Overview

Tonsillitis is an infection of the tonsils found on either side of the throat, it is mostly classified as a childhood illness, but people of any age can develop it. A viral infection typically causes tonsillitis, but it can be caused by bacteria too, meaning its infection-causing pathogens are contagious.¹ This is especially risky for those with weaker or compromised immune systems, for example, people living with chronic illnesses, such as Cystic Fibrosis (CF), as they can lead to a faster decline in lung function.² 

Children with chronic conditions like CF are more vulnerable to infections, meaning some illnesses can prove to be very dangerous. Hence, they need to be especially cautious when dealing with conditions such as tonsillitis. 

Tonsillitis and its impact 

Tonsillitis is one of the most common illnesses, especially in children and is caused predominantly by viral or bacterial infections. Tonsils act as the body's first line of defence against pathogens which could enter through the mouth, making them vulnerable to infection themselves. Their immune function is known to decline as the child passes through puberty, making it more uncommon in adults and older people.²

Common signs and symptoms of tonsillitis include:

• Red, swollen tonsils
• Sore throat
• Difficulty in swallowing fluids and solids
• Headaches
• Fever
• Stomach ache and abdominal pain
• Pain around the neck area
• White or yellow patches on the tonsils
• Muffled or hoarse voice and pain when speaking
• Enlarged and tender glands in the neck

Typical treatment

The treatment given following a tonsillitis diagnosis depends entirely on whether it was caused by a bacterial or viral infection. There is, however, general advice given in both causes to ease symptoms and to promote a better recovery time. 

Some at-home advice includes:

• Encouraging plenty of fluids - Give the child lots of fluids to keep the throat hydrated, this keeps the area moist making it slightly more comfortable
• Plenty of rest - Sleep gives the body time to fight the infection whilst conserving energy making it easier to recover in a shorter period of time
• A saltwater gargle - A saltwater gargle of ½ a teaspoon of salt in warm water can help soothe the sore throat. This is only helpful if the child is able to gargle, this may not be possible in very young children
• An air humidifier - Keeping a humidifier in the room with the child helps them avoid breathing dry air which can sometimes irritate the symptoms more. Allowing the child to remain in a steamy bathroom provides the same effects
• Lozenges - Over-the-counter throat lozenges offer a great soothing relief on sore throats. Children should only consume 4 a day
• Fever treatment - Painkillers, both prescribed and shop-bought, can help reduce fevers and their associated aches and pains. Avoid unnecessary medication if the fever is mild and with no pain

It is recommended that if you are unsure about what medication to give to a child, contact a healthcare professional first for advice. 

If the tonsillitis is viral, the above advice is all that the doctor will suggest, no further medication will be given. However, in bacterial instances, antibiotics may be prescribed to help treat it. A 10-day oral course of Penicillin is the typical treatment option unless the child is allergic, in which case an alternative will be suggested. The full course of antibiotics must be completed by the child even if their symptoms disappear, this is to ensure all the bacteria is destroyed so the symptoms do not reappear in the future. 

In serious cases where the child frequently gets tonsillitis, more than 6 times in one year or 5 times in 2 years, surgery to remove the tonsils may be suggested.

Cystic Fibrosis in Children 

Cystic fibrosis is a predisposed genetic condition which impacts the respiratory and digestive systems by disrupting the normal flow of salt and water in and out of the lungs. This causes lung infections and issues with digesting food. Symptoms typically start in early childhood and vary from child to child, damage to the lungs and digestive system does progressively get worse and worse. 

Main symptoms

The accumulation of sticky mucus in the lungs causes difficulty breathing over time and increases the risk of lung infection. The sticky mucus also clogs the pancreas preventing vital digestive enzymes from reaching food, meaning those with CF do not absorb nutrients very well and need to eat more food to accommodate for this.³ 

The main symptoms of CF include:

• Recurring chest infections
• Difficulty putting on weight/growing
• Wheezing, coughing, shortness of breath, and damage to the airways
• Yellowing of the skin and eyes

Treatment and management

There is no cure for CF meaning, unfortunately, it does shorten the lifetime expectancy, but there are treatment options to make the condition easier to live with. People with CF are at a higher risk of developing other conditions so it is suggested that people with CF should not meet face to face as they are more likely to spread infections making them more likely to develop complications if they are infected. 

Tonsillitis in CF children

Children with CF are much more likely to develop complications if exposed to bacteria and viruses. When the body is exposed to an infection, the immune system responds by attacking the germs. This causes the lungs to become further inflamed and produce more mucus. This can further block airways, preventing the efficient removal of the pathogens, allowing them to settle and grow inside the lungs. 

This is a serious problem and can cause worsened lung health and permanent damage to the CF child's already weaker lungs. Research has shown that people with CF can develop serious lung infections if infected with common illnesses, such as the flu. This means more intense illnesses such as tonsillitis can prove especially harmful. 

The pathogens can quickly exacerbate symptoms and conditions in CF patients and because CF patients are more likely to have to battle these infections regularly, they are also at a higher risk of antibiotic resistance. This could mean that if they develop bacterial tonsillitis, the typically prescribed antibiotics will not work for them. 

Infection weakens the immune system, leading to more frequent lung infections over time, this throughout a CF patient's lifetime can lead to serious complications, such as sepsis in immuno-compromised children.⁴

Prevention and management 

Respiratory illnesses are generally treated with a variety of treatments depending on the type of condition and the person being treated. This can include:

• Antibiotics such as Penicillin
• Mucus thinners
• Oral anti-inflammatory mediation
• Airway clearance medications
• Inhaled steroids
• Bronchodilators

Managing the symptoms of CF and tonsillitis simultaneously can prove difficult due to the overlapping symptoms, but healthcare providers can help most of the time. The most efficient method is prevention and early detection. 

Prevention methods

Regular healthcare appointments to monitor the health of CF patients, especially children are vital to help notice any early signs of infection. This is especially important in children as they sometimes struggle to accurately communicate all their symptoms to caregivers meaning things can be accidentally missed or overlooked. 

Strengthening the immune system through nutritional support, vaccinations, and regular physical therapy can significantly reduce the risk of infections. This can be done by ensuring a good balanced amount of vitamins and minerals through diet and supplements. 

Overall, the best way is to promote and encourage good hygiene practices around patients with CF, as avoiding exposure to common external bacteria and viruses is the best way to avoid frequent infection. This includes regular thorough hand washing of the CF child and everyone in their household, especially after being outside. It is recommended that CF patients should not come within six feet of each other at the risk of passing on infections, so it is a good idea to keep CF children physically separate. 

Summary

Chronic conditions such as cystic fibrosis in children mean that they are at an elevated risk of developing complications following infection of common bacteria and viruses. Tonsillitis can cause sore throats and fevers in most infected children so those with a predisposed weakened immune system can develop more serious complications and a longer recovery time, as well as permanent damage to their lungs and airways. 

Maintaining good hygiene practices around children with chronic conditions, such as cystic fibrosis, helps to prevent these risky infections.