Carl T. Hayden Veterans' Administration Medical Center
How To Tell The Difference Between Viral And Bacterial Tonsillitis
It can be hard to tell the difference between viral and bacterial tonsillitis from symptoms alone. However, tonsillitis caused by a viral infection may be milder than tonsillitis caused by a bacterial infection.
Tonsillitis is an inflammation of the tonsils — the two glands that sit in the back of your throat. It may be caused by viral or bacterial infections.
The most common symptom of tonsillitis is a sore throat, but it's difficult to tell whether the cause is a viral or bacterial infection by sight or symptoms alone. A doctor can order a throat swab culture to see if the infection is bacterial.
This article reviews the primary differences between viral and bacterial tonsillitis, including symptoms, treatment, causes, and risk factors.
The primary symptom of both bacterial and viral tonsillitis is a sore throat. Both types of tonsillitis can also cause your tonsils to become red, swollen, and painful, making it difficult for you to swallow.
If you have tonsillitis from a viral infection, such as the common cold or flu, your symptoms may be milder than if the cause is bacterial. You might also have a cough, congestion, and runny nose.
Bacterial tonsillitis tends to be more severe, and you may notice you have bad breath, according to the NHS. There are a number of bacteria that can cause tonsillitis, but most commonly, group A streptococcus bacteria is to blame.
Symptom-wise, it's hard to distinguish between bacterial and viral tonsillitis, which is why testing is so important.
How tonsillitis is treated will depend on the cause. In most cases, symptoms will go away between 3 and 7 days, whether it's a viral or bacterial infection.
There's no specific treatment if the infection is viral. But, if the infection is confirmed to be bacterial, your doctor will likely prescribe antibiotics.
Whether you have viral or bacterial tonsillitis, here are some things you can do to make yourself more comfortable:
For some people, bacterial infections become chronic. If you experience five or more bacterial infections in a year, you may need to have a tonsillectomy, which is surgery to have your tonsils removed.
Complications from tonsillitis are rare, and really only occur with bacterial infections. Sometimes secondary infections can occur, such as a middle ear infection or an abscess that develops between the tonsil and the throat.
Viral tonsillitis is more common than bacterial tonsillitis. It's caused by viruses such as the common cold, the flu, and COVID-19.
Bacterial infections are most often caused by the group A streptococcus bacteria. Bacterial tonsillitis affects between 5% and 15% of adults who see a doctor for a sore throat and between 15% and 30% of children between the ages of 5 and 15 who seek treatment.
The most common age range for developing viral or bacterial tonsillitis is 5–15. Tonsillitis is not as common in adults as it is in children.
The most common symptom shared by all types of tonsillitis is sore throat. But it's hard to tell the difference between viral and bacterial tonsillitis just from the symptoms.
A throat swab culture needs to be done to determine if the infection is bacterial and requires antibiotics for treatment.
Complications are rare, but some people have recurring bacterial infections that may require a tonsillectomy.
What Is A Bacterial Infection?
Medically reviewed by Kashif J. Piracha, MD
A bacterial infection is a common type of illness that occurs when harmful bacteria invade your body and start to multiply. There are several types of bacterial infections, all of which cause their own set of symptoms. While some bacterial infections are mild and can be treated with antibiotics, other infections can be more serious and cause life-threatening complications.
Though anyone can develop a bacterial infection, factors such as compromised immune systems, environmental exposures to bacteria, and improper personal hygiene can increase your risk of developing a bacterial infection. If you develop an infection, getting a diagnosis is crucial to keep symptoms at bay and reduce your risk of complications.
Related: What Is a Viral Infection?
Types of Bacterial InfectionsThere are several types of bacterial infections, and each of them can affect different parts of your body. The most common types include:
Respiratory infections: Affect the lungs, which may include infections such as pneumonia, bronchitis, and sinusitis
Urinary tract infections (UTIs): Affect your urinary system (e.G., kidneys, bladder, or urethra)
Skin infections: Affect the skin, and may include infections like impetigo and folliculitis
Sexually transmitted infections (STIs): Affect your genitals, rectum (butt), and sometimes your mouth, which may occur due to infections such as gonorrhea and chlamydia that you can develop after sexual contact
Ear infections: Affect the middle ear, but may cause symptoms like headaches and dizziness in addition to ear pain
Gastrointestinal infections: Affect the digestive system, which may caused by infections like H. Pylori
Meningitis: Affects the membranes surrounding your brain and spinal cord, and can be life-threatening without prompt treatment
Bloodstream infections: Affect the bloodstream and can enter various organs, which may be caused by serious infections like sepsis
The symptoms of a bacterial infection will usually depend on the type of bacterial infection you have and which body parts are most affected by a specific bacteria. However, most bacterial infections do share some common symptoms, including:
Fever
Chills
Pain or discomfort in the affected body part (e.G., throat, joints, chest, ears, urethra, etc.)
