What other problems (complications) can tonsillitis cause?
In the majority of cases, tonsillitis simply causes a sore throat with or without a fever (pyrexia). It usually lasts a few days and settles down with or without a course of antibiotics. It has been found that antibiotics reduce the duration of tonsillitis by one or two days, and reduces the risk of it causing other problems (complications). Tonsillitis is often caused by streptococcal infections, in particular Streptococcus Pyogenes (also known as Group A Streptococcus). Rarely, such types of tonsillitis can cause more serious problems which are discussed here.
Peritonsillar abscess ("Quinsy")
A peritonsillar abscess (PTA) occurs when infection spreads through the tonsil and and a collection of pus forms around the outer edge. This collection of pus pushes the tonsil inwards. Patients with this condition often cannot eat or drink at all. It is usually treated by numbing the back of the throat, and inserting a needle or scalpel to drain the pus. Whilst this doesn't sound like the most pleasant of experiences, most patients experience a profound relief if pus is drained.
Very occasionally, abscess can form at the back of the throat, or spread through the neck and into the chest.
Rheumatic fever (RF) can occur when tonsillitis is caused by a bacteria called group A streptococcus. It is an unusual complication that occurs two to three weeks after the original infection. RF can cause inflammation of the joints (arthritis), heart (carditis) and valves of the heart (valvulitis), and also affect the brain and nerves causing an unusual movement disorder called 'Syndenham's Chorea'. Sometimes the skin is affected, with nodule formation.
Post-streptococcal arthritis is inflammation of the joints that occurs within a month of tonsillitis caused by Group A Streptococcus.
Certain types of Group A Streptococcus are more likely to affect the kidneys. Patients with tonsillitis due to this variety of bacteria can have problems with inflammation of the kidneys. This can give rise to blood in the urine, and rarely kidney failure. However, if appropriately treated, the outcome is usually good.
Scarlet Fever is caused by a toxin released by Group A Streptococci, which causes a bright red rash, with slightly raised areas, which often gives the skin the appearance of sandpaper. It usually starts in the groins and armpits. Children who have Scarlet Fever can usually return to school one or two days after antibiotics have been started.
Toxic Shock Syndrome
Toxic Shock Syndrome is a rare, but very serious complication of tonsillitis caused by GAS. It causes a loss of blood pressure, and organ failure, and can be a fatal condition in 30-60% of cases.
Ear infections and sinusitis
Infections of the tonsils can spread through the Eustachian tube to cause ear infections, or via the back of the nose into the sinuses to cause sinus infections.
Meningitis and brain abscess
Infections from the tonsil can very rarely spread to infect the lining of the brain (meningitis) or cause collections of pus (abscesses) in the brain.
Jugular vein thrombophlebitis (Lemierre's Syndrome)
This occurs when infection from the tonsil spreads to the jugular vein, which is a large blood vessel that drains blood from the brain, head and neck region. It is a condition that is more common in healthy young adults. The infection causes both inflammation of the jugular vein, which can also be blocked by the formation of a blood clot. It typically causes a high fever (more than 39 degrees celsius), throat and/or neck pain, and breathing difficulty. Occasionally bits of the infected clot ('septic emoboli') can break off and spread to other parts of the body, typically the lungs.
PANDAs stands for 'Paediatric Autoimmune Neuropsyhchiatric Disorder associated with Group A Streptococcus'. This is a controversial condition, that is to say not all doctors agree it exists. It is believed to be a condition in which children who have obsessive compulsive disorder and/or tic disorders that are made worse following a Group A streptococcal infection.
This another very rare, but serious, complication of tonsillitis caused by Group A Streptococcus. This is an aggressive infection that causes death of soft-tissue. The treatment is usually surgical removal of the dead, infected tissue along with the administration of strong antibiotics put directly into the blood stream.