but suggests viral etiology. […] The clinical suspicion of IM should be confirmed by laboratory examinations in doubtful cases or in cases of high risk patients (pregnancy, HIV infection, immune deficiency).

• #2 Tonsillitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544342/

  Tonsillitis, or inflammation of the tonsils, is a common disease and makes up approximately 1.3% of outpatient visits. […] Acute tonsillitis is a clinical diagnosis. Differentiation between bacterial and viral causes can be difficult; however, this is crucial to prevent the overuse of antibiotics. This activity reviews the etiology, presentation, evaluation, and management of tonsillitis, and examines the role of the interprofessional team in evaluating, diagnosing, and managing the condition. […] For the majority of patients, evaluation for tonsillitis includes physical examination, risk stratification by scoring systems, and consideration of rapid antigen testing and/or throat culture. Imaging is rarely necessary for uncomplicated infections. Evaluation should begin with a thorough history and physical exam, and this information can be used to calculate a Centor Score.

• #2 Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7087627/

  The diagnosis of tonsillitis is established based on clinical symptoms and patient history rather than histopathological examination. […] Acute tonsillitis is to be a clinical diagnosis. […] Parameters like the patients history, clinical symptoms, and laboratory values are required to distinguish between viral and bacterial origin of tonsillitis. […] The immune response against streptococci does not lead to a complete immune protection so that streptococcal infection might re-occur. […] The detection of bacterial commensals does not confirm a bacterial infection in symptomatic patients but suggests viral etiology. […] The clinical suspicion of IM should be confirmed by laboratory examinations in doubtful cases or in cases of high risk patients (pregnancy, HIV infection, immune deficiency).

• #2 Tonsillitis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/tonsillitis/treatment

  How is Tonsillitis Diagnosed? Diagnosis To diagnose tonsillitis, a healthcare provider will first conduct a physical examination. This involves examining your throat, reviewing your symptoms, examining the ears and nose, feeling the lymph nodes in the neck to check for swelling, and using a stethoscope to listen to your breathing. […] After confirming a tonsillitis diagnosis, the doctor will determine whether the infection is viral or bacterial. This can be done by performing a bacteria culture test, which involves swabbing the back of the throat to gather a sample which is then tested in a clinic or laboratory. Your doctor may also recommend a CBC (complete blood count) test, where a sample of blood is analyzed to help determine whether the infection is viral or bacterial.

• #2 Tonsillitis and Peritonsillar Abscess Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/871977-workup

  Tonsillitis and peritonsillar abscess (PTA) are clinical diagnoses. Testing is indicated when group A beta-hemolytic Streptococcus pyogenes (GABHS) infection is suspected. Throat cultures are the criterion standard for detecting GABHS. […] For patients in whom acute tonsillitis is suspected to have spread to deep neck structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using plain films of the lateral neck or CT scans with contrast is warranted. In cases of PTA, CT scanning with contrast is indicated. […] Throat cultures are the criterion standard for detecting group A beta-hemolytic Streptococcus pyogenes (GABHS). GABHS is the principal organism for which antibiotic therapy (sensitivity 90-95%) is definitely indicated. […] Relying only on clinical criteria, such as the presence of exudate, erythema, fever, and lymphadenopathy, is not an accurate method for distinguishing GABHS from viral tonsillitis.

• #2 Tonsillopharyngitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/tonsillopharyngitis

  Diagnosis is clinical, supplemented by culture or rapid antigen test. […] Group A beta-hemolytic streptococcus (GABHS) ruled out by rapid antigen test, culture, or both, routinely or selectively. […] Because GABHS requires antibiotics, it must be diagnosed early. […] Many authorities recommend testing with a rapid antigen test or culture for all children. […] In adults, many authorities recommend using the following 4 criteria of the modified Centor score. […] Patients who meet 1 or no criteria are unlikely to have GABHS and should not be tested. […] Patients who meet 2 criteria can be tested. […] Patients who meet 3 or 4 criteria can be tested or treated empirically for GABHS. […] Pharyngitis itself is easily recognized clinically; however, in 25 to 30% of cases, testing is likely to be required to determine whether the infection is a streptococcal infection (ie, strep throat). […] Clinical criteria (modified Centor score) can help to select patients for further testing or empiric antibiotic treatment, although some authorities recommend testing all children using a rapid antigen test and sometimes culture.

