Chronic Tonsillitis in Suspected or Confirmed Infectious Mononucleosis (EBV)

When chronic tonsillitis presents alongside suspected or confirmed Epstein-Barr virus (EBV) infection — infectious mononucleosis — the clinical picture and the management priorities change. Recognising this scenario early shapes both what is indicated and, critically, what must be avoided.

Clinical Scenario

This protocol applies to patients with chronic tonsillitis in whom Epstein-Barr virus infection (infectious mononucleosis) is suspected or confirmed. EBV-driven tonsillar enlargement can create significant upper airway compromise, and the viral aetiology introduces important management considerations that do not apply to routine tonsillitis.

Treatment Approach — Partial Overview

Management is centred on supportive measures, with close monitoring of upper airway status. There is a specific antibiotic class contraindicated in this setting that does not carry the same restriction in other tonsillitis presentations. Additional interventions may be warranted depending on the degree of tonsillar obstruction. The full stepwise regimen and decision criteria are available in the complete protocol.

Treatment Goal

The primary objective is downsizing of the tonsils with relief of upper airway obstruction.

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References

DOI: 10.1007/s00405-015-3872-6

If EBV infection is suspected or confirmed, physical rest, sufficient iv-hydration, analgesia, and antipyretic medication should be in the focus of treatment.

Because of the high risk of cross-reaction rash (about 90 %), treatment with ampicillin is contraindicated.

The large size of the infected tonsils may result in significant upper airway obstruction, and patients may benefit from administration of anti-inflammatory steroids to downsize the tonsils.

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