Exudative Tonsillitis Research Articles

CD5+ Large B cell lymphoma with IRF4 rearrangement: case report and review of the literature

Abstract Introduction/Objective Large B cell lymphoma with IRF4 rearrangement was introduced as a diagnosis by WHO in 2017. It is a rare entity that affects Waldeyer’s ring in mostly males, children and young adults. The lesional immunophenotype may be positive for CD10. FISH is positive for IRF4 rearrangement on chromosome 6p25.Among reported cases in the English literature only 6 cases have reported specifically CD5 being negative. We present review of the literature during years 2020-2024, and a case of large B cell lymphoma with IRF4 rearrangement, specifically positive for CD5. Methods/Case Report The patient is a 5 years old male, since 2017 suffering from recurring ear infections with approximately 4-5 episodes of otitis media during every 6 months. In 2019 the patient’s mother reported snoring, constant sore throat, bad breath for 2 years. On physical examination the left tonsil appeared enlarged; exudative tonsillitis was present. Later on, an asymmetric, firm mass in the location of the left tonsil with induration of the left palate was identified. CT scan showed mild asymmetric soft tissue thickening of the left aspect of the soft palate and left palatine tonsil. Mildly prominent left-sided levels IIa and IIb lymph nodes, measuring up to 1 cm were identified. H&E sections revealed an expansile proliferation of neoplastic cells, large with void to indented nuclei, vesicular chromatin, small nucleoli, visible cytoplasms. Frequent mitoses, apoptosis and individual cell necrosis were seen. Immunohistochemistry revealed CD20+ B cell neoplasm with high expression for MUM1 and high proliferation rate along with strong CD5+ and CD10-. By multicolor flow cytometric studies, an abnormal B cell population was found (40%) with increased forward scatter along with expression for CD5, CD19, CD20, CD22, CD45, CD79a (cytoplasmic), FMC7, (dim) lambda-restriction. Fluorescence In Situ Hybridization Study revealed IRF4 (DUSP22) rearrangement on chromosome 6p25. Results (if a Case Study enter NA) NA Conclusion We analyzed 24 cases reported in the English literature. The mean age of the patients is 7 years old. The majority are males (14/24 = 58%).The most common location is tonsil/ neck mass (15/24 = 62%).CD5 was negative in 6/24 cases.

Exploring factors for predicting colchicine responsiveness in children with PFAPA

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA) are the most common autoinflammatory syndromes in children. This study aimed to evaluate the clinical and laboratory parameters that may predict colchicine responsiveness.This retrospective, multicenter, cross-sectional study involved nine pediatric rheumatology centers from our country., The patients diagnosed with PFAPA were compared on the basis of their responses to colchicine. In the 806 (42.3% female 57.7% male) patients, the most common clinical findings were fever (100%), exudative tonsillitis (86.5%), pharyngitis (80.9%), and aphthous stomatitis (50.5%). The mean attack frequency was 13.5 ± 6.8 attacks per year lasting for a mean of 3.9 ± 1.1 days. Colchicine treatment was attempted in 519 (64.4%) patients, with 419 (80.7%) showing a favorable response. In patients who underwent MEFV gene analysis (70.8%), the most common variant was M694V heterozygous (16.8%). The presence of pharyngitis (p = 0.03, 95% CI 0.885 to 0.994), the presence of arthralgia (p = 0.04, 95% CI 0.169 to 0.958), and having more frequent attacks (p = 0.001, 95% CI 0.028 to 0.748) were found to be associated with colchicine unresponsiveness, whereas the carriage of the M694V variant (p = 0.001, 95% CI 0.065 to 0.242) was associated with colchicine responsiveness.Conclusion: This study identified the presence of pharyngitis, arthralgia, and increased attack frequency in patients with PFAPA as factors predicting colchicine unresponsiveness, whereas the carriage of the M694V variant emerged as a predictor of colchicine responsiveness. Predicting colchicine response at disease onset may facilitate a more effective management of PFAPA.What is Known:• Colchicine treatment can be used in the prophylaxis of PFAPA disease.• Having the MEFV variant is the most commonly known factor in predicting response to colchicine.What is New:• The presence of pharyngitis or arthralgia, and more frequent attacks in PFAPA disease were found to be independently associated with colchicine unresponsiveness. • Carrying the M694V variant was identified as the sole factor predicting colchicine responsiveness.

