Case Studies

 Case 2.4 Acute bacterial tonsillitis

A 5-year-old boy presented to his general practitioner with a 36-h history of acute malaise, shivering and vague pains in his legs. For 12h he had complained of a dry, sore throat and had vomited twice. He was febrile (temperature 40.2°C) with a tachycardia of 140/min and tender, bilateral, cervical lymphadenopathy. His pharynx, tonsils and buccal mucosa were red and inflamed and his tonsils were studded with white areas of exudate. He was diagnosed as having acute bacterial tonsillitis and treated with phenoxymethyl penicillin for 5 days. A throat swab taken before starting antibiotics grew beta-haemolytic streptococci (Group A). After 3 days of treatment, his temperature had returned to normal and he made an uneventful recovery. Haemolytic streptococcal infections illustrate an important point about bacterial infection - namely, that immune defences plus antibiotics cope satisfactorily with most bacterial infections in most people.