Cases Of Peritonsillar Abscess Research Articles

Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta-analysis.

Distinguishing peritonsillar abscess (PTA) from peritonsillar cellulitis using clinical assessment is challenging as many features overlap for both conditions, and physical examination is only about 75% sensitive and 50% specific for diagnosing PTA. The primary objective of this systematic review was to determine the test characteristics of ultrasound for diagnosing PTA when compared to a reference standard of computed tomography or acquisition of pus via needle aspiration or incision and drainage. This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) guidelines. We searched seven databases from 1960 to November 2022. Two independent reviewers completed study selection, data extraction, and QUADAS-2 risk-of-bias assessment. We used a bivariate random-effects model to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-). We also conducted subgroup analyses on radiology ultrasound compared to point-of-care ultrasound (POCUS) and intraoral compared to transcervical scanning techniques. From 339 citations, we identified 18 studies for inclusion. Because one study only reported positive cases of PTA (thereby preventing the calculation of specificity), it was excluded from the analysis, so the analysis included a total of 17 studies with 812 patients, of whom 541 had PTA. Pooled bivariate sensitivity was 86% (95% confidence interval [CI] 78%-91%), specificity 76% (95% CI 67%-82%), LR+ 3.51 (95% CI 2.59-4.89), and LR- 0.19 (95% CI 0.12-0.30). On subgroup analysis, radiology-performed ultrasound had a sensitivity and specificity of 89% and 71%, compared to POCUS, which had a sensitivity and specificity of 74% and 79%. Comparing the two different techniques, intraoral had a sensitivity and specificity of 91% and 75% while transcervical had a sensitivity and specificity of 80% and 81%. Ultrasound demonstrates high sensitivity for ruling out PTA, but it only has moderate specificity for ruling in the diagnosis.

Parapharyngeal Acinic Cell Carcinoma: Initially Managed as a Case of Peritonsillar Abscess

Parapharyngeal Acinic Cell Carcinoma: Initially Managed as a Case of Peritonsillar Abscess

Peritonsillar abscess: an 8-year retrospective, culture based evaluation of 208 cases.

Introduction. Peritonsillar abscess (PTA) is a common infection which requires surgical intervention and suitable antibiotic therapy.Hypotheses/Gap Statement. Beside Streptococcus pyogenes and Fusobacterium necrophorum several other mostly anaerobic bacteria can be cultured from the properly taken pus samples of PTA, the clinical significance of which is still not fully understood.Aim. This study focused on the culture-based microbiological evaluation of PTA cases, compared to surgical intervention and empirical antibiotic management.Methodology. A retrospective analysis of PTA cases was performed between 2012 and 2019. Data about the aerobic and anaerobic culture results of the samples taken during different surgical interventions were summarized and the coverage of the empirically selected antibiotics was evaluated. The patient's history, the development of complications and the recurrence rate were also evaluated.Results. The microbiological culture results were available for 208 of 320 patients with clinically diagnosed PTA. Incision and drainage (I and D) and immediate tonsillectomy were the leading surgical interventions. Ninety-five Fusobacterium species (including 44 Fusobacterium necrophorum), 52 Actinomyces species and 47 Streptococcus pyogenes were obtained from PTA samples alone or together with polymicrobial flora. S. pyogenes (33.7 %, n=28) and F. necrophorum (22.9 %, n=19) were the dominating pathogens in the 83 monobacterial PTA samples. In >60 % of the patients polymicrobial infection was demonstrated, involving a great variety of anaerobic bacteria. In 22 out of 42 cases where intravenous cefuroxime was empirically started, the therapy should be changed to properly cover the culture-proven anaerobic flora. There were no serious complications, abscess recurrence was detected in two cases (0.96 %).Conclusion. PTAs are often polymicrobial infections including a great variety of anaerobes. Targeted antibiotic therapy, in conjunction with adequate surgical drainage eliminating the anaerobic milieu, can accelerate the healing process and radically reduce the complication and recurrence rate.

