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| A pair of palatine tonsils ex vivo (i.e. removed) |
No doubt you’ve heard the terms, “tonsillitis,” “strep
throat, “ and “mono” mentioned by family and friends alike, many who’ve
suffered through one or more of these problems.
But are these one in the same or three different problems altogether?
If you’ve read the prior chapter in Sore Throats 102, you’ll
recall the palatine tonsils, adenoids and lingual tonsils are collectively
called Waldeyer’s Ring (“The Ring”),
an area of the throat prone to infections, and we’ll talk about some of the
more common infections in this area. Sometimes
“The Ring” is simply called the “tonsils”, though most folks are referring to
the palatine tonsils since they are the only visible parts of “The Ring” when one opens the mouth and looks back into the throat.
Tonsillitis is a nonspecific term for an infection of any or
all areas of The Ring. Remember, -itis means inflammation, but we’re
focusing only on infections causing inflammation in this chapter, meaning
little microorganisms such as viruses, bacteria and fungi invading the
tissues. Most causes of tonsillitis are
viral or bacterial, less so with fungi (such as a yeast infection, also called thrush).
Viral causes resolve with no treatment.
Bacterial infections also can resolve on their own, but sometimes need
an antibiotic to do so. Oftentimes your
doctor or healthcare provider may do a swap of the throat—taking a
cotton-tipped applicator (similar to a long Q-Tip—which by the way, you
shouldn’t use in the ears since they can cause ear trauma, but that’s another
story altogether) and test it for any bacteria that may be the cause.
Strep Throat refers to a specific type of bacterial infection,
caused by a critter called Group A beta-hemolytic streptococcus or Streptococcus pyogenes. We’ll refer to this particular bacterium
simply as “Group A Strept” for short.
When this little guy invades “The Ring, “ it can also create havoc elsewhere
in the body if left untreated. Some of
the nasty complications this little guy can cause are:
Scarlet Fever: this
occurs due to toxins released by the
bacterium, causing a diffuse red rash, “strawberry tongue” (very red and
swollen tongue) and high fevers.
Rheumatic Fever:
this can cause muscle inflammation, damage to tissues of the heart, and
inflammation of the joints (called polyarthritis).
Kidney problems (called
glomerulonephritis): due to inflammation and damage to the microscopic
filtering structures (the glomeruli) of the kidneys.
PANDAS (Pediatric
Autoimmune Neuropsychiatric Disorder Associated with Strep) which is an unusual
problems presenting as tics, anxiety, obsessive and fearful thoughts. Believed to be an immunologic reaction to
certain areas of the brain triggered by the Group A Strep infection.
The last 3 complications are not really caused by the infection
itself, but by the body’s immunologic response to the infection, creating
unintended inflammatory reaction to those organs.
Fortunately these problems are rare nowadays due to prompt
diagnosis and treatment of the offending Group A Strept organism. There are also different types of Streptococcus
and non-Streptcoccus bacteria that don’t cause the gamut of problems associated
with Group A Strep. Your doctor will
often test you with a rapid strept screen, rendering whether or not you have
Group A Strep in 10-15 minutes.
Sometimes a culture is sent of the swab, requiring growing the bacteria
on a Petri dish(at least this was how we did it in the old days)and testing for
the specific bacteria, usually taking 2 days to get a result. Group A Strept fortunately is very
responsive to antibiotics, and the bad stuff mentioned above is rarely seen
these days.
Mononucleosis or “mono” is a particular type of viral infection
caused by the Ebstein-Barr virus. It is
a lymphoproliferative disease, meaning it affects the immunologic system of the
body which includes lymph nodes, the spleen, liver, and also The Ring which is part of this
system. That’s the reason a sore throat is
a common symptom, and you’ll often see enlarged palatine tonsils with a pale,
whitish-gray-yellow, dirty-ish coating (what we call a pseudomembranous exudate) .
Mononucleosis refers to the type of lymphocytes triggered in this type
of infection—they’re “atypical” in appearance when seen under a microscope. Sore throat, dysphagia (difficulty
swallowing), enlarged lymph nodes in the body and especially the neck, malaise
(extreme tiredness), fevers are common symptoms. A monospot
blood test is diagnostic for this disease but this test is often negative
in the first two weeks. Other tests such
as a CBC with diff (complete blood count with differential) will show increased
white blood cells with increased atypical lymphocytes earlier on in the course
of the disease, and sometimes tests for liver enzymes are also elevated. In many cases, the diagnosis is made by the
clinical picture. Treatment is symptomatic:
plenty of fluids, pain medication (Tylenol or ibuprofen as needed), and
rest. Since the spleen and liver are
part of this immunologic system, these organs can be enlarged, and contact sports
(such as football or any activity where on could get hit in the abdomen) must
be avoided for around 6 weeks, to avoid inadvertent injury or rupture of these
structures which would require emergent abdominal surgery. Sometimes antibiotics are given if your
doctor suspects a simultaneous bacterial infection along with mono, but
penicillin-type antibiotics are avoided since some patients can develop a rash
with these and mono. Steroids can also
be used to reduce swelling and ease the pain and dysphagia. Surgery by removing the tonsils does not cure
the disease or hasten the clearance of the virus from the body, yet is done in
cases where the tonsils are so large the patient is having difficulty breathing
or severe dysphagia (ie, problems swallowing his/her own saliva).
In a nutshell:
Tonsillitis = can be caused by nonspecific infection, a non-S. pyogenes organism.
Strep Throat = an infection cause by the bacterium S. pyogenes
Mononucleosis = an infection caused by the Ebstein-Barr
virus
Any of the above illnesses can be passed by saliva
contact. So avoid spreading it by
spraying saliva on someone (i.e., coughing, kissing, sneezing in the direction
of others, whether you’re fond of them or not) and don’t share drinking cups,
eating utensils or food. Also, throw out
your tooth brush and use a new one since those little microorganisms will lay
around in the bristles, waiting to
infect you again.
And if you’ve ever had all three of these infections,
well…congratulations! You’ve earned the
Triple Crown of Sore Throats!
For information on surgical removal of the tonsils, check out Tonsillectomy-Indications and Tonsillectomy-The Technique.
©Randall S. Fong, M.D.
www.randallfong.com
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