This isn’t a request for medical advice per se, as I am currently seeing a doctor and receiving treatment regarding this problem, but I’m wondering if anyone might have any insight that might at least help satisfy my own curiosity.
For the past month and a half or so I’ve been battling a case of tonsillitis. The most serious symptom was the extreme pain in swallowing. I was prescribed penicillin twice, and both times the swelling of the tonsils went away with dramatic quickness (around 2 days for my throat to feel fully “normal”), leaving only a few vague, general “feeling under the weather” kind of symptoms. However, both times, around ~4 days after completing the penicillin prescriptions, the inflammation returned. After the second relapse, I was prescribed Erythromycin for 2 weeks. I also had a blood test and throat culture taken, and while the blood test showed a higher level of immune cells, the throat sample apparently had only normal levels of bacteria and tested negative for streptococcus.
I have another appointment soon when the erythromycin prescription is completed where we’ll gauge the results and determine the next step, but until then, I was wondering if anyone had any suggestions for bacterial infections (as it almost certainly must be, given the effectiveness of the antibiotics) that can cause tonsillitis, but aren’t strep throat? There is no swelling of the lymph nodes under the arms or groin, only the throat. The only other notable symptoms are a general feeling of fatigue/lethargy, and thick, viscous nasal mucus that drains a bit and hardens during the night, becoming rather uncomfortable in the morning (although in slightly less dramatic quantities as the runny nose I get during a typical cold). If anyone has any insight, it would be appreciated! Thanks.
I was on antibiotics for about 6 months before I got a tonsillectomy. My tonsils were swollen up to the size of golf balls, and I’d get better on antibiotics, but every time I finished a cycle, it would come back. I think that one of the ENTs I saw said that since I tested negative for strept, it was probably a staph infection, but they don’t usually culture for that. The reason it kept coming back was because the antibiotics weren’t actually able to penetrate the communities of bacteria–I can’t remember the technical term for them, but it was something like a cyst, although I know that’s not the right word.
Anyway, good luck with your treatment! I tried all those antibiotics, too (over 4 different ones were used–amoxicillin, penicillin K, erythromycin, Biaxin, and Augmentin if I recall correctly), and they really never did much for me. The reservoir of bacteria was too strong. During this ordeal, I was wondering why they wouldn’t just culture the bacteria and find out what it was to target it better. I researched phage therapy and desperately wished that it was available in the US.
You asked what else it could be…well, it could be just about anything really. If you have been sexually active, perhaps you might want to get cultured for oral gonorrhea and chlamydia at an STD clinic, just to rule those out and give you peace of mind, if your tonsillitis returns again?
Antibiotics generally don’t work that quickly, taking 48hrs to start making an improvement.
But, other bacterial causes of sore throats include:
Mycoplasma
Arcanobacterium haemolyticum
Haemophilus influenza
Non Group A strep
Meningococcus
Gonococcus
Chlamydia
and various weird and wonderful other things.
Many are not easy to culture or are normal commensal organisms, making diagnosis difficult.
Most sore throats, whether bacterial or viral, will be better within 10days- whether or not they are treated with antibiotics.
High use of antibiotics (mainly Penicillin, used mainly to prevent Rheumatic fever) has increased the antibiotic resistance prevalence- it is possible you may have got a bug which is partially resistant to the antibiotics you were on.
Penicillin-resistant strains of Group A Streptococcus Pyogenes have not been reported, although there are patients with penicillin-sensitive strains who don’t get cured with penicillin, for a variety of reasons (more likely related to the patient and not the relative sensitivity of Strep).
The causes of, and approach to, “tonsillitis” makes for fabulous hours-long discussion fodder in the Infectious Disease world. Many organisms, including Strep, are causative for sore throats, along with various mechanical and chemical etiologies. “Strep throat” from Group A Streptococcus Pyogenes has historically received the most attention because of its tendency to occur in outbreaks within crowds of children and because there are a couple of post-Strep complications involving the heart and kidneys with some strains–though not it recent years in the US, at least for rheumatic fever. Although patients frequently attribute their improvement to antibiotics, such post hoc ergo propter hoc reasoning is probably often wrong. Most Group A Strep tonsillitis resolves spontaneously, and antibiotics might shorten the course by a day or two. Ordinary tests for Strep are not particularly diagnostic since asymptomatic carrier states are common (rendering positive Strep tests even if the real cause is Mono, for example) and many throat swabs simply check for the presence of antigen which doesn’t even mean there is a live colony of Strep living in your tonsillar crypts.
