Viral Infections of Adenotonsil

Patients presenting with viral tonsillitis, usually simultaneously with viral pharyngitis, commonly complain of sore throat and difficulty swallowing. Upon examination, there is often fever and oropharyngeal erythema, usually without a tonsillar exudate. Viruses such as adenovirus, rhinovirus, reovirus, respiratory syncytial virus (RSV), and the influenza and parainfluenza viruses have all been shown to be possible pathogens. Most of these infections are self-limited and require only symptomatic treatment.

The Epstein-Barr virus (EBV) causes acute pharyngitis as a part of infectious mononucleosis syndrome. It is common in children and young adults, is transmitted by oral contact, and manifests as fever, generalized malaise, lymphadenopathy, hepatosplenomegaly, and pharyngitis. Upon examination, petechiae may be present at the junction of the soft and hard palates. The tonsils are severely enlarged, sometimes to the point of compromising the airway, and classically are covered with an extensive grayish-white exudate. A complete blood count (cbc) may be significant for lymphocytosis with atypical lymphocytes (activated T-cells). A Monospot test is more sensitive and specific than a heterophil antibody test, which can be negative in 10–15% of patients in the first week of illness. Treatment is largely supportive, with IV fluids and rest. In the case of progressive airway obstruction due to obstructive tonsillar swelling, a short course of systemic steroids can be very helpful. Rarely, a nasopharyngeal airway, nasotracheal intubation, or tracheotomy may be required to secure the airway.

Tonsillar infections with the Coxsackie virus result in herpangina, which presents as ulcerative vesicles over the tonsils, posterior pharynx, and palate. The disease commonly occurs in children under the age of 16. Patients present with generalized symptoms of headache, high fever, anorexia, and odynophagia.

Treatment for viral infections is mostly supportive, but the tonsils can have a bacterial superinfection that results in more severe symptoms. These patients can benefit from systemic antibiotics.