• #2 Acute tonsillitis and pharyngitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-tonsillitis-and-pharyngitis/

  The diagnosis of acute tonsillitis or acute pharyngitis is primarily clinical. […] Clinical evaluation: Assess for clinical features of acute bacterial tonsillopharyngitis, acute viral tonsillopharyngitis, and differential diagnoses of acute tonsillopharyngitis. […] Suspected acute bacterial tonsillopharyngitis: Consider diagnostic testing to identify and treat GAS infection and minimize its transmission and complications (e.g., acute rheumatic fever). […] Routine testing for GAS is not recommended for children, as their prevalence of GAS pharyngitis and risk of developing subsequent acute rheumatic fever are both low. […] Testing for GAS infection is not recommended in patients with clinical features that strongly suggest acute viral tonsillopharyngitis. […] The presence of any of the red flag features listed below may indicate suppurative and/or invasive complications of acute tonsillitis and/or pharyngitis, such as deep neck infections (e.g., peritonsillar abscess, retropharyngeal abscess), cervical lymphadenitis, mastoiditis, and rarely, sepsis.

• #2 Acute Tonsillitis – Clinical presentation and Treatment – Dr Sanu P Moideen

  https://drsanu.com/articles/acute-tonsillitis-clinical-presentation-and-treatment/

  Acute tonsillitis is an inflammatory condition of tonsil lasting less than 3 weeks duration. […] Acute tonsillitis is a clinical diagnosis. […] Diagnosis of causative agent has little role in management as both bacterial and viral tonsillitis tend to resolve quickly without treatment in most cases. Hence throat swab and culture is usually indicated in severe cases only. […] Throat swab may yield positive culture for GABHS. But this may be false positive as positive culture is seen in upto 40% of asymptomatic carriers. […] Rapid Antigen Test (RAT) is an office procedure with high speed in reporting results obtained usually within 10 minutes. […] A mononucleosis spot test can be a consideration when the Ebstein-Barr virus is suspected (usually will have kissing tonsils). […] Imaging and other lab investigations are rarely necessary for uncomplicated infections. […] CT imaging of the neck with intravenous contrast to exclude dangerous causes such as abscess, Lemierre disease, and epiglottitis. […] Complete blood count and basic metabolic panel to assess renal function, etc. also to be considered accordingly.

• #2 Tonsillitis and Peritonsillar Abscess Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/871977-workup

  A rapid antigen detection test (RADT), also known as the rapid streptococcal test, detects the presence of GABHS cell wall carbohydrate from swabbed material and is considered less sensitive than throat cultures; however, the test has a specificity of 95% or more and produces a result in significantly less time than that required for throat cultures. A negative RADT requires that a throat culture be obtained before excluding GABHS infection. […] Laboratory evaluation in chronic tonsillitis relies upon documentation of results of pharyngeal swabs or cultures taken during prior episodes of tonsillitis. […] For patients in whom acute tonsillitis is suspected to have spread to deep neck structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using plain films of the lateral neck or CT scans with contrast is warranted. […] In cases of peritonsillar abscess (PTA), CT scanning with contrast is indicated in general for unusual presentations (eg, an inferior pole abscess) and for patients at high risk for drainage procedures (eg, patients with coagulopathy or anesthetic risk).

• #2 Tonsillitis: Diagnosis, Treatment, Medicines, and More

  https://www.webmd.com/oral-health/understanding-tonsillitis-treatment

  To check your child’s tonsils, gently place the handle of a spoon, if possible, on their tongue and ask the child to say „aaahhh” while you shine a light on the back of the throat. If the tonsils look bright red and swollen, see your pediatrician or family doctor. […] Your pediatrician will examine your child’s tonsils and take a throat swab to check for strep throat. The test can be done with results available during the office visit. This is the rapid strep test. If this is negative a culture is done for confirmation which takes 24-48 hours. […] If your doctor discovers or suspects an abscess, you may need to be seen by an ear, nose, and throat doctor (called an ENT or otolaryngologist) to be evaluated for possible drainage of pus. […] Frequent cases of tonsillitis that affect your child’s general health, interfere with school attendance, cause breathing problems (snoring), snoring, or difficulty swallowing may warrant surgical removal of the tonsils (tonsillectomy).

• #2 Tonsillitis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/tonsillitis

  Tonsillitis is easy to diagnose. Symptoms usually resolve within 710 days. […] A doctor will examine your throat to reach a diagnosis. They may also take a throat culture by gently swabbing the back of your throat. The culture is sent to a laboratory to identify the cause of your throat infection. […] A doctor may also order a blood sample for a complete blood count. This test can show whether your infection is viral or bacterial, which may affect your treatment options.

