my 5 year old son has a swollen tonsil since August 22nd/23rd 2011. Swabs @ emerge did not show strep throat or anything, went to family doctor, can not do anything unless they are oozing or bleeding. He has had tubes in ears & is forever blowing nose & coughing. Just getting very frustrated with his fevers & inability to clear his throat. Freezie pos are what we were told to give him for the swelling, its not working. Is there anything else I could try?, thanks for your time.
The most important agents causing pharyngitis are viruses and group A β-hemolytic streptococcus. Other organisms sometimes associated with pharyngitis include group C streptococcus (especially Streptococcus equisimilis), Arcanobacterium haemolyticum, Francisella tularensis, Mycoplasma pneumoniae, Neisseria gonorrhoeae, Fusobacterium necrophorum, and Corynebacterium diphtheriae.
The clinical presentations of streptococcal and viral pharyngitis show considerable overlap. False negative cultures can result from inadequate throat swab specimens. The specificity of rapid tests to detect group A streptococcal infection (the most common type of bacterial tonsillitis) is high. Confirmation of a negative rapid test with a throat culture is recommended, especially if the clinical suspicion of strep throat is high.
It is appropriate to be concerned about a swollen tonsil that has persisted for over a month, especially when associated with fevers. This would be most unusual with viral infection and suggests that either your son has a Strep Throat with a false-negative culture, infection with a bacterium other than Strep, or another non-infectious cause of enlargement of his tonsil. Suspicion of the latter, a non-infectious cause should be high if only one tonsil is involved.
I recommend the following: That a Strep culture (not a rapid test culture) be repeated or, if a rapid test was done initially, performed for the first time. If the repeat culture(s) are negative but his tonsil remains swollen and he continues to have fevers, you and his family doctor should request consultation with a Pediatrician, preferably one with an interest in Infectious Disease, without further delay. The risk in allowing more time for his disease to spontaneously resolve is that this might be an infectious tonsillitis and, with the passage of time, infection could spread to his neck or other parts of his body.
Do not hesitate to request consultation, as recommended above.
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