THU446 A Case Of Isolated Osteonecrosis Of Torus Palatinus In A Patient On Alendronate

Abstract Disclosure: A.A. Noor: None. A. Zia: None. B. Hoard: None. K. Romo: None. S. Bhamre: None. M. Gabriel: None. S. Shu: None. R. Ozolins: None. T. Pulisetty: None. G.I. Uwaifo: None. Introduction: Osteonecrosis of the jaw (OJN) is a rare complication of bisphosphonate and RANKL inhibitor use. Most cases have been described in cancer or immunocompromised patients using high dose parenteral therapy, but have even more rarely been described with oral bisphosphonate (OBP) use. The estimated risk is 1 in 10,000 to 1 in 100,000 patient-years in patients taking OBP for osteoporosis. We describe a case isolated osteonecrosis of torus palatinus (OTP) in a patient with long-term use of OBP (alendronate) for postmenopausal osteoporosis. Case Report: 75-year-old female with a history of torus palatinus (TP), osteoporosis, fibromyalgia, echondromas of humerus, degenerative disc disease, and spinal stenosis initially presented at a primary care clinic with three weeks of inflamed, painful, red, and swollen oral ulcer; associated with exudative tonsillitis. She finished an antimicrobial course which improved tonsillitis, but the oral ulcer persisted. She was on alendronate 70 mg weekly for ∼ three years prior to symptom onset. Examination showed a nearly 1 cm shallow ulcer on the left aspect of her large TP with associated erythema and tenderness to palpation. The rest of the oral cavity was normal. She was given triamcinolone paste for two weeks. Follow-up 1 month later showed progression of ulcer down to bone underlying the TP. The mucosa of the TP was erythematous, thickened, and tender. Given the lack of resolution after antimicrobials and topical steroids, a biopsy was done which showed squamous mucosa with reactive changes, hyperkeratosis, and chronic inflammation, but negative for dysplasia or malignancy. Maxillofacial CT showed, “a lobulated bony mass in the roof of the mouth consistent with TP with left-central heterogeneous density and cortical bone thinning without soft tissue mass or extension. Due to suspicion for osteomyelitis and possible underlying malignancy, lesion excision, and debridement was done. Alendronate was stopped at this point. Excisional biopsy showed necrotic bone consistent with OTP with associated acute and chronic osteomyelitis. She was treated with four weeks of metronidazole and two weeks of fluconazole. The postoperative course was uneventful, with appropriate healing. Conclusion: While OJN is uncommon in setting of OBP use, among patients with TP and other bone overgrowth states high index of suspicion is needed for bony lesions developing in such patients. The possibility of OTP development should be considered with appropriate oral complaints among OBP users with TP. Further retrospective analyses to ascertain how prevalent this uncommon condition is would provide much needed clinical information. Presentation: Thursday, June 15, 2023

Clinical characterization, long-term follow-up, and response to treatment of patients with syndrome of undifferentiated recurrent fever (SURF)

ObjectivesTo describe a homogeneous group of patients with undifferentiated recurrent fevers followed-up in a tertiary referral center for systemic autoinflammatory diseases (SAIDs). MethodsPatients with undifferentiated recurrent fevers seen at our Center from 2008 to 2021 and followed-up for at least one year were included in a retrospective study. Monogenic recurrent fevers, patients carrying variants of unknown origin and PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) syndrome were excluded. ResultsFifty patients (34 male, 16 female) were included in the study. The median age at onset was 3 years, and the median follow-up was 3.3 years. At baseline, arthralgia (70%) and abdominal pain (65%) were the most frequent manifestations. NSAIDs or steroids on demand had a variable and transient effect. Tonsillectomy was ineffective in the 10 patients (20%) that underwent surgery. Forty-eight patients (96%) were treated with colchicine. A complete response (absence of fever) was achieved in 31 patients (64.6%). Nine patients (18%) showed a partial response, with a median reduction of fever episodes per year of 72%. Nine patients (16.7%) were considered resistant to colchicine. The presence of generalized lymphadenopathy and, to a lesser extent, exudative tonsillitis was associated with a lack of response to colchicine. ConclusionsWe describe the largest series of patients with syndrome of undifferentiated recurrent fever (SURF) reported in the literature so far. SURF should be considered as a distinct clinical entity in the context of multifactorial autoinflammatory diseases.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA) or recurrent urinary tract infections: a case report