Skin swelling or redness at the site of infection
Persistent cough
Shortness of breath
Fatigue
Headache
Depending on the type of bacterial infection you have, you may also experience additional symptoms. UTIs can often cause pain while urinating or needing to use the bathroom often. Gastrointestinal infections can cause diarrhea, nausea, vomiting, or abdominal pain. Skin infections may lead to boils, rashes, or pus-filled bumps.
CausesSeveral types of bacteria can cause infections. These bacteria often enter the body through avenues such as the mouth, nose, eyes, or openings in the skin. The bacteria may target specific organs, tissues, or systems, causing disruptions in your normal bodily functions.
Some common bacteria that are known to cause infections include:
Streptococcus (strep): Usually causes infections such as strep throat, pneumonia, and skin infections like cellulitis
Staphylococcus (staph): Responsible for staph infections, abscesses, bone infections, food poisoning, and endocarditis
Escherichia coli (E. Coli): Commonly associated with gastrointestinal infections
Salmonella: Often leads to food poisoning and bacterial gastroenteritis (stomach flu)
Neisseria gonorrhoeae: Causes gonorrhea, a common STI
Haemophilus influenzae: Can lead to respiratory tract infections, meningitis, bloodstream infections, and pneumonia
The above list compiles only a few examples. In fact, there are many other bacterial species that can cause infections in different parts of your body. Identifying the specific bacteria that is affecting your body is an important part of the diagnostic process.
Risk FactorsAnyone can get a bacterial infection. However, certain factors can increase your risk, including:
Being immunocompromised
Living with a chronic health condition
Spending time with people who are sick
Not washing hands regularly
Not getting vaccinated
Not practicing safe sex
If you're experiencing symptoms of a bacterial infection or are feeling sick, it's important to reach out to your healthcare provider and make an appointment under their guidance. Diagnosing bacterial infections often involves a combination of clinical assessments, laboratory tests, and imaging studies. Some common diagnostic measures that your provider may use to test for bacterial infections include:
Blood test to identify the presence of bacteria in the bloodstream
Urine test to check for bacteria, white blood cells, or other signs of infection in your pee
Culture tests (such as skin samples or throat swabs) to learn which bacteria are causing your symptoms
Imaging tests like X-rays, CT scans, or MRIs to visualize signs of infection in your internal organs
Stool tests to analyze samples of your poop for potential signs of bacteria
Lumbar puncture, which takes a sample of cerebrospinal fluid (the fluid surrounding the brain and spine) to diagnose meningitis
Rapid antigen tests to quickly detect specific bacteria for common infections like strep throat
The exact tests your healthcare provider will choose will depend on your symptoms and where in the body you're experiencing them.
TreatmentNot every bacterial infection requires antibiotics. But, antibiotic medications are the most common treatment for people with bacterial infections. If your specific infection requires antibiotics, your provider may prescribe a medication that you can take orally (by mouth), apply topically (directly onto your skin), or use intravenously (through an IV injection).
It's essential to take antibiotics only when needed and prescribed. Mishandling antibiotics or using them when they're not necessary can lead to antibiotic resistance—which occurs when bacteria in your body start to evolve and resist the healing effects of antibiotic medication, making them no longer effective for your infection.
How to Prevent Bacterial InfectionsWhile bacterial infections are common, there are ways to reduce your risk of developing one. Follow these seven prevention strategies to keep yourself safe from an infection:
Washing your hands regularly to prevent the spread of bacteria
Getting vaccinated against bacterial infections, such as bacteria that can cause pneumonia or meningitis
Using proper food handling practices, such as washing vegetables, cooking food thoroughly, and avoiding eating raw or uncooked meat
Drinking clean water
Practicing safe sex to prevent STIs
Limiting contact with people who have a bacterial infection or are sick
Cleaning wounds and applying bandages on the skin to prevent bacteria from spreading
If you suspect that you have a bacterial infection, it is essential to see your healthcare provider for treatment. Untreated bacterial infections can lead to serious and even life-threatening health conditions. These complications may include:
Cellulitis: A serious skin infection that can occur if you do not treat an infected wound or cut on the skin. Cellulitis can develop when bacteria enter the skin through a cut or wound, which may cause symptoms like redness, swelling, and tenderness. Antibiotic treatment is necessary to treat symptoms.
