Pediatric Tonsillitis: Symptoms, Diagnosis, and Treatment

Q: Pediatric Tonsillitis: Symptoms, Diagnosis, and Treatment

Hello： You have a fever, tonsillitis, swollen cervical lymph nodes, and hepatitis; these symptoms are most likely indicative of an EB virus infection. <br>Antibiotics should be targeted towards the possible pneumonia and tonsillitis. <br>Wishing you safety and health. <br>Sincere

Tonsillar suppuration, lymphadenopathy, upper abdominal swelling, fever?

A six-year-old girl developed fever symptoms on March 2, which resolved on its own.
However, she experienced another fever on March 4 and was taken to the hospital, where she was diagnosed with tonsillitis.
The doctor advised her to drink plenty of fluids and prescribed medication, including antipyretics.
After stopping the antipyretic medication on March 8, she began to experience recurrent fevers that would subside only with medication.
During fever episodes, she felt chills and would sweat profusely.
On March 10, she could only breathe through her mouth due to nasal congestion, but there was no nasal discharge.
On March 11, she returned to the doctor, who noted that her tonsils were purulent and advised her to continue drinking fluids without prescribing additional medication, except for antihistamines for an allergy flare-up at that time.

On March 12, due to rapid breathing from mouth breathing and fever, there were concerns about phlegm leading to pneumonia, and previous symptoms had not improved.
That evening, she returned for a follow-up but was redirected to the emergency department due to fever.
The emergency physician noted the same findings as on March 11 and ordered blood tests, prescribed antibiotics, and antipyretics.

On March 13, she presented with swelling on both sides of her neck near the jaw (which was not painful) and returned for another follow-up.
The doctor indicated signs of liver enlargement, and since her symptoms had not improved, hospitalization was recommended.
Blood was drawn during her admission on March 14, and the report indicated liver enlargement with liver enzyme levels at 300.
She is currently hospitalized and receiving intravenous antibiotics.
During her hospital stay, she has been soaking her pillow with sweat during fever episodes (but her clothes remain dry) repeatedly.
An abdominal ultrasound is scheduled for March 16.

Given the above symptoms and history, please provide recommendations and clarifications.
Thank you!

Qing, 0~9 year old female. Ask Date: 2020/03/15

Dr. Pei Rensheng reply Pediatrics

Hello: You have a fever, tonsillitis, swollen cervical lymph nodes, and hepatitis; these symptoms are most likely indicative of an EB virus infection.
Antibiotics should be targeted towards the possible pneumonia and tonsillitis.
Wishing you safety and health.
Sincerely, Dr.
Pei Ren-Sheng, Attending Physician, Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/03/15

More Info

Pediatric tonsillitis is a common condition in children, characterized by inflammation of the tonsils, which are two lymph nodes located on each side of the back of the throat. The symptoms, diagnosis, and treatment of tonsillitis can vary significantly, especially in young children, as seen in the case of your six-year-old daughter.

Symptoms of Tonsillitis
The symptoms of tonsillitis can include:
1. Sore Throat: This is often the most prominent symptom. Children may complain of pain when swallowing or may refuse to eat due to discomfort.

2. Fever: A high fever is common, and it may be accompanied by chills.

3. Swollen Tonsils: The tonsils may appear red and swollen, and in cases of bacterial infection, they may have white patches or streaks of pus.

4. Difficulty Breathing or Swallowing: In severe cases, swollen tonsils can obstruct the airway, leading to difficulty breathing, which may require immediate medical attention.

5. Bad Breath: Foul-smelling breath can occur due to the infection.

6. Swollen Lymph Nodes: The lymph nodes in the neck may become swollen and tender.

7. Mouth Breathing: If nasal passages are blocked, children may breathe through their mouths, leading to dry mouth and discomfort.

Diagnosis
Diagnosis typically involves a physical examination where a healthcare provider will look for swollen tonsils, redness, and any exudate (pus). They may also check for swollen lymph nodes in the neck. A rapid strep test or throat culture may be performed to determine if the cause is bacterial (such as Group A Streptococcus) or viral. Blood tests may also be conducted if there are concerns about other underlying conditions, especially if the child presents with additional symptoms like liver enlargement or persistent fever.

Treatment
The treatment for tonsillitis depends on whether it is caused by a viral or bacterial infection:
1. Viral Tonsillitis: This is usually self-limiting, and treatment focuses on symptom relief. This can include:
- Hydration: Encouraging the child to drink plenty of fluids.

- Pain Relief: Over-the-counter medications like ibuprofen or acetaminophen can help reduce fever and alleviate throat pain.

- Rest: Ensuring the child gets plenty of rest to aid recovery.

2. Bacterial Tonsillitis: If a bacterial infection is confirmed, antibiotics are prescribed. It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication. In cases of recurrent tonsillitis or complications, a tonsillectomy (surgical removal of the tonsils) may be considered.

Complications
In your daughter's case, the presence of persistent fever, swollen lymph nodes, and liver enlargement raises concerns for potential complications. These could include:
- Peritonsillar Abscess: A collection of pus that can develop near the tonsils, leading to severe pain and difficulty swallowing.

- Systemic Infections: If the infection spreads, it could lead to more serious conditions requiring hospitalization and intravenous antibiotics.

- Liver Involvement: Elevated liver enzymes may indicate a systemic response to infection or a separate viral infection, such as Epstein-Barr virus (EBV), which can cause infectious mononucleosis.

Recommendations
Given the complexity of your daughter's symptoms and the fact that she is currently hospitalized, it is essential to follow the medical team's advice closely. They will monitor her condition and adjust treatment as necessary. If her symptoms do not improve or worsen, further diagnostic tests may be warranted to rule out other conditions.

It is also advisable to maintain open communication with her healthcare providers. Ask questions about her treatment plan, the reasons for specific tests, and what to expect moving forward. Understanding the rationale behind medical decisions can help alleviate concerns and ensure that you are well-informed about your daughter's health.

In summary, pediatric tonsillitis can present with various symptoms and may require different approaches based on its cause. Close monitoring and appropriate medical care are crucial, especially in cases with complications.

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