BackgroundFever is the most frequent reason for medical consultation in children, and makes up 15–25% of all consultations in primary care and emergency departments. In here we report a case of a 13 year-old girl who referred with an unusual presentation of fever and was misdiagnosed with recurrent urinary tract infection for 8 years.Case presentationThis is a Clinical Reasoning Cycle case study. A 13 year-old girl was referred with a chief complaint of recurrent fevers from 8 years. During her first febrile episode, she had a 5-day high-grade fever associated with loss of appetite. Her physical examination at that time was unremarkable. Blood tests showed leukocytosis with a shift to the left and urine examination was in favor of pyuria. The urine culture was positive for bacterial growth. The episodes of fever were repeated every 45 days. Accordingly, the patient was diagnosed as a case of recurrent urinary tract infection. In the intervals between her febrile episodes, the patient was healthy and laboratory tests were normal. Ultrasonography, voiding cystourethrogram and dimercaptosuccinic acid scans were normal. During her last visit, the patient mentioned difficulty in swallowing and on examination cervical lymph nodes, exudative tonsillitis and painful aphthous stomatitis were detected. All antibiotics were stopped and corticosteroids were started. The patient’s symptoms were relieved and the interval between her febrile episodes became longer.ConclusionsOur study shows that a patient should never be marked, particularly when the symptom and signs aren’t completely justifying a patient’s condition.

Клініко-сонографічні показники як діагностичні критерії інфекційного мононуклеозу в дітей

Актуальність. Значний поліморфізм клінічних проявів інфекційного мононуклеозу, поліорганність ураження, часта відсутність чітких клініко-параклічних критеріїв та відстроченість результатів доступних лабораторних тестів, а іноді і неможливість їх проведення утруднюють діагностику захворювання на догоспітальному етапі та при надходженні до стаціонару. Мета дослідження: оптимізувати діагностику та лікування інфекційного мононуклеозу в дітей шляхом вивчення сучасних особливостей перебігу та аналізу діагностичної цінності клінічних та інструментальних показників у верифікації захворювання. Матеріали та методи. На базі інфекційного боксованого відділення крапельних інфекцій КМУ «Обласна дитяча клінічна лікарня» (м. Чернівці) обстежені 65 дітей, хворих на інфекційний мононуклеоз, які знаходилися на стаціонарному лікуванні в період 2014–2015 рр., першу клінічну групу (І) сформували 42 дитини, заключний клінічний діагноз захворювання у яких верифіковано на підставі комплексу клініко-гематологічних критеріїв, до другої (ІІ) клінічної групи порівняння увійшли 23 дитини, хворі на серологічно підтверджений інфекційний мононуклеоз. За основними клінічними ознаками групи спостереження вірогідно не відрізнялися. Результати. Установлено, що для хворих на інфекційний мононуклеоз дітей характерні клінічні особливості, зокрема раптовий початок захворювання (у 93,8 %) із лихоманки, вищої за 37,5 °С (у 80 %), наявність ексудативного тонзиліту (у 81,6 %), підщелепної та шийної лімфаденопатії (у 90,7 %), утрудненого носового дихання (у 78,4 %) та гугнявості голосу (у 73,8 %). У підтвердженні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології явища ексудативного тонзиліту та лімфаденопатії виявилися високочутливими (90 та 95 % відповідно), проте із значною часткою хибнопозитивних результатів. Висновок. Таким чином, з урахуванням недостатньої діагностичної цінності клініко-анамнестичних та сонографічних показників у виявленні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології в дітей, що підтверджувалося низькими значеннями відношення правдоподібності та показників ризику, використання їх доцільне лише в комплексі.

Clinical Usefulness of Acute-Phase Markers in Distinguishing between PFAPA and Other Exudative Tonsillitis Causes: A Methodological Study.

