Who gets Quinsy?

• Quinsy starts during tonsillitis
• It’s commoner in people who get tonsillitis recurrently
• It happens to between 1 and 4 in 10,000 people per year
• Tonsillitis is when your tonsils become swollen, inflamed and painful
  • This is usually caused by bacteria or viruses
• People with tonsillitis can therefore progress to developing quinsy
• Anybody can develop quinsy. Certain people are more likely to get it:
  • People on immune-suppressing medications
  • People with illnesses affecting the  immune system (eg. HIV)
  • People with diabetes
  • Smokers
  • People with poor dental health (bad teeth/gums) – (1, 2)

What causes Quinsy?

• Bacteria responsible for tonsillitis (usually Streptococcus or Haemophilus species) form an abscess on a tonsil
• It’s not known why this happens

What is the treatment for Quinsy?

• You need to go to hospital urgently, as it’s important that quinsy is treated before it affects your breathing
• Antibiotics given intravenously (in a drip, usually into your arm)
• You’ll usually be given intravenous fluids as well (for dehydration)
• Sometimes steroids are given – these have been shown to help
• The abscess will usually be drained by a doctor, using a scalpel (sharp surgical knife) or a needle
  • Usually the area is numbed first using a spray
  • Some people have a general anaesthetic for this (surgery after being put to sleep)

Can I die of Quinsy?

• Yes, though this extremely rare if you are treated in hospital
• Outcomes are usually excellent if the right treatments are given

What’s the prognosis for Quinsy?

• Outcomes are generally very good
• You usually need to have your tonsils surgically removed (tonsillectomy) a few weeks after you’ve recovered to prevent it from happening again

Article Resources

1 Geißler K et al Functional characterization of T-cells from palatine tonsils in patients with chronic tonsillitis

2 Wikstén J at al Renewal of peritonsillar abscess: Impact of the bacterial species of the infection and clinical features of the patient-A prospective comparative aetiological study

• A widespread raised itchy rash can occur if a person with Glandular Fever is mistakenly given an antibiotic called Amoxicillin for their symptoms- that’s why Amoxicillin should not be prescribed as treatment for a sore throat. The same problem can occur with the antibiotics Co-amoxiclav and Ampicillin.
• Neurological complications are rare but include viral meningitis and encephalitis.
• Jaundice- this is when there is yellow discolouration of the whites of the eyes and the skin. It affects about 4% of people who get Glandular Fever.
• Hepatitis (inflammation of the liver) is rare
• In the longer term, the Epstein Barr Virus can trigger certain forms of lymphoma

How do you get Glandular Fever?

• It is usually spread through saliva, or droplets that are coughed or sneezed into the air.

How long does it take symptoms of Glandular Fever to develop?

It can take from 30 to 50 days for symptoms of Glandular Fever to show, following exposure to the virus. However, around 50% of the time, it is a “silent infection”, and the person is unaware they have it.

If you have symptoms of Glandular Fever, you should see your doctor for assessment and advice.

Further Patient Resources

Mononucleosis mayoclinic.org

Glandular Fever betterhealth.vic.gov.au

Article Resources

Lennon P, Crotty M, Fenton JE. (2015) Infectious Mononucleosis

Tonsillar abscess (Quinsy)

• Tonsillar abscess (also known as “Quinsy” ) is a possible complication of tonsillitis.
• An abscess containing pus forms near the infected tonsil, often leading to severe pain and swelling, as well as fevers and chills.
• The pain will usually be worse on one side of the throat. Quinsy can be so painful that a person cannot swallow their own saliva, which can lead to drooling.
• It may be hard to open the mouth and quite difficult to speak.
• It’s a serious condition and usually requires treatment in hospital, which may involve intravenous antibiotics and surgical drainage of the abscess.

Tonsil stones  (Tonsilloliths)

• Also known as tonsilloliths, these are small hard white or yellow deposits that occur on the tonsils.
• They can be formed from a build up of food particles, mucus, calcium and dead cells- and tend to build up in the natural hollow on the surface of the tonsil.
• Quite often they cause no problems and may just be noticed when looking into the mouth.
• Sometimes they lead to bad breath (halitosis) or discomfort.
• They may be prevented by good oral and dental hygiene, not smoking, and staying well hydrated.
• It’s not recommended to remove stones yourself- if you’re having a lot of trouble with them, it may be worth speaking to your doctor.

Tonsillar Hypertrophy (enlarged tonsils)

• Tonsillar Hypertrophy means persistently enlarged tonsils.
• Some people have naturally large tonsils, and it causes no symptoms or complications. For others, large tonsils can be a sign of infection, irritation or allergy.
• Tonsillar Hypertrophy is very common in children, but most of the time there is no need to do anything about it as the problem often goes away over time.
• However, if there is recurrent tonsillitis, mouth breathing, bad snoring, sleep apnoea or glue ear, sometimes a tonsillectomy may be considered.
• Obviously if there are any underlying triggers such allergies, these should be addressed first.

Is Glandular Fever dangerous?

No, it is usually not serious. As mentioned above, many people who catch the Epstein Barr Virus get no symptoms at all.

Less common complications include:

• Jaundice (yellow discolouration of the skin and eyes)
• Rupture of the spleen
• Hepatitis (inflammation of the liver)
• Viral meningitis (inflammation of the lining of the brain) or encephalitis (inflammation of the brain itself)
• Neurological conditions
• Inflammation of the heart (myocarditis and pericarditis)
• In the longer term, certain cancers can be triggered, such as lymphoma

For how long is Glandular fever contagious?

• Glandular fever can be contagious for several months after the symptoms have settled. That is why there is no specific recommendation regarding school exclusion.
• It is also very common for people to pick it up from “silent carriers”, therefore isolation of symptomatic cases is not very helpful.
• Once you’ve caught the Epstein Barr Virus (EBV) it never leaves your body- as with many viruses (e.g cold sores, chicken pox etc) it lies dormant in your system . A small number of people may continue to excrete or shed the virus for life, and can pass it on to others.

How is Glandular Fever diagnosed?

It is usually diagnosed on the basis of symptoms, and confirmed by a blood test. Sometimes it does not show up on the first blood test, but a follow-up blood test a few weeks later may be positive for the virus.