• #2 Tonsillitis

  https://www.healthhub.sg/a-z/diseases-and-conditions/tonsillitis

  Before treatment, your doctor will check for signs of infection, such as redness and pus from the tonsils. […] To diagnose your tonsil infection, your doctor may conduct the following tests: […] A throat swab, where a sterile swab is rubbed over the back of your throat to collect a sample of secretions. The sample is then sent to the laboratory to check for signs of streptococcus. […] A blood test, known as complete blood cell count (CBC), to identify the cause of the infection. A high white blood cell count or the presence of abnormal cells is an indication of a viral infection.

• #2 Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7087627/

  The approach is not transferrable to diphtheria, since even the slightest clinical suspicion of diphtheria mandates immediate inpatient hospitalization and medical therapy. […] The ASLO titer and all other currently known human antibody titers against -hemolytic streptococci do not provide valid diagnostic criteria for the diagnostics of tonsillitis so that there is no need for determination.

• #2 Tonsillitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tonsillitis?lang=us

  Tonsillitis refers to inflammation of any of the tonsils and is one of the most common head and neck infections in adolescents and young adults. […] Imaging is not indicated in simple cases of tonsillitis but can be useful if there is doubt about the diagnosis, inability to examine the patient or concerns about the development of a peritonsillar abscess or other complications. […] Tonsillitis is often treated with oral antibiotics. In severe cases inpatient admission for intravenous antibiotics and rehydration is sometimes required.

• #2 Diagnosing Tonsillitis & Adenoiditis | NYU Langone Health

  https://nyulangone.org/conditions/tonsillitis-adenoiditis-in-children/diagnosis

  To obtain samples that can be tested for the bacterium that causes strep throat, a doctor or a nurse may swab the back of your child’s throat with a cotton-tipped stick. […] The doctor may perform a nasal endoscopy, a convenient and reliable method of assessing whether your child’s adenoid tissue is inflamed or enlarged. […] The doctor may refer you to an allergist at Hassenfeld Childrens Hospital if your child’s adenoid tissue remains enlarged when there is no evidence of infection. […] Your child’s doctor may recommend an overnight sleep study, or polysomnogram, as part of the Pediatric Sleep Disorders Program at Hassenfeld Childrens Hospital if the child has enlarged tonsils or adenoid tissue and seems to be having difficulty sleeping at night.

• #2 Tonsillitis: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/tonsillitis/?srsltid=AfmBOopEHC3x-q3xSPFjpyI3f6lqw5IPrpa8T7LSJBZchdL5JQeuJmrj

  Tonsillitis is diagnosed by completing a review of the presenting signs and symptoms, performing rapid antigen testing, and/or obtaining a throat culture. A Centor Score may be used to assess the severity of symptoms and decide the next steps of treatment (Windfuhr, et al., 2016). Centor scoring involves assigning one point for each of the following four signs: […] GABHS testing is specific (88% to 100%) but not sensitive (61% to 95%), making false negatives possible (Anderson Paterek, 2021). […] Five or more episodes of tonsillitis in a year is considered chronic or recurrent tonsillitis. This frequency is arbitrary but warrants further clinical investigation (Anderson Paterek, 2021). […] The differential diagnosis for tonsillitis includes: Pharyngitis, Retropharyngeal abscess, Epiglottitis, Ludwig angina, Dental abscess, Kawasaki disease, Primary HIV, Coxsackie virus, Epstein-Barr virus, Oral candidiasis.

• #2 Tonsillitis – Wikipedia

  https://en.wikipedia.org/wiki/Tonsillitis

  Tonsillitis is most commonly caused by a viral infection and about 5% to 40% of cases are caused by a bacterial infection. […] Confirmation may be by a throat swab or rapid strep test. […] In primary care settings, the Centor criteria are used to determine the likelihood of group A beta-hemolytic streptococcus (GABHS) infection in an acute tonsillitis and the need of antibiotics for tonsillitis treatment. […] The diagnosis of GABHS tonsillitis can be confirmed by culture of samples obtained by swabbing the throat and plating them on blood agar medium. […] Bacterial culture may need to be performed in cases of a negative rapid streptococcal test. […] Epstein Barr virus serology can be tested for those who may have infectious mononucleosis with a typical lymphocyte count in full blood count result. […] Nasoendoscopy can be used for those with severe neck pain and inability to swallow any fluids to rule out masked epiglotitis and supraglotitis.

