Bacterial suppurative tonsillitis is among the most frequent paediatric infections. Group A beta-haemolytic streptococci are the most frequent cause. Other common isolates in bacterial tonsillitis are Hemophilus influenza, Streptococcus pyogenes, Streptococcus milleri and Staphylococcus aureus [97, 202, 205]. Children with acute strep-tococcal tonsillitis are significantly older than children with viral tonsillitis. The treatment of choice is penicillin administration for 10 days. Prevention of acute rheumatic fever is the principal goal of treatment. Surgical specimens of acute tonsillitis are rarely encountered. The surface epithelium may be ulcerated, and the surface and crypt epithelium is infiltrated by neutrophilic granulo-cytes producing a cryptitis with crypt abscesses. Acute bacterial infections may advance to intraparenchymal and peritonsillar abscesses (quinsy) with a lateral extension into the parapharyngeal space, base of skull and the sheath of the carotid artery [33, 64]. Rare other bacteria causing acute necrotising tonsillitis include Clostridium perfringens and Bartonella henselae with an unusual presentation of cat scratch disease [61, 121].
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