We are in the midst of catarrhal processes, which involve fever and even sore throat and cough. In fact, pharyngotonsillitis is one of the most common colds in the coldest times of the year and one of the most common reasons for consulting a doctor, not only in children, but also in adults.
“The main cause of pharyngotonsillitis is infectious. Viruses and some bacteria are the most common agents. In pharyngotonsillitis, an inflammatory process occurs that globally affects the pharynx and tonsils. In fact, the tonsils are a glandular structure that is part of the pharynx,” says Dr. Pere Sala, head of the Pediatric Service of the General University Hospital of Catalonia (Barcelona).
Viruses and bacteria, the main causes
Viral tonsillitis is associated with a cold and cough, while bacterial tonsillitis presents a high fever and sore throat.
“Viruses are the most common cause of pharyngotonsillitis in children and, generally, among young children under 3-4 years of age; unlike bacterial infection, which usually affects those over 3 years of age, and more frequently between 5 and 15 years of age. Viral pharyngotonsillitis usually involves a cold and cough. On the other hand, in the case of bacterial infection, high fever and more intense pain in the throat predominate,” this expert differentiates.
Viral pharyngotonsillitis
Specifically, it details that if it is a viral condition, pharymphotonsillitis affects the pharynx and tonsils, generally in the context of an upper respiratory tract infection. Different types of viruses can cause it, as mentioned, such as adenoviruses, rhinoviruses, enteroviruses, and the Epstein-Barr virus (causative agent of infectious mononucleosis), among others.
“The symptoms of viral pharyngotonsillitis are, in general, those of a catarrhal condition of the upper tract with fever, congestion of the nasal passages, which manifests itself with mucous secretion and sneezing, as well as cough and general discomfort or pain. mild when swallowing,” this pediatrician emphasizes.
Doctor Pere Sala, head of the Pediatric Service of the Hospital Universitari General de Catalunya (Barcelona).
The bacterial case
Dr. Sala adds that bacterial pharyngotonsillitis is an inflammatory process that affects the pharynx globally, but especially predominates in the tonsils.
“Different bacteria can cause pharyngotonsillitis, but the most common is group A streptococcus, also known as the Streptococcus pyogenes species. The symptoms are rapid-onset fever that can be high, pain in the neck and especially when swallowing, and which is usually more intense than in viral pharyngotonsillitis,” describes this Pediatrics specialist.
The importance of diagnosis in these cases
In these cases, the head of the Pediatric Service of the Hospital Universitari General de Catalunya emphasizes that the diagnosis is based on the clinical data presented by the patient, as well as on the physical examination that shows signs of inflammation in the pharynx.
“Often, a whitish exudate is seen on the surface of the tonsils, which can be produced by both viruses and bacteria. There are some scales based on the clinic that guide us on the differentiation between viral and bacterial causes,” mentions the pediatrician.
However, Dr. Sala sees it as advisable to perform a rapid diagnostic test, using a sample of pharyngeal exudate with a swab or stick with cotton on the tip, to diagnose bacterial pharyngotonsillitis due to group A streptococcus, always before starting the procedure. an antibiotic treatment: “The objective is to avoid unnecessary use of antibiotics in viral pharyngotonsillitis. Sometimes, a pharyngeal culture is performed to isolate bacteria, although the result may take 2-3 days.”
The consequences
Viral pharyngotonsillitis is usually mild and evolves without major problems.
Possible complications
With all this, Dr. Sala highlights that viral pharyngotonsillitis is usually mild and evolves without major complications; although he warns that in the case of bacterial infections, caused by group A streptococcus, these can cause a long-term complication when not treated, the so-called ‘rheumatic fever’, although he insists that these are “exceptional” cases in our environment.
Other complications, as it continues, and always in the context of a bacterial infection, are those that occur by extension of the infection to the soft tissues of the neck, in the form of peritonsillar phlegmon, or parapharyngeal or retropharyngeal abscess, which may require up to a hospital admission for intravenous antibiotic treatment, and sometimes surgical drainage.
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