Distinguishing Bacterial Tonsillitis vs. Viral Tonsillitis

Tonsillitis, the inflammation of tonsils, commonly causes sore throats, particularly in children and young adults. While most cases are viral and resolve spontaneously, around 15 – 30% stem from bacterial infections requiring antibiotics. While only testing can confirm the cause, recognizing symptoms can guide seeking medical attention.

Noticing a Runny Nose as a Viral Symptom: Viral tonsillitis often accompanies a runny or congested nose. Although both viral and bacterial infections may induce a general malaise and fever, viral fevers tend to be lower, around 100.4°F (38°C), compared to bacterial fevers, which may reach 102°F (38.9°C).

Consider a viral origin for your cough. While coughing can occur with either condition, a cough and hoarseness are more commonly associated with viral infections. These symptoms can be caused by laryngitis, often accompanying tonsillitis, usually of viral origin.

Observe if you notice improvement within four days. Viral tonsillitis typically resolves or shows improvement within three to four days. If you experience relief within this timeframe, it's likely due to a passing viral infection. Bacterial tonsillitis may persist longer and may necessitate medical intervention.

Get screened for the Epstein-Barr virus (EBV) if you experience persistent fatigue. EBV, which often causes mononucleosis (mono), is a common culprit of tonsillitis in adolescents and young adults. Mono, characterized by fatigue, sore throat, fever, swollen lymph nodes, and headache, can last for weeks and typically resolves without specific treatment.

Inspect the roof of your mouth for any rash. Some individuals with mono develop a red, speckled rash on the palate. Use a mirror to examine the top of your mouth. The presence of red speckles may indicate mono. Additionally, check for a gray membrane covering your tonsils, another potential sign of mono.

Assess for tenderness around your spleen.

Gently palpate the area of your spleen beneath your ribcage, above your stomach, on the left side of your abdomen. Enlargement and tenderness of the spleen may occur with mono. Use caution as a swollen spleen can rupture if handled roughly.

Examine your tonsils for the presence of white spots. Bacterial tonsillitis can lead to the formation of small, white, pus-filled spots on the tonsils. To check, use a mirror to look at the back of your throat and observe any abnormalities. If visibility is limited, seek assistance from a family member and try using a light source.

Palpate your neck to detect any swollen lymph nodes. Gently press along the sides of your neck, under your chin, and behind your ears. Swollen lymph nodes, indicated by hard or tender lumps, are more common with bacterial infections.

Regard an ear infection as a potential sign of bacterial involvement. Bacterial pathogens from a throat infection can sometimes migrate to the middle ear, resulting in otitis media. Symptoms include ear pain, hearing difficulties, balance issues, ear drainage, and fever.

Be vigilant for the development of a peritonsillar abscess. A peritonsillar abscess, or quinsy, strongly suggests bacterial tonsillitis. It manifests as a collection of pus near one tonsil, prompting symptoms such as worsening sore throat, difficulty swallowing, altered voice, swollen lymph nodes, tonsil swelling, mouth opening challenges, halitosis, and uvula displacement.

Observe any emergence of skin rashes. Scarlet fever and rheumatic fever are potential complications of bacterial tonsillitis, especially if left untreated. These conditions may manifest with a skin rash. If you detect new rashes alongside a sore throat, it could indicate a bacterial infection, necessitating prompt medical attention.

• Rheumatic fever may also induce widespread joint discomfort.

Opt for a rapid test at your physician’s clinic. A rapid strep test, performed via a throat swab, swiftly detects the presence of streptococcus bacteria responsible for strep throat. While these tests offer quick results, they may yield false negatives in about one-third of cases.

• While useful initially, a throat culture is often necessary for precise diagnosis.

Await the results of your throat culture analysis. The most accurate method to ascertain the cause of tonsillitis involves your doctor reviewing the findings of a throat culture. This entails sending your throat swab to a laboratory for analysis, where a technician identifies any bacteria present on your tonsils. Subsequently, your doctor can prescribe appropriate antibiotics to address the underlying cause of your tonsillitis.

Undergo a blood examination to screen for the mono virus. Mono diagnosis relies on a blood test. As mono is viral, it typically resolves on its own with adequate hydration and rest. However, seek medical evaluation if experiencing mono symptoms, as it can lead to an enlarged spleen, prone to rupture with overexertion. Your doctor will provide guidance for managing the condition and facilitating recovery.

• The most accurate method to diagnose tonsillitis is by having your tonsils swabbed at your doctor’s office. The information provided above serves as general guidance only.
• Tonsillitis is contagious, so ensure thorough handwashing and avoid sharing food with anyone who is unwell. If you have tonsillitis, always cover your mouth and nose when coughing or sneezing, wash your hands frequently, and refrain from attending work or school until you recover.
• As young children may not express their symptoms verbally, be attentive to their behaviors. Signs of tonsillitis in children may include refusal to eat or unusual fussiness. Seek immediate medical assistance if your child exhibits symptoms such as drooling, difficulty breathing, or severe swallowing problems.

• Bacterial tonsillitis can sometimes arise as a complication of viral tonsillitis.
• If your symptoms significantly impede your ability to eat, drink, or breathe normally, seek prompt medical attention from your doctor.