Complications of peritonsillar abscess

Abstract

Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum , the current findings suggest that viridans group streptococci, S. aureus , Prevotella , and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.

Methanobrevibacter smithii tonsillar phlegmon: a case report

“…Although previously unreported, here, detection of M. smithii in tonsillar pus was not surprising as M. smithii is known to colonize the oral fluid microbiota [ 22 ], being further implicated in oral cavity dysbiosis such as periodontitis and peri implantitis [ 23 , 24 ]. The presence of methanogens in saliva reinforces the hypothesis of a possible inflammation of the salivary glands that would cause tonsillar phlegmon [ 2 , 25 ].…”

“…Tonsillar phlegmon, a retropharyngeal abscess resulting from the infection of the peritonsillar space and the pharyngeal constrictor muscle through the connective tissue of the amygdala [ 1 ], is a life-threatening situation in the case of cellulitis, with extension to the mediastinum and potential extensive venous thrombosis up to the cavernous sinus [ 2 ]. Tonsillar phlegmon is affecting particularly adolescent and young adults [ 3 ], complicating acute pharyngitis, recurrent pharyngitis, and chronic tonsillitis [ 4 ].…”

“…, and anaerobes including Fusobacterium necrophorum , Fusobacterium nucleatum , Prevotella melaninogenica , Prevotella intermedia , and Peptostreptococcus spp. are isolated from most patients (82–90%) [ 2 , 8 , 9 ].…”

Peritonsillar abscess subsequently complicated by Ludwig's angina

“…Peritonsillar abscess is one of the commonest deep‐neck infections and is associated with life‐threatening complications such as descending mediastinitis or parapharyngeal and retropharyngeal abscesses 1 . Deep‐neck spaces generally play an important role in the spread of deep‐neck infections,usually, peritonsillar abscesses spread posteriorly into the contiguous deep‐neck spaces via the parapharyngeal space, although extension into the anterolateral or inferior deep‐neck spaces has been reported sometimes 1,2 . The submandibular space is superior and adjacent to the parapharyngeal space, Ludwig's angina, a gangrenous infection of the submandibular space, is usually odontogenic, although peritonsillar abscess could be a possible cause 3 …”

Recurrent paratonsillitis of odontogenic origin

“…Паратонзиллит может вызывать серьезные осложнения, такие как парафарингеальный абсцесс, некротический фасциит, флегмона шеи, гнойный медиастенит, сепсис [8,9,10]. Это объясняет актуальность ранней диагностики и лечения пациентов с данной патологией.…”