A practical approach is to make sure there is not some other cause besides a simple infection for a persistent sore throat. If there isn’t, in time (with a normal host), pretty much all causes will declare themselves and render specific treatment obvious (for example, a tonsillar or retropharyngeal abscess or carotid aneurysm or some other horrible thing) or else–in the case of pretty much all viral and bacterial superficial infections–just go away on its own.
Sorry Chief Pedant,- I didn’t mean to imply he had GAS that was pen resistant, but that the causative organism, if not GAS, might be pen resistant- does that make sense?
Sure; I think I assumed the reference was to GAS since it was juxtaposed next to rheumatic fever. Didn’t mean to get overly pedantic…
Interestingly, while beta lactams in general are commonly prescribed for non-specific pharyngitis, it’s not my experience than plain old penicillin is used very often, even though it’s still the drug of choice (in my opinion, at least) for presumptive GAS tonsillitis. ( My favorite if I really think it’s clinically acute GAS tonsillitis) is pcn by injection–usually BicillinCR as the formulation. I hope the OP really did get penicillin and not, for example, amoxicillin which is not only less effective, but much more likely to cause a rash if the causative organism happens to be EB virus.
Heh- here it’s Ben Pen IV or Pen V PO for tonsils, Amox for ears and chests, Clarith if there’s a Pen allergy. But, you know the NHS- we like cheap and generic!
I feel like I’m single handedly increasing resistance; I’ve seen so many chesty coughs with green spit and pleuritic chest pain and fevers over the last few days. Unfortunately most of them had creps and nearly all of them got Amox, mainly because it is coming up to a 4 day Holiday and the last thing my out-of-hours centre and A&E colleagues need is a buttload of pneumonias to cope with over xmas.
Thanks for the replies! It was Penicillin V I was initially prescribed, if that makes any difference.
I was curious about this, not a doctor myself of course but nonetheless I was a considering that it might be possible that the sore throat went away on its own, although that would entail it coincidentally diminishing over the course of two days right after I was prescribed antibiotics, three times in a row.
This is really interesting, I wasn’t sure if an infection like this was something that’s spread all throughout the body, or clustered around a single area. Do they typically hide out in a particular place, or are they all different?
I’ll be heading back into the clinic today to see what the doctor says. Now that I’ve finished the Erythromycin, I suspect I’ll just have to wait a few days and see if the symptoms return. It would be nice if I could get over this without a tonsillectomy, but even if I had one, wouldn’t that still leave the infection in place?
“Crypt” is the term when it comes to tonsils. When tonsils are inflamed for a long time they can develop nooks and crannies on the surface called crypts. They can trap food debris, saliva, mucus and bacteria within these crypts and the bacteria can then multiply happily.
Visually the tonsils look sort of like a very ripe passion fruit- dents and dimples and irregular areas.
There is an image here, but it is, like most medical websites, probably best viewed with an empty stomach. You have been warned.
If you do need to get your tonsils out, that will cure your infection for good, since all the bacteria that are living there will get removed along with the infected tissue. The infection is localized, not systemic. Strangely enough, I didn’t have any crypts on the surface of my tonsils–they were very smooth like the surface of a balloon. I think the word I was looking for earlier was “abscess.”
I’d always had large tonsils since a bad childhood infection when I was about 6 years old. My mother was afraid to actually give me the antibiotics I was prescribed, so I suffered with horrible, recurrent infections over the years. Strangely enough, a few months before my last flare-up at the age of 25, I had whitened my teeth with overnight trays, and I noticed that my tonsils shrunk down smaller than I’d ever seen them before, presumably from the carbamide peroxide in the bleach I’d swallowed. I never mentioned this to any of my doctors though, since I doubt it was related to the infection that occurred months after.
