Issue 2/2026
Trifonov, Y., Gabrovska, N., Spasova, A., Khan, N., Ivanova, I., Velizarova, S.
SBALDB “Prof. I. Mitev” – Pneumology Clinic – Sofia
Acute tonsillitis is a common childhood infection, dominated by viruses in young children and by Streptococcus pyogenes (GAS) in school-aged children. The diagnosis is complex and aims for precise differentiation (by clinical assessment, scoring systems, RADT and microbiological culture) to minimize unjustified antibiotic therapy.
Differential diagnosis is critical, with particular attention paid to PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis). PFAPA is an autoinflammatory disease with cyclic periodicity and a dramatic response to corticosteroids, in which antibiotics are ineffective.
Complications of streptococcal tonsillitis are serious and require early diagnosis and adequate therapy: non-suppurative (e.g. acute rheumatic fever – ORT) and suppurative (e.g. peritonsillar abscess). ORT is the main reason for mandatory antibiotic treatment.
Recurrent tonsillitis is defined by the Paradise Criteria (7/5/3 episodes), which also serve as an indication for tonsillectomy. However, a large-scale study in the UK found that 88.3% of operated children did not meet these criteria, indicating an unfoundedness in clinical practice.
Address for correspondence:
Dr. Y. Trifonov
SBALDB „Prof. I. Mitev“ – Clinic of Pneumology,
11 Acad. I.E. Geshov Blvd.
1606, Sofia