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Abstract:
A prospective 1-year study of acute febrile exudative tonsillitis in 110 children was carried out. Viral infection was associated with 42% of the cases, beta-hemolytic streptococci with 31% (12% group A), Mycoplasma pneumoniae with 5%, and unknown cause with 35%. More than one agent was implicated in 14% of the cases. Adenovirus was the viral agent most frequently (19%) recorded. Other viruses involved were Epstein-Barr virus, parainfluenza, influenza A, herpes simplex, and respiratory syncytial viruses. The responsible agent was found by rapid viral antigen detection in 20% of all cases and by rapid test for group A streptococcal antigen detection in 10%. Age was the most important factor in predicting the causative agent. Viral tonsillitis was most common in children younger than 3 years of age and group A beta-hemolytic streptococci tonsillitis in children 6 years of age or more. Clinical analysis of the illness, WBC count, and ESR did not reveal differences that could help in differentiating bacterial from viral tonsillitis. All patients were treated with a regimen of oral penicillin. Fever associated with group A beta-hemolytic streptococci tonsillitis responded to penicillin therapy significantly more rapidly than fever associated with viral infections. These observations demonstrate the prominent role of viruses in the etiology of febrile exudative tonsillitis, especially in young children, and reinforce the benefit of rapid tests before antibiotic therapy is started.
Insights
Viruses are the most common cause of acute febrile exudative tonsillitis in children, particularly those under 3. Rapid diagnostic tests aid in identifying the cause before antibiotic treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute febrile exudative tonsillitis is a common childhood illness.
- Identifying the causative agent is crucial for appropriate treatment and preventing complications.
- Distinguishing between viral and bacterial tonsillitis can be challenging based on clinical presentation alone.
Purpose of the Study:
- To investigate the etiological agents of acute febrile exudative tonsillitis in children.
- To determine the role of age in predicting the causative agent.
- To evaluate the utility of rapid diagnostic tests and clinical findings in differentiating causes.
Main Methods:
- Prospective 1-year study involving 110 children with acute febrile exudative tonsillitis.
- Etiological agents identified using rapid viral antigen detection and rapid tests for group A streptococcal antigen.
- Clinical data, white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were analyzed.
Main Results:
- Viral infections accounted for 42% of cases, with adenovirus being the most frequent viral agent.
- Group A beta-hemolytic streptococci caused 12% of tonsillitis cases.
- Age was a significant factor: viral tonsillitis was more common in children under 3, while streptococcal tonsillitis was more prevalent in those 6 and older.
Conclusions:
- Viruses play a prominent role in the etiology of febrile exudative tonsillitis, especially in young children.
- Clinical symptoms, WBC, and ESR are not reliable for differentiating bacterial from viral tonsillitis.
- Rapid diagnostic tests are beneficial for guiding antibiotic therapy decisions.