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Throat pain, esp. while swallowing, is the cardinal symptom of tonsillitis; fever and malaise are common. Abrupt-onset headache, nausea and vomiting, and cervical lymphadenopathy are more commonly seen with streptococcal infections. Rhinorrhea, cough, and diarrhea are usually associated with viral infection. The tonsils are usually enlarged and red, but the degree of erythema does not reflect the severity of the pain. An exudate is often, but not always, present on the tonsils. Adolescents should be assessed for infectious mononucleosis, as it is quite common among teenagers and young adults.
Viruses are the most common cause of tonsillitis. Beta-hemolytic streptococci infections may follow viral infections or occur as primary infections, esp. in school-aged children and immunocompromised adults (5% to 20% of cases).
Viral tonsillitis is treated symptomatically. If group A beta-hemolytic streptococci infection is suspected, a throat culture is taken. Streptococcal tonsillitis must be treated with a 10-day course of oral penicillin or one intramuscular dose of long-acting benzathine penicillin to decrease the risk of rheumatic fever or glomerulonephritis. Rheumatic fever develops 2 to 3 weeks after streptococcal infections in about 3% of patients. If chronic tonsillitis occurs, the tonsils may be removed, but this operation is not as common as it was years ago. See: rheumatic fever