Sepsis: A life-threatening illness that occurs when your whole body responds to an infection. Sepsis can cause widespread inflammation in your body and affect the functioning of your organs. Without prompt treatment, your organs can start to fail and increase your risk of death. If you or a loved one is experiencing sepsis, it's essential to call 911 or go to the emergency room as soon as possible.
Bacterial infections can develop due to a variety of bacteria. Each bacterial infection can affect your body a little differently. But, common symptoms include fever, chills, headaches, fatigue, and coughing. Most bacterial infections use antibiotics for treatment, which are effective in reducing symptoms. But don't wait to get tested. If you have symptoms, early treatment is crucial to limit your risk of complications.
Frequently Asked QuestionsDo bacterial infections go away on their own?
Some bacterial infections, such as ear infections, may resolve on their own. However, many require prompt and appropriate antibiotic treatment to prevent complications and ensure a complete recovery.
How long do bacterial infections usually last?
The length of a bacterial infection will depend on the type of infection you have and your overall health status. Some infections resolve in a week while others may last for weeks or longer, especially if you don't receive proper treatment.
How do you tell if an infection is viral or bacterial?
You will need to see your healthcare provider to learn whether your symptoms are caused by a viral or bacterial infection. They may perform diagnostic tests, such as a blood test, nose or throat swab, stool sample, or urinalysis to detect what type of pathogen (harmful cell) is causing your infection.
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New Approach To Tackling Bacterial Infections Identified
Researchers at the Icahn School of Medicine at Mount Sinai have identified a new approach to controlling bacterial infections.The findings were described in the February 6 online issue of Nature Structural & Molecular Biology.
The team found a way to turn on a vital bacterial defense mechanism to fight and manage bacterial infections. The defense system, called cyclic oligonucleotide-based antiphage signaling system (CBASS), is a natural mechanism used by certain bacteria to protect themselves from viral attacks. Bacteria self-destruct as a means to prevent the spread of virus to other bacterial cells in the population.
"We wanted to see how the bacterial self-killing CBASS system is activated and whether it can be leveraged to limit bacterial infections," says co-senior author Aneel Aggarwal, PhD, Professor of Pharmacological Sciences at Icahn Mount Sinai. "This is a fresh approach to tackling bacterial infections, a significant concern in hospitals and other settings. It's essential to find new tools for fighting antibiotic resistance. In the war against superbugs, we need to constantly innovate and expand our toolkit to stay ahead of evolving drug resistance."
According to a 2019 report by the Centers for Disease Control and Prevention, more than 2.8 million antimicrobial-resistant infections occur in the United States each year, with over 35,000 people dying as a result.
As part of the experiments, the researchers studied how "Cap5," or CBASS-associated protein 5, is activated for DNA degradation and how it could be used to control bacterial infections through a combination of structural analysis and various biophysical, biochemical, and cellular assays. Cap5 is a key protein that becomes activated by cyclic nucleotides (small signaling molecules) to destroy the bacterial cell's own DNA.
"In our study, we started by identifying which of the many cyclic nucleotides could activate the effector Cap5 of the CBASS system," says co-senior author Olga Rechkoblit, PhD, Assistant Professor of Pharmacological Sciences at Icahn Mount Sinai. "Once we figured that out, we looked closely at the structure of Cap5 when it's bound to these small signaling molecules. Then, with expert help from Daniela Sciaky, PhD, a researcher at Icahn Mount Sinai, we showed that by adding these special molecules to the bacteria's environment, these molecules could potentially be used to eliminate the bacteria."
The researchers found that determining the structure of Cap5 with cyclic nucleotides posed a technical challenge, requiring expert help from Dale F. Kreitler, PhD, AMX Beamline Scientist at Brookhaven National Laboratory. It was achieved by using micro-focused synchrotron X-ray radiation at the same facility. Micro-focused synchrotron X-ray radiation is a type of X-ray radiation that is not only produced using a specific type of particle accelerator (synchrotron) but is also carefully concentrated or focused on a tiny area for more detailed imaging or analysis.
Next, the researchers will explore how their discoveries apply to other types of bacteria and assess whether their method can be used to manage infections caused by various harmful bacteria.
The paper is titled "Activation of CBASS-Cap5 endonuclease immune effector by cyclic nucleotides."
Other authors who contributed to this work are Angeliki Buku, PhD, and Jithesh Kottur, PhD, both with Icahn Mount Sinai.
The work was funded by National Institutes of Health grants R35-GM131780, P41GM111244, KP1605010, P30 GM124165, S10OD021527, GM103310, and by the Simons Foundation grant SF349247.
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