Peritonsillar Abscess

Klug, Tejs Ehlers; Rusan, Maria; Fuursted, Kurt; Ovesen, Therese

doi:10.1177/0194599816639551

Cited by 51 publications

(16 citation statements)

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“…Peritonsillar abscess (PTA) refers to pus collection between the tonsillar capsule and the pharyngeal constrictor muscle. The pathogenesis is unclarified, but closely related to an initial acute tonsillitis and it is likely that bacteria spread to the peritonsillar space via the salivary duct system [ 1 ]. The incidence of PTA peaks in young adult life (15–19 years: 167 per 100,000 population) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Complications of peritonsillar abscess

Klug

Greve

Hentze

2020

Ann Clin Microbiol Antimicrob

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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.

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Section: Introductionmentioning

confidence: 99%

Complications of peritonsillar abscess

Klug

Greve

Hentze

2020

Ann Clin Microbiol Antimicrob

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“…Laboratory results of the patient on arrival to the emergency department salivary gland specifically Weber's glands. [5][6][7] It may be difficult to diagnose bilateral PTA clinically due to different diagnoses such as lymphoma, infectious mononucleosis, severe acute bacterial tonsillitis, or major salivary gland mass. [2,8,9] Therefore, advocating the need for contrast-enhanced computed tomography (CT) imaging may help diagnosis, especially in the absence of inflammatory findings.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Bilateral peritonsillar abscess in a child: Impending Deadly Condition

Arunathan¹

2020

Anatol JFM

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We present a rare bilateral PTA in a child and highlight the need for a high level of clinical suspicion to reach a prompt diagnosis. CASE REPORTA 5-year-old girl presented with two-weeks history of sore throat, odynophagia, and loss of appetite. Her condition was aggravated by a week-long fever with an inability to fully open her mouth, drooling, and a muffled "hot potato" voice. There were no breathing difficulty, no Peritonsillar abscess (PTA) is one of the deep neck infections. Unilateral PTA is more common than bilateral PTA and is more common in adults than children. Therefore, it is a rare condition with a low rate of incidence. To the best of our knowledge, the literature on this topic (bilateral PTA in children) is limited with this manuscript. In this study, we present a 5-year-old girl who presented with sore throat, odynophagia, and loss of appetite for two weeks, and fever for one week. On clinical examination,a bilateral enlarged tonsil with grade III-IV right tonsil, and grade III left tonsil was observed, respectively. The right tonsil is more erythematous, bulging, and exudative compared to the left tonsil, with the uvula centrally placed. The patient underwent bilateral incision and drainage under general anesthesia followed by intravenous antibiotics for one week. This case report highlighted the need for a high level of clinical suspicion to reach a prompt diagnosis. The management of the airway, which would be difficult, is an important aspect of the treatment. Thus, an immediate rapid drainage is required as much as an emergency surgical intervention to avoid unwanted morbidity and mortality.

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“…Peritonsillar abscess (PTA) is a head and neck infection caused by pus accumulation in the space between the lateral side of the palatine tonsils and the superior pharyngeal constrictor muscles [1]. Patients with PTA typically present to the emergency department with fever, severe sore throat, odynophagia, dysphagia, trismus, and even, respiratory distress, and they often require pus drainage, antibiotic therapy, and supportive therapy [2,3].…”

Section: Introductionmentioning

confidence: 99%

High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study

Chang

Liu

et al. 2021

IJERPH

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Background: Peritonsillar abscess (PTA) is an infectious emergency in the head and neck, and patients with end-stage renal disease (ESRD) have an immunocompromised status. However, no relevant research has focused on the ESRD–PTA relationship. This study explored PTA in ESRD patients and their prognosis. Methods: We identified 157,026 patients diagnosed as having ESRD over January 1997 to December 2013 from Taiwan’s National Health Insurance Research Database (NHIRD). Each patient with ESRD (hereafter, patients) was matched with one control without chronic kidney disease (CKD; hereafter, controls) by sex, age, urbanization level, and income. Next, PTA incidence until death or the end of 2013 was compared between the two groups, and the relative risk of PTA was analyzed using a multiple logistic regression model. Results: The patients had a significantly higher PTA incidence than did the controls (incidence rate ratio: 2.02, 95% confidence interval [CI]: 1.40–2.91, p < 0.001). The Kaplan–Meier analysis revealed that the patients had a higher cumulative incidence of PTA than did the controls (p < 0.001). In Cox regression analysis, the patients had nearly twofold higher PTA risk (adjusted hazard ratio [HR]: 1.98, 95% CI: 1.37–2.86, p < 0.001). The between-group differences in the PTA-related hospital stay length (8.1 ± 10.3 days in patients and 5.7 ± 4.6 days in controls, p = 0.09), consequent deep-neck infection complication (4.2% in patients and 6.3% in controls, p = 0.682), and mortality (0.0% in both groups) were nonsignificant. Conclusions: Although ESRD does not predict a poor prognosis of PTA, it is an independent PTA risk factor.

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Peritonsillar Abscess

Abstract: Our findings support the rationale for antibiotic treatment of patients with severe acute tonsillitis to reduce the risk of abscess development. Improved understanding of peritonsillar abscess pathogenesis is important for the development of efficient prevention strategies.

Cited by 51 publications

References 79 publications

Complications of peritonsillar abscess

Complications of peritonsillar abscess

A Rare Case of Bilateral peritonsillar abscess in a child: Impending Deadly Condition

High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study

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