We investigated the practical use of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and complete blood count (CBC) parameters in distinguishing periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA) attacks from exudative tonsillitis associated with group A streptococcus (GAS) and Epstein-Barre virus (EBV). The study population consisted of cases with exudative tonsillitis who had been subsequently diagnosed as PFAPA, EBV, and GAS tonsillitis through a period of 6 years. We retrieved the CBC, ESR, CRP and PCT data from patients' medical records. Of the patients, 47 (35.6%) had PFAPA, 36 (27.3%) had GAS and 49 (37.1%) had EBV tonsillitis. Median CRP, ESR and PCT values of patients with PFAPA were 78 (17-92) mg/dl, 44 (11-83) mm/h, 0.16 (0.01-1.45) ng/ml, respectively. The CRP and ESR levels were significantly higher in PFAPA and GAS groups compared with the EBV group (p = 0.001). There was no significant difference between the groups regarding the PCT levels. The study indicated no benefit of PCT in distinguishing PFAPA from the others. However, we found that CRP, ESR, and CBC parameters could be useful in identifying PFAPA and GAS than EBV tonsillitis.

Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature

Ceftriaxone plays a vital role in modern medicine due to its broad-spectrum coverage of common microbes. A relatively frequent, yet underplayed side effect is pseudolithiasis, especially in the pediatric setting. While most cases resolve spontaneously, there have been reports of patients requiring surgical treatment after developing further complications. We report a case of an abrupt onset (<3 days) pseudolithiasis occurring after just four moderate doses of Ceftriaxone. A previously healthy 2 years and 9-month-old girl was admitted as a case of exudative tonsillitis with secondary gastroenteritis. On day three of Ceftriaxone treatment, sudden onset severe abdominal pain ensued which warranted an abdominal ultrasound showing multiple gallbladder stones. Consequently, Ceftriaxone was changed to Cefotaxime and the pain subsided following a further two inpatient days and outpatient follow-up appointments were scheduled. Ceftriaxone has a high elimination in the bile, which gives predominance for potential biliary complications. It is well documented that high and prolonged doses increase the likelihood of these complications. In our case the accelerated progression of the pseudolithiasis could be due to the dehydration caused by the background gastroenteritis. Reduced oral intake and dehydration causes biliary stasis which accelerates the formation of biliary sludge and gallbladder precipitates due to biliary stasis. In the future, physicians could reconsider the use of ceftriaxone in patients with similar presentations.

Acute tonsillitis and pediatric functional gastrointestinal disorders: the first result of a possible association analysis

Acute tonsillitis (AT) and functional disorders of the digestive system (FDDS) are widespread among children. There is insufficient information about whether FDDS affects the incidence and course of АT, or whether АT may predispose to the development of АT. The aim is to discover a possible relationship between acute exudative tonsillitis and FDDS in children in the context of clinical and medico-social assessment. Materials and Methods: An observational cross-sectional study was performed using the continuous sampling method. There were 137 patients under observation, aged from one to 18 years, hospitalized in a hospital with АT, proceeding with overlaps on the tonsils, including 44 children younger and 93 older than 4 years. Bacterial АT was diagnosed on the MacIsack scale (≥ 4 points) in combination with the determination of inflammatory markers (leukocytosis, CRP). Epstein-Barr viral etiology of АT was diagnosed based on the detection of anti-EBV-VCA IgM and/or anti-EBV-EA IgG in the absence of anti-EBV-NA IgG. The legal representatives of the children agreed to participate in the study and completed a developed questionnaire containing 41 questions to assess medical and social factors, health status and gastrointestinal symptoms. FDDS diagnosis was carried out according to Rome IV 2016 criteria. Stool character was assessed using the Bristol scale, and clinical symptoms of АT were also analyzed. Results: Bacterial АT was diagnosed in 51.1% (70) of patients and EBV tonsillitis — in 48.9% (67), namely with equal frequency. The incidence of FDDS was 41.6% (95% CI (confidence interval) (33.3, 50.3), including 38.7% in children from 1 to 4 years old (95% CI (24.4, 54.5) and over 4 years 43.0% (95% CI (32.8, 53.7). Functional constipation (25.0%) and functional diarrhea (13.6%) were found in young children, all children over the age of 4 years had abdominal pain (including irritable bowel syndrome with a predominance of constipation — 4.3%). In EBV-RT with FDDS, the incidence of hepatolienal syndrome was 33.3% higher (RR (relative risk) 2.40; 95% CI (1.02, 5.66) and OR (odds ratio) 5.46; 95% CI (1.39, 21.28). Children with FDDS are 22.4% more likely (RR 1.65; 95% CI (1.21, 2.24) and OR 4.1; 95% CI (1.39, 12.07) suffered from recurrent acute respiratory infections; their relatives were more likely to have gastroenterological diseases (RR 1.54; 95% CI (1.12, 2.13) and OR 2.99; 95% CI (1.22, 7.34). Perinatal hypoxic lesions of the central nervous system were more often recorded in patients with FDDS in the anamnesis (RR 1.99; 95% CI (1.25, 3.15) and OR 4.13; 95% CI (1.37, 12.42). Conclusion: The etiological role of EBV among children with exudative АT admitted to the hospital is high. FDDS is more common among children with exudative АT over 4 years of age than in the general pediatric population. The influence of FDDS on the clinical manifestations of EBV-RT is highly probable. It is advisable to continue the study to determine the significance of АT in the development of FDDS in children and adolescents; their results may be useful for clinical practice.

