Tonsillar Exudate

Tonsillar exudate refers to a fluid that is secreted by the tonsils in response to tonsillitis, also known as inflammation of the tonsils. The exudate fluid is usually made up of cells and proteins, as well as leukocytes and neutrophils (infection-fighting white blood cells), involved in eradicating the infectious virus or bacteria causing the tonsillitis. 

The tonsils are a pair of oval-shaped tissues located at the back of the throat, one on each side. They are part of the lymphatic system, which works to protect the body against microbes, maintain adequate fluid levels, absorb nutrients, and remove certain waste products. The positioning of the tonsils allows them to act as a barrier to help prevent germs from entering the body through the mouth or nose. 

In most cases, tonsillar exudates are produced in response to an infection of the tonsils or throat, causing the tonsils to become inflamed. A bacteria or virus that invades the mucosa, or membrane of the throat, can cause inflammation, irritation and redness to the area and can result in the subsequent secretion of tonsillar exudates. 

Mononucleosis, or infectious mononucleosis, is a viral infection that is transmitted through saliva. Mononucleosis is caused by the Epstein–Barr virus and usually produces white or gray-green exudates on the tonsils, often appearing as a film on the back of the throat. Other symptoms of mononucleosis include fatigue, fever, swollen lymph nodes, and an enlarged liver and spleen. 

In order to diagnose strep throat, a rapid antigen detection test (RADT) is performed by taking a sample of the exudate. Within a few minutes, the test will indicate whether or not the group A strep bacteria is present. If, however, the rapid test results are negative but strep throat is still suspected, a throat culture may be performed. A throat culture is more accurate, though takes around 24 to 48 hours to produce results. 

Tonsillar exudates from viral pharyngitis and most other forms of viral and bacterial tonsillitis usually last for around 3 to 5 days. Treatment for these infections is typically focused on symptom control and usually consists of an increase in fluid intake, rest, and the use of medications, such as nonsteroidal anti-inflammatory medications or acetaminophen, for pain relief and fever reduction. Salt water gargling may also be recommended to help relieve throat discomfort.

Tonsillar exudates from mononucleosis can last for up to 2 to 4 weeks. In some cases, individuals may continue to feel fatigue and have liver and spleen enlargement for up to 6 months. Recommended treatment for mononucleosis typically involves increased fluid intake, rest, and the use of medications, such as nonsteroidal anti-inflammatory medications or acetaminophen, for pain relief and fever reduction. 

With strep throat, the tonsillar exudates usually resolve within 5 days of antibiotic treatment. Per the guidelines of the Infectious Disease Society of America, the treatment for a streptococcal infection consists of oral penicillin or amoxicillin over a 10-day course.