Case Report: Bilateral peritonsillar abscess with complications of upper airway obstruction

Background: Peritonsillar abscess is a collection of pus between the tonsillar fibrous capsule and the pharyngeal constrictor muscle. Unilateral peritonsillar abscess is a common complication of acute tonsillitis, whereas bilateral peritonsillar abscess is rare. The incidence of bilateral peritonsillar abscess remains unknown but is estimated to be 4.9% of all peritonsillar abscess cases. Case report: A 20-year-old man came to the emergency room with bilateral peritonsillar abscess and complaining of shortness of breath for two weeks. Physical examination showed muffled voice, 82% oxygen saturation, and inspiratory stridor. The isthmus faucium was narrow, with approximately 30% remaining. Peritonsillar puncture revealed pus mixed with blood. The treatment for this patient included bilateral peritonsillar incision and drainage and intravenous antibiotics of levofloxacin and metronidazole. The patient came to the Ear, Nose, Throat, Head, and Neck (ENTHN) Outpatient Unit eight days after the procedure for a control checkup and was in good condition. Conclusion: We have reported a bilateral peritonsillar abscess with complications of upper airway obstruction, in which we performed incision and drainage. Prompt and appropriate management is needed to avoid unwanted morbidity and mortality.

Admission avoidance in tonsillitis and peritonsillar abscess: A prospective national audit during the initial peak of the COVID‐19 pandemic

ObjectivesTo report changes in practice brought about by COVID‐19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA), and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED).DesignProspective multicentre national audit over 12 weeks from 6 April 2020.SettingUK secondary care ENT departments.ParticipantsAdult patients with acute tonsillitis or PTA.Main outcome measuresRe‐presentation within 10 days for patients discharged from the ED.Results83 centres submitted 765 tonsillitis and 416 PTA cases. 54.4% (n = 410) of tonsillitis and 45.3% (187/413) of PTAs were discharged from ED. 9.6% (39/408) of tonsillitis and 10.3% (19/184) of PTA discharges re‐presented within 10 days, compared to 9.7% (33/341) and 10.6% (24/224) for those admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTAs.IV steroids and antibiotics increased the percentage of patients able to swallow from 35.8% to 72.5% for tonsillitis (n = 270/754 and 441/608) and from 22.3% to 71.0% for PTA (n = 92/413 and 265/373).77.2% of PTAs underwent drainage (n = 319/413), with no significant difference in re‐presentations in those drained vs not‐drained (10.6% vs 9.5%, n = 15/142 vs 4/42, P = .846).Univariable logistic regression showed no significant predictors of re‐presentation within 10 days.ConclusionsManagement of tonsillitis and PTA changed during the initial peak of the pandemic, shifting towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.

Bilateral peritonsillar abscess: a case series

<p class="abstract">Peritonsillar abscess (PTA) is one of the most common deep neck abscesses. Unlike unilateral peritonsillar abscess, bilateral peritonsillar abscess is rather rare. We report 3 cases of bilateral peritonsillar abscess which were proven by either computerized tomography imaging or needle aspiration. One of the patients was treated with intravenous antibiotics and corticosteroid. The other 2 patients underwent needle aspiration for confirmation of diagnosis and subsequent incision and drainage. All patients were treated successfully with complete resolution. Bilateral PTA should always be considered when there is presence of bilateral peritonsillar swelling with non-deviated uvula and trismus. Despite surgical drainage being the most common management, the option of medical therapy alone may be sufficient. To the best of our knowledge, this is the first case of bilateral PTA reported being treated successfully with medical therapy.</p>

Epidemiology and Clinical Features of Peritonsillar Abscess: Is It Related to Seasonal Variations?