Evaluation of Clinical and Laboratory Characteristics of Patients with PFAPA Syndrome

INTRODUCTION: Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome is the most common periodic fever syndrome. The aim of this study was to evaluate the clinical and laboratory findings of patients with PFAPA syndrome at the time of the attack and the response to the given treatments. MATERIALS and METHODS: Sixty-three individuals that applied to the pediatric rheumatology policlinic due to recurrent fever and throat infection and diagnosed with PFAPA syndrome were enrolled in this study. Patients' folders were evaluated retrospectively concerning demographic, clinical and laboratory data. RESULTS: Forty-two (66.7%) of the patients were male, 21 (33.3%) were female. The age of onset of complaints was 2.72±1.59 years. The average delay in diagnosis was 1.71 ± 1.28 years. The remarkable finding which was seen all of our patients was the high fever. Lymphadenitis was detected in 59 (93.7%) of the patients and aphthous stomatitis was found in 56 (88.9%) of the patients. As a laboratory finding, leukocytosis, the increase in C-reactive protein and sedimentation was observed in patients. Fever decreased within a mean of 2.24 ± 1.13 hours after steroid treatment. Another remarkable finding after the first steroid treatment was the resolution of exudative tonsillitis 24 hours after the treatment. CONCLUSIONS: Signs and symptoms of PFAPA syndrome are among the most common signs and symptoms in pediatric outpatient clinics. With increased awareness of PFAPA syndrome in clinicians, patients will be prevented from unnecessary laboratory procedures and medical treatments.

An atypical presentation of multidermatomal herpes zoster: a case report

BackgroundHerpes zoster (HZ) also known as shingles is a common dermatological pathology seen in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to immunocompromised individuals. However, it is rarely reported in the immunocompetent population.Case presentationWe report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and an uncomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and influenza and was treated for both and discharged. He returned to the emergency department reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained, and he was discharged with a steroid topical cream. Fourteen days later, he returned to the clinic reporting crusting of the rash; the biopsy results were positive for herpes zoster. The diagnosis of multidermatomal herpes zoster was made, and he was then treated with antivirals.ConclusionsHerpes zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation.