• #2 Tonsillitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/598?locale=fr

  Tonsillitis can be difficult to distinguish from viral pharyngitis as both present with similar clinical symptoms. […] Most cases resolve spontaneously within a few days and do not require antibiotics, although analgesia is recommended for symptom relief. Antibiotics are used to treat group A streptococcal infection that make up between 5% to 15% of cases of pharyngitis in adults and 15% to 30% of cases in children. […] Key diagnostic factors include pain on swallowing, fever (100.5F [38C]), and tonsillar exudate. […] 1st tests to order include throat culture and rapid streptococcal antigen test.

• #2 Tonsillitis

  https://www2.hse.ie/conditions/tonsillitis/

  Your doctor can usually tell its tonsillitis by asking about your symptoms and looking at the back of your throat. […] Sometimes they might wipe a cotton bud at the back of your throat to test for bacteria. Your GP might organise a blood test to rule out glandular fever. […] Treatment will depend on what caused your tonsillitis. Most children and adults get viral tonsillitis. This type has to run its course and antibiotics won’t help. Your GP may prescribe antibiotics for bacterial tonsillitis. […] Usually, your GP will have to wait for the test results to tell which type you have.

• #2 Tonsillitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479

  Because appropriate treatment for tonsillitis depends on the cause, it’s important to get a prompt and accurate diagnosis. […] It’s important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis. […] Call your doctor if your child is experiencing: A sore throat with fever, A sore throat that doesn’t go away within 24 to 48 hours, Painful or difficult swallowing, Extreme weakness, fatigue or fussiness. […] The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. […] If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn’t treated or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as: Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin.

• #2 Chronic Tonsillitis: Symptoms, Diagnosis, Treatment, and More

  https://www.healthline.com/health/chronic-tonsillitis

  Chronic tonsillitis is an ongoing infection of the tonsils. […] Tonsillitis is an infection of the tonsils. […] Chronic tonsillitis is an infection of the tonsils that lasts longer than a week or two. It may last weeks or months. […] To diagnose tonsillitis, your healthcare professional will do a physical exam of your throat and tonsils. During the exam, they may also perform a throat culture by gently taking a sample of mucus from the back of your throat using a long swab. They will send the sample to a lab to see if you have an infection in your tonsils. […] They may also take a blood sample and send it to the lab for testing. A test called a complete blood count can help your healthcare professional determine if the infection is caused by a virus or bacteria. […] While tonsillitis may resolve without treatment in a week or less, you’ll need to see a healthcare professional if you have chronic tonsillitis. Treatment options for chronic tonsillitis include: oral antibiotics if the infection is caused by bacteria. […] Some people with chronic tonsillitis may need to have their tonsils surgically removed.

• #2 Diagnosing Tonsillitis & Adenoiditis | NYU Langone Health

  https://nyulangone.org/conditions/tonsillitis-adenoiditis-in-children/diagnosis

  Determining the cause and severity of your child’s condition allows our specialists to identify the most effective treatments. […] Your pediatrician may refer your child to an ear, nose, and throat specialist, also known as an otolaryngologist, for an exam if your child has repeated upper respiratory infections and significant discomfort. Otolaryngologists at Hassenfeld Childrens Hospital at NYU Langone examine your child to determine the cause and severity of the condition and to identify the most effective treatment. In addition to asking about your child’s symptoms and medical history, our doctors may perform the following tests. […] During an upper respiratory exam, a doctor asks you or your child about any recent illnesses, allergies, or symptoms, such as a stuffy nose or sore throat.

• #3 Tonsillitis and Peritonsillar Abscess: Practice Essentials, Background, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/871977-overview

  Tonsillitis and PTA are clinical diagnoses. Testing is indicated when GABHS infection is suspected. Throat cultures are the criterion standard for detecting GABHS. For patients in whom acute tonsillitis is suspected to have spread to deep neck structures (ie, beyond the fascial planes of the oropharynx), radiologic imaging using plain films of the lateral neck or computed tomography (CT) scanning with contrast is warranted. In cases of PTA, CT scanning with contrast is indicated. […] Treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate hydration and caloric intake and controlling pain and fever. […] GABHS infection obligates antibiotic coverage.

• #3

  https://link.springer.com/article/10.1007/s00405-015-3872-6

  More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. […] To estimate the probability of tonsillitis caused by -hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. […] If therapy is considered, a positive score of 3 should lead to pharyngeal swab or rapid test or culture in order to identify -hemolytic streptococci. […] Routinely performed blood tests for acute tonsillitis are not indicated. […] After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. […] The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed.

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