Bacterial, Viral, and Fungal Tonsillitis: How They Differ

Your throat has been sore for three days, your child winces at tea and asks for "something cold," and you've already run through every name you know. Tonsillitis is not one diagnosis but several different conditions, and what caused the inflammation determines how long it will last and whether a doctor will be needed.

What tonsillitis is and what causes it

The tonsils are two clusters of tissue deep in the throat, part of the lymphatic system: they catch microbes entering through the mouth and nose. Tonsillitis, also known as acute tonsillitis, is their inflammation; sometimes the adenoids swell too. It mainly affects children over two years old, but adolescents and adults get it as well.

What happens inside. Most often a virus is to blame — the same one that causes a cold; less often a bacterium, such as streptococcus; even less often fungi of the genus Candida. Catarrhal, lacunar, follicular, and membranous forms are distinguished. Contributing factors include exposure to cold, reduced immunity, tonsil trauma, impaired nasal breathing, and chronic foci of infection in the mouth, nose, and sinuses.

Bacterial (streptococcal) tonsillitis

In more than half of cases the leading role belongs to group A beta-hemolytic streptococcus; less commonly staphylococcus, a combination of the two, or pneumococcus is involved. In children aged 5–15, the bacterial form occurs more often than in younger children.

Symptoms: severe sore throat, difficulty swallowing, high fever, pus spots or white patches on reddened tonsils, tender enlarged lymph nodes in the neck, bad breath. When a bacterial cause is confirmed, the doctor may prescribe antibiotics, including to prevent rheumatic fever from developing. Tonsils are removed extremely rarely — in severe tonsillitis that keeps coming back.

Viral tonsillitis: symptoms

The most common form: most children and adults get this one, and it resolves on its own. The culprits are adenoviruses, Coxsackie enterovirus, and herpes virus; in younger children the viral variant occurs more often than the bacterial one.

Symptoms resemble a very severe cold: sore throat, difficulty swallowing, fever, cough, headache, ear pain, nausea, and fatigue. Usually everything subsides within 3–4 days, but it can drag on. Tonsillitis itself is not contagious — the viruses and bacteria that cause it are.

Fungal (candidal) tonsillitis

It is caused by fungi of the genus Candida, often together with coccal flora. It frequently appears after prolonged antibiotic treatment. Treatment is prescribed by a doctor.

How to tell bacterial tonsillitis from viral

By symptoms alone, you certainly can't: both viruses and bacteria cause red, swollen tonsils, pain when swallowing, and fever. There are still some clues. Pus spots, white patches, severe pain, and tender neck lymph nodes are described as a more severe picture, and an age of 5–15 years raises the chances of the bacterial form. The doctor usually waits for test results before talking about the nature of the infection.

How the causative agent is identified and when to see a doctor

The doctor asks about symptoms and examines the throat. Then a throat swab is usually taken: a rapid strep test gives an answer within minutes, a culture takes several days but is more reliable; if the rapid test is negative, a culture may be done additionally. In severe or prolonged cases, blood is tested for infectious mononucleosis. You should see a doctor if:

• your child has had a sore throat for more than two days;
• swallowing is painful or difficult, and pain makes it hard to eat and drink;
• pus spots are visible on the tonsils;
• symptoms do not go away within a week;
• throat infections keep coming back again and again.

Tonsillitis by itself is not a reason to call an ambulance. You should call 103 or 112 if severe sore throat is rapidly worsening, the mouth and throat are swelling, it is hard to speak, swallow, or breathe, it is hard to open the mouth, or drooling appears. These are signs of a complication — a collection of pus between the tonsil and the pharyngeal wall (quinsy).

This material is for reference and does not replace a doctor's consultation: when it comes to a child's throat, it is better to distinguish "it will go away on its own" from "it needs to be checked" together with a doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer