white patches of tonsils Seham alenzi Ahad alqahtani

Membranous tonsillitis It occurs due to pyogenic organisms. An exudative membrane forms over the medial surface of the tonsils, along with the features of acute tonsillitis.

Signs 1- Foetid breath and tongue is coated. 2- Hyperaemia of pillars, soft palate and uvula 3- Tonsils appear congested and swollen Yellowish spots at the opening of crypts – follicular Whitish membrane on the medial surface of tonsil and easily wiped away membranous enlarged and congested and almost meet in the midline– parenchymatous 4- Enlarged and tender jugulodigastric nodes

Symptoms 1. Sore throat. 2. Difficulty in swallowing. 3. Fever. It may vary from 38 to 40°C and may be associated with chills and rigors. 4. Earache. It is either referred pain from the tonsil or the result of acute otitis media which may occur as a complication. 5. Constitutional symptoms. headache, general body aches, malaise and constipation.

Complications Chronic tonsillitis with recurrent acute attacks Peritonsillar abscess (quinsy) Parapharyngeal abscess Cervical abscess due to suppuration of jugulodigastric lymph nodes. Acute otitis media Rheumatic fever Often seen in association with tonsillitis due to Group A beta-haemolytic Streptococci. Acute golomerulonephritis Subacute bacterial endocarditis in a patient with valvular heart disease streptococcus viridans infection.

Treatment Bed rest + plenty of fluids Analgesia (Aspirin or Paracetamol) to relieve local pain and bring down the fever. Antimicrobial (Penicillin is the drug of choice) should be continued for 7 -10 days

Aetiology It is an acute specific infection caused by the Gram-positive bacillus, C. Diphtheriae . It spreads by droplet infection. Incubation period is 2–6 days. Some persons are “carriers” of this disease, i.e. they harbour organisms in their throat but have no symptoms.

CLINICAL FEATURES Oropharynx is commonly involved and the larynx and nasal cavity may also be affected. In the oropharynx, a greyish white membrane forms over the tonsils and spreads to the soft palate and posterior pharyngeal wall. It is quite tenacious and causes bleeding when removed.

Cont.. Cervical lymph nodes, particularly the jugulodigastric, become enlarged and tender, sometimes presenting a “bull-neck” appearance. Patient is ill and toxaemic but fever seldom rises above 38°C.

COMPLICATIONS Exotoxin produced by C. diphtheriae is toxic to the CVS & CNS. CVS: - Myocarditis. - Cardiac arrhythmias. - Acute circulatory failure. CNS: usually appear a few weeks after infection and include paralysis of soft palate, diaphragm and ocular muscles. In the larynx, diphtheritic membrane may cause airway obstruction.

TREATMENT Treatment of diphtheria is started on clinical suspicion without waiting for the culture report. Antitoxin is given by i.v. infusion in saline in about 60 min. Dose of antitoxin is based on the site involved and the duration and severity of disease. Antibiotics used are benzyl penicillin 600 mg 6 hourly for 7 days. (Erythromycin) is used in penicillin-sensitive individuals (500 mg 6 hourly orally).

INFECTIOUS MONONUCLEOSIS

INFECTIOUS MONONUCLEOSIS Organism: : Epstein barr virus ( EPV) The virus is spread through saliva which is why some people call it “the kissing disease.” affects older children and young adults incubation period : 4 to 8 weeks.

Signs and Symptoms: Fever sore throat lymphadenopathy ( especially posterior cervical ) malaise exudative tonsillitis + enlargement Splenomegaly white membranes of tonsils

Diagnosis monosopt test May be –ve in the first few weeks after symptoms begin EBV-specific antibodies Ordered in patients with suspected mononucleosis and a –ve monospot test . CBC with differential mild thrombocytopenia with relative 50% Lymphocytosis . 10% Atypical T lymphocytes . **may be normal in the first week but rises in the second week.

Complications CNS infection : Cranial nerve involvement, aseptic meningitis Splenic rupture Upper airway obstruction Bacterial superinfection : 2o streptococcal pharyngitis Fulminant hepatic necrosis Autoimmune hemolytic anemia

Treatment Mostly supportive adequate hydration nonsteroidal anti-inflammatory drugs or acetaminophen for fever and myalgia. No effective antiviral therapy short-term high-dose Corticosteroids (indicated for airway compromise due to tonsillar enlargement )

Refrence Diseases of Ear Nose and Throat 6th Edition by PL Dhingra and Shruti Dhingra.

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