Staphylococcal infection

Disease Description (Causes and Pathophysiology, Main Symptoms)

• Causes: Viruses (including influenza, parainfluenza, coxsackievirus, adenovirus, respiratory syncytial virus, etc.) or bacteria (the most common cause: β-hemolytic group A Streptococcus; other causes include Staphylococcus, pneumococcus, anaerobic strains, etc.). By age group, viral causes account for a higher proportion in children, while the proportion of bacterial causes—particularly group A Streptococcus—increases among adolescents and young adults.
• Pathophysiology: Pathogens invade the tonsillar tissue, causing local inflammation (swelling, redness, and exudate formation), accompanied by localized lymph node enlargement and systemic symptoms (fever and general weakness). Recurrent infections or tonsillar enlargement may cause airway obstruction and affect occlusion and facial bone growth.
• Main symptoms: Sore throat, difficulty swallowing (odynophagia), high fever, chills, cervical lymph node enlargement, tonsillar enlargement and redness, purulent exudate on the tonsils (in bacterial cases), halitosis, and increased mucus on the tongue epithelium. A peritonsillar abscess can cause unilateral tonsillar bulging, uvular deviation, a muffled voice, and drooling.

Treatment Methods

• Conservative treatment (in most cases)
  • Adequate rest and fluid intake, temperature control (antipyretics such as acetaminophen), and analgesic·anti-inflammatory drugs (NSAIDs).
  • Warm gargling and eating soft foods.
• Antibiotic treatment (when bacterial infection is suspected or confirmed)
  • First-line choice: Penicillins (e.g., penicillin V or amoxicillin)—generally administered for 10 days (recommended for complete eradication of streptococcal infection).
  • Penicillin allergy: Macrolides (azithromycin, clarithromycin) or, in some cases, second- or third-generation cephalosporins (caution is required in non-severe allergies).
  • The choice and duration of antibiotics are adjusted according to age, history of allergies, local resistance rates, and clinical presentation.
• Treatment of complications
  • Peritonsillar abscess: Immediate drainage (needle aspiration or incision and drainage) and intravenous or oral antibiotics; inpatient treatment if necessary.
  • Severe infection (airway narrowing or severe systemic symptoms): Consider hospitalization, intravenous antibiotics, and surgical treatment.
• Surgical treatment
  • Tonsillectomy: Considered for recurrent tonsillitis (such as according to the Paradise criteria), reduced daily functioning due to repeated tonsillitis, or sleep-disordered breathing, dental problems, and facial growth problems caused by chronic tonsillar enlargement.
    • Examples of representative surgical indications: Severe tonsillitis 7 or more times in 1 year, or 5 or more times per year for 2 consecutive years, or 3 or more times per year for 3 consecutive years (however, this varies depending on the individual’s condition and severity).
• Prevention and lifestyle management
  • Wash hands, avoid contact with infected people, and do not share utensils or cups.
  • When taking antibiotics, complete the course as prescribed (do not stop them on your own after symptoms improve).

Checklist Before an Outpatient Visit (Items to Bring and Sample Questions)

• Items to bring
  • A list of medications currently being taken (prescription drugs, over-the-counter medications, and supplements) and information about medication allergies
  • Recent temperature records and the date symptoms began (when they started and how they have progressed)
  • Previous examination and test results (such as recent throat swab and culture results, blood tests, and imaging findings)
  • History of tonsillitis (number of recurrences and history of hospitalization or surgery)
  • Eating and fluid intake status due to breathing or swallowing difficulties (whether there is a risk of dehydration)
• Important information to tell the doctor first during the outpatient visit
  • Whether there is an allergy to penicillin or other medications
  • Whether antibiotics were taken recently and whether they were effective
  • Symptoms threatening the airway (difficulty breathing, voice changes, or excessive salivation)
• Sample questions for the outpatient visit (patient→healthcare provider)
  • "How can you confirm whether the symptoms are bacterial or viral?"
  • "Do I need antibiotics today, and should I start them right away?"

General Sample Questions to Ask the Doctor

• What are the expected side effects and precautions for this medication (the prescribed antibiotic or pain reliever)?
• By when should the symptoms normally improve (prognosis), and what signs mean that I should come to the hospital immediately if they worsen?
• What should I pay attention to in my daily life to reduce recurrences?
• Is this a situation in which tonsillectomy is recommended, and what are the benefits and risks of the surgery?

Disease-Specific Sample Questions

• What tests should I undergo to quickly determine whether my tonsillitis is caused by group A β-hemolytic Streptococcus (rapid antigen test versus culture)?
• When considering tonsillectomy for recurrent tonsillitis, could you explain whether my case (frequency of recurrence and symptom severity) meets the indications for surgery?

Additional Information

• When to visit the hospital as an emergency: Immediate emergency department evaluation is recommended in cases of severe difficulty breathing, inability to consume water or food due to difficulty swallowing, altered consciousness, persistent high fever (especially 39°C or higher), or suspected peritonsillar abscess (severe unilateral sore throat, uvular deviation, drooling, or voice changes).
• Prognosis: Most cases improve with conservative treatment or appropriate antibiotics, and the prognosis is generally good. Recurrent or severe infections increase the risk of complications (peritonsillar abscess, rheumatic fever, acute glomerulonephritis, etc.), so appropriate diagnosis and treatment are necessary.