’Predictors of hospitalization in children with infectious mononucleosis

Background: Infectious mononucleosis (IM), characterized by fever, lymphadenopathy and pharyngitis, is a common infectious disease caused by Epstein-Barr virus (EBV). In this study, we performed a retrospective analysis of the clinical findings, laboratory data and management of children with IM due to EBV to find out the predictors of hospitalizations. Methods:We retrospectively reviewed the medical records of patients under the age of 18 years who were diagnosed with IM between October 31, 2017 and October 31, 2018 at Muğla Sıtkı Koçman University Medical Faculty Hospital. The study population was categorized into three groups according to the age; the 0-4 years, 5-10 years, and above 10 years. Complaints, physical examination findings, laboratory data, complications and treatment strategies of the patients were compared in these groups. Factors associated with hospitalizations and predictors of hospitalization were also investigated.Results: This study included 158 patients. The mean age of the patients was 88.9 ± 53.5 months and 93 (58.9%) were male. The most common complaint was fever (57.6%), and the most common physical examination finding was hepatomegaly (73.4%). No significant difference was found between the age groups in most of the clinical and laboratory findings. The antibiotic treatment was administered in 44% of the patients and 34.8% of the patients were required hospitalization. Patients who needed hospitalization were more symptomatic, had more physical examination findings and had higher acute phase reactants. For variables were found to be significant predictors of hospitalization: presence of fever, palatal petechiae, or exudative tonsillitis and higher levels of C-reactive protein at presentation.Conclusions: More than one third of the children with IM required hospitalization. Presence of fever, palatal petechiae, or exudative tonsillitis and higher levels of C-reactive protein at presentation were ssociated with higher rates of hospitalizations. Key words: Infectious mononucleosis, children, clinical features

Long-term management of patients with PFAPA syndrome.

To evaluate the long-term treatment results of patients with PFAPA syndrome and to determine their need for tonsillectomy. The clinical characteristics, treatments and long-term results of 16 patients admitted to the Pediatric and Otorhinolaryngology Clinic between 2015 and 2019 were retrospectively analyzed. Twelve male and four female patients were examined between 1.5 and 8years (mean age 4.8 ± 1.1) (75% male, 25% female). The mean duration of attacks was 4.4 ± 1.4weeks. Twelve patients recovered completely with single-dose steroid therapy. In the 4-year follow-up of 12 patients who were given a single dose of steroid therapy, there were no relapses.Surgical decisions were made for four patients whose attacks did not pass with steroid treatment.Two patients (75%) underwent adenotonsillectomy, and one patient underwent tonsillectomyWhile three of these patients did not have an attack again, one patient continued to have an attack every 8weeks. At the age of 9, his attacks were completely resolved spontaneously. All patients had fever. The most common concomitant symptoms were pharyngitis (94%), cervical adenitis (82%) and aphthous stomatitis (77%). Exudative tonsillitis was present in 25% of the patients. Medical treatment should be the first treatment option in patients with PFAPA syndrome. Although single-dose steroid treatment is effective in these patients, tonsillectomy is an important treatment option in refractory cases.

Exudative tonsillitis in children. How can we reduce the unnecessary antibiotic consumption?

Introduction: Exudative tonsillitis is a common clinical picture during childhood. The majority of these cases are caused by viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], influenza virus, parainfluenza virus, and adenovirus), and only some infections are caused by bacteria, mainly group A streptococci (GAS). On the basis of international guidelines, routine use of early antibiotic treatment is not recommended in these cases, because it seems not to prevent GAS-associated complications. Aim: Our aim was to determine those laboratory results which are useful to distinguish between bacterial and viral infections in children with exudative tonsillitis to reduce antibiotic overuse. Method: In our study, we evaluated 135 clinical data from 133 children with exudative tonsillitis. Patients were grouped according to the following criteria: the first group contained patients with acute CMV or EBV infections, while in the second group, CMV or EBV infections were not confirmed using serology. Results: On the basis of our results, EBV or CMV infections (66/135, 48.8%) were serologically confirmed in the majority of cases with exudative tonsillitis between 2016 and 2017, while the causative role of GAS was minimal in this patient group (3/65, 4.61%). In spite of this finding, the majority of patients (92%) were treated with antibiotics. Conclusion: Our retrospective findings confirmed that it is not possible to determine the causative agent of this clinical picture on the basis of symptoms, and physical findings, moreover laboratory results, such as high white blood cell count could not confirm bacterial infection. At the same time, elevated transaminase levels may refer to viral origin of infection, especially EBV or CMV with high predictive value; the use of extended laboratory tests may reduce the unnecessary antibiotic consumption. Orv Hetil. 2020; 161(2): 50-55.

Quinsy in Adult: Clinical Profile and Management Challenges in Two Tertiary Hospitals Northwest Nigeria

Purpose of the Study: Quinsy also known as Peritonsillar abscess (PTA) is a life threatened complication of