Tonsillar Exudate

What Is It, Causes, Important Facts, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Abbey Richard


What is 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. 

What causes tonsillar exudate?

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. 

The most common cause of tonsillar exudates are viral infections including those caused by the adenovirus, Epstein–Barr virus, herpes simplex virus, cytomegalovirus, and measles virus. Bacterial infections, such as those caused by streptococcal bacteria, can also cause tonsillar exudates and are most common in children over the age of 5. 

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Can tonsillar exudates happen in viral pharyngitis?

Viral pharyngitis refers to the inflammation and irritation of the throat (also known as the pharynx) due to a viral invasion. Commonly, this is referred to as a sore throat caused by a viral infection. When the pharynx becomes inflamed, it can cause the tonsils to become inflamed and, in response, they can produce tonsillar exudate. The resulting exudate is usually clear in color. Viral pharyngitis may be caused by several different viruses, including rhinovirus, influenza, adenovirus, and coronavirus. In addition to tonsillar exudates, someone with viral pharyngitis can often also have a fever, sore throat, ear pain, and redness of the throat.

Can tonsillar exudates happen with mononucleosis?

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. 

Mononucleosis is diagnosed through a blood test that tests for the presence of Epstein–Barr virus antibodies. Blood tests can reveal if the individual has a previous, or current, Epstein–Barr virus infection. A Monospot test can also be performed, although there is a risk that it will produce false positive or false negative results.

Does strep throat have tonsillar exudates?

Strep throat, or streptococcal pharyngitis, is a bacterial throat infection that can cause inflammation of the tonsils and the production of tonsillar exudates. The exudates are typically white or yellow in color and may have a very foul odor. Strep throat is caused by a bacteria known as group A Streptococcus, or group A strep. Additional symptoms and signs of strep throat can include a fever, sore throat, and reddened and swollen tonsils. Individuals may also have petechiae, or tiny red spots on the top of the mouth.

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. 

If a streptococcal infection is not treated promptly, several complications may develop. In some cases, rheumatic fever (a disease affecting the heart, joints, brain, and skin) can develop. In other cases, a peritonsillar abscess—which is an infected pocket of pus near one of the tonsils—can form. A peritonsillar abscess can lead to the spread of infection throughout the body; prompt treatment with antibiotics is often required to fight the infection. For some large abscesses, manual drainage with a needle may also be required. 

How long does tonsillar exudate last?

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. 

In some cases, individuals may see recurrent or persistent tonsillar exudates resulting from recurrent strep throat or chronic tonsillitis (tonsillitis lasting longer than 3 months). In order to resolve these conditions, a tonsillectomy, or the removal of the tonsils, may be required. A tonsillectomy is also often performed if the tonsils show signs of blocking the airways due to severe swelling and inflammation.

What are the most important facts to know about tonsillar exudate?

Tonsillar exudate is a fluid secreted by the tonsils in response to infection or inflammation. Various types of bacterial infections and viral infections cause tonsillitis, or the inflammation of the tonsils, which then results in secretion of tonsillar exudate. Some of the most common causes of tonsillar exudate include viral pharyngitis, infectious mononucleosis, and strep throat. Viral pharyngitis, otherwise known as a sore throat, is a common cause of tonsillar exudates. Infectious mononucleosis, caused by the Epstein–Barr virus, can lead to the secretion of white or gray-green tonsillar exudate. Strep throat is the most common bacterial cause of tonsillar exudates and can result in white or yellow exudate that often has a foul smell. Depending on the cause, tonsillar exudate can last anywhere from a few days to 4 weeks. To resolve the presence of tonsillar exudates, it is important to treat the underlying infection. If the tonsillar exudates are caused by viral pharyngitis or infectious mononucleosis, treatment focuses on fluid intake, rest, and medications for pain relief and fever reduction. With strep throat, a 10-day oral course of an antibiotic, such as penicillin, may be recommended. In cases of chronic tonsillitis, recurrent strep throat, or tonsillar enlargement blocking the throat, a tonsillectomy may be required. 

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Clinical Reasoning: Pediatric ear, nose, and throat conditions
Clinical Reasoning: Pediatric infectious rashes
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