Peritonsillar abscess (PTA) is defined as pus accumulation between the tonsillar capsule and constrictor pharyngeal muscle. It can be seen as a complication of acute tonsillitis, but other mechanisms have also been proposed. In this study we aimed to reveal the seasonal variations and epidemiologic features of PTA. This is a retrospective, observational study. We reviewed 221 patients, and together with 24 recurrent cases, 245 admissions were reviewed in total. Age, gender, the duration of admission, seasonal and monthly distribution of cases, diabetes and smoking status, white blood cell count, and C-reactive protein (CRP) levels were recorded. Monthly and seasonal incidences of PTA were reviewed to see if there is any association of climate variations and PTA incidence rate. Features associated with the length of hospitalization and recurrence were also analyzed. A total of 245 PTA cases were admitted to our clinic between June 2014 and June 2017. The highest amount of cases was observed in spring and winter. The C-reactive protein and white blood cell count (WBC) levels were found to be positively correlated with the length of hospitalization. There was no statistically significant correlation with recurrence and smoking, the WBC levels, CRP levels, and length of prior hospitalization. Diabetes status was not found to be associated with length of hospitalization and CRP levels. The present study reflects the epidemiologic and clinical features of PTA in İstanbul. Our findings showed that seasonal variation was not significant, consistent with previous studies. The highest incidence rate was observed in spring and winter. Length of hospitalization was found to be positively correlated with C-reactive protein and white blood cell count (WBC) levels. Recurrence was not statistically correlated with and smoking, the WBC levels, CRP levels, and length of hospitalization. More studies are recommended to reveal the different epidemiologic factors affecting the incidence of PTA.

Non-steroids anti-inflammatory drugs and risk of peritonsillar abscess in pharyngitis: a French longitudinal study in primary care†.

The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature. To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care. A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model. During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6-5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3-7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5-13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7). Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis.

A clinical and epidemiological study on peritonsillar abscess in tertiary health center

Background: Peritonsillar abscesses (PTA) are the most common deep neck space infection and are a common complication of tonsillitis with variable sequelae. Objective: To evaluate 22 cases of PTA cases observed at the SS Medical College and GM Hospital, Rewa. Materials and Methods: The present study was done on 22 patients of PTA who presented to the SS Medical College and GM Hospital, Rewa from August 2012 to August 2013. Results: The most common age group was found to be 11-20 years with age ranging from 12 to 55 years. Males (14 cases) were found to be predominant. The right side involvement was seen in the majority of cases. One case of the bilateral peritonsillar abscess was found. The majority of patients presented with odynophagia and dysphagia. The appropriate antibiotic therapy must be initiated after aspiration of the abscess. Treatment included mainly incision/drainage in 11 cases, needle aspiration in 4 cases, quinsy tonsillectomy in 1 case, and conservative treatment was done in 6 cases. Conclusion: The need of hour is to diagnose the cases of peritonsillar abscess earlier and to intervene thereafter. The early diagnosis and recognition of the abscess help in appropriate treatment to begin before the involvement of surrounding anatomic structures.

Detection of peritonsillar abscess using smartphone-based thermal imaging.

Objective:Smartphone-based thermal imaging was evaluated for its utility in the detection of peritonsillar abscesses.Methods:We describe six cases of peritonsillar abscess in which computed tomography and thermography scans of the neck were performed prior to surgery.Results:Open-mouth thermal photographic images were obtained preoperatively from patients, and asymmetric hot spots with significantly higher temperatures in the peritonsillar area were identified as abscesses.Conclusions:This new portable smartphone-based thermal imaging technique may be useful in the detection of peritonsillar abscesses.

東京都西多摩地域における扁桃周囲膿瘍症例の検討

東京都西多摩地域における扁桃周囲膿瘍症例の検討

National prospective cohort study of peritonsillar abscess management and outcomes: the Multicentre Audit of Quinsies study.

To investigate variations in the management and outcomes of peritonsillar abscesses, and to develop a trainee collaborative network in the UK. Data were collected prospectively on suspected peritonsillar abscess cases presenting over a 2-month period at 42 participating secondary care centres, covering a population of 16 million. The primary outcome was an adverse event at 30 days, defined as re-presentation or re-drainage. Eighteen per cent of the 325 cases experienced an adverse event. Follow-up data were valid for 90 per cent of cases. Regression analyses showed a significant reduction in adverse events in the 12 per cent of patients who were discharged within 12 hours, and there was no significant increase in adverse events for the 70 per cent receiving corticosteroids. Out-patient management of peritonsillar abscess is not commonly practised in the UK. Corticosteroid usage is common and appears safe. This study demonstrates that trainees working in collaboration can effectively deliver prospective multicentre cohort studies in the UK.

Microbiology of polymicrobial abscess

Polymicrobial diseases involve multiple infectious agents and are referred to as complex, complicated, mixed, synergistic, concurrent, coinfections. Polymicrobial diseases, caused by combinations of viruses, bacteria, fungi, and parasites, are being recognised with increasing frequency. In these infections, the presence of one micro-organism generates a niche for other pathogenic micro-organisms to colonise, one micro-organism predisposes the host to colonisation by other micro-organisms, or two or more non-pathogenic micro-organisms together cause disease. This review summarizes past studies published by group on the microbiology of polymicrobial abscesses that occur at various body sites abscesses can show up any place on your body. The most common sites are in your armpits (axillae), areas around your anus and vagina(Bartholin gland abscess), the base of your spine (pilonidal abscess), around a tooth (dental abscess), and in your groin. Most of the peritonsillar abscess cases have a polymicrobial infection. Prevotella sp and Peptostreptococcus sp found. Anaerobic streptococci, Anaerobic Gram negative bacilli, Enterobacteriaceae, Streptococcus pneumoniae, s-haemolytic streptococciwas found to be the most common source of infection for anaerobic brain abscess. Staphylococcus aureus and Group A s-haemolytic streptococci are the most prevalent aerobes in skin and soft tissue abscesses and are isolated at all body sites. Group A s-haemolytic streptococci, pigmented Prevotella and Porphyromonas spp., and Fusobacterium spp. were most commonly found in lesions of the mouth, head, neck and fingers

A Case of Peritonsillar Abscess Associated with Suspected Anaphylactoid Purpura

A Case of Peritonsillar Abscess Associated with Suspected Anaphylactoid Purpura

アナフィラクトイド紫斑病が疑われた扁桃周囲膿瘍例

アナフィラクトイド紫斑病が疑われた扁桃周囲膿瘍例

Possible role of anti-inflammatory drugs in complications of pharyngitis. A retrospective analysis of 163 cases

ObjectivesComplications of pharyngitis (peritonsillar abscess, retropharyngeal abscess, and cervical cellulitis) are rare, but appear to be on the increase over recent years and many of these patients have been treated by anti-inflammatory drugs prior to admission. The purpose of this study was to review the current epidemiological data concerning these complications and investigate a possible correlation with anti-inflammatory drug use. Material and methodsA single-centre retrospective review of epidemiological, clinical and microbiological data was performed on the medical charts of patients hospitalised for peritonsillar abscess, retropharyngeal abscess or cervical cellulitis between 2005 and 2010. ResultsOver a six-year period, 163 patients were hospitalised for complications of pharyngitis, with a sex-ratio of 1.82 (104/57). The number of cases of peritonsillar abscess (PTA) increased from 13 to 28 cases per year from 2005 to 2010 and the number of cases of retropharyngeal abscess increased from three to six cases per year over the same period. The number of cases of cellulitis remained stable with an average of 1.82 cases per year. Each year, significantly more patients with an abscess were admitted to our unit with a history of anti-inflammatory drug use (13.3 ± 4.6) than without anti-inflammatory drug use (7.8±4.3) (P<0.01). Micro-organisms were identified in 80% of cases, with mixed strains in 73% of cases, Streptococcus in 72% of samples and Streptococcus pyogenes in 19% of cases of PTA. A favourable outcome was observed in all patients in response to medical and surgical treatment. ConclusionIn line with the literature, we observed an increasing incidence of complications of pharyngitis. The present series comprised significantly more patients admitted for PTA with a history of anti-inflammatory drug use. A multicentre prospective controlled study in Nantes on a large cohort is currently underway and will probably confirm these preliminary results.

Epidemiology, clinical history and microbiology of peritonsillar abscess.

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA). A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken. A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5–78) years. Smokers comprised 22.0 % of the study group. The seasonal variation of PTA was statistically insignificant (p = 0.45). Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1–148.7, p = 0.001]. Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0–10.9, p = 0.0005) and had significantly longer hospital stay (p = 0.03). Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures. PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease. The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

Bacteriology of peritonsillar abscess in patients over 40 years—a neglected age group

The clinical presentation of peritonsillar abscess (PTA) in patients over 40years is scarcely reported. Since older patients present differently than younger patients, our aim was to investigate possible correlation between illness severity in the older age group and their bacteriologic studies. A retrospective study on all cases of PTA admitted between June 1996 and June 2003 was carried out. Details regarding sex and age were obtained. Bacteriologic studies were analyzed for gram stain, aerobic and anaerobic culture results. Two hundred and eighty-two patients (143 male and 139 female) had 311 hospitalizations due to PTA with known results of the microbiologic studies. Mean age was 29.6 (range 4-80years). Sixty-five adults over 40 of age were found comprising 23% of our cohort. Aerobic growth in the older group was found to be significantly lower (P<0.05). Anaerobic growth was identified in 44.7% of the positive pathogen growth. The older age group also showed a tendency to higher rates of anaerobic bacterial growth (57.1% compared to 41% in the young age group; P=0.09, OR=1.91). Older population with PTA presents with significant lower rates of aerobic bacteria and a tendency towards higher rates of anaerobic growth. The dangerous combination of the latter with the higher reported rates of comorbidities and less prominent symptoms and signs compared to the younger patients might clarify the need for prompt and aggressive surgical and antibiotic treatment.

Gram Staining for the Treatment of Peritonsillar Abscess

Objective. To examine whether Gram staining can influence the choice of antibiotic for the treatment of peritonsillar abscess. Methods. Between 2005 and 2009, a total of 57 cases of peritonsillar abscess were analyzed with regard to cultured bacteria and Gram staining. Results. Only aerobes were cultured in 16% of cases, and only anaerobes were cultured in 51% of cases. Mixed growth of aerobes and anaerobes was observed in 21% of cases. The cultured bacteria were mainly aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. Phagocytosis of bacteria on Gram staining was observed in 9 cases. The bacteria cultured from these cases were aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. The sensitivity of Gram staining for the Gram-positive cocci and Gram-negative rods was 90% and 64%, respectively. The specificity of Gram staining for the Gram-positive cocci and Gram-negative rods was 62% and 76%, respectively. Most of the Gram-positive cocci were sensitive to penicillin, but some of anaerobic Gram-negative rods were resistant to penicillin. Conclusion. When Gram staining shows only Gram-positive cocci, penicillin is the treatment of choice. In other cases, antibiotics effective for the penicillin-resistant organisms should be used.

Unique Extension of Peritonsillar Abscess to the Masticator Space Encountered in the Early Phase of Antiviral Therapy for Hepatitis C

Background: To describe a unique case of peritonsillar abscess showing peculiar extension to the masticator space, encountered in the early phase of telaprevir therapy in combination with peginterferonalfa-2b and ribavirin for hepatitis C virus (HCV) infection. Methods: Review of clinical case records, including computed tomography and surgical approaches. Results: A 64-year-old woman was taking medications for HCV, including telaprevir therapy in combination with peginterferonalfa-2b and ribavirin every one week. She was also receiving medical treatment for diabetes mellitus. Her symptoms started 3 days after the commencement of antiviral therapy. She underwent surgery for drainage of the abscess, including endoscopy-assisted intraoral drainage and quinsy tonsillectomy. Conclusions: It is important to bear in mind that a patient suffering from multiple systemic diseases may display unique clinical presentations with head and neck infections. Endoscopy-assisted intraoral drainageof the lateral masticator space was less invasive than other approaches, obviating the need for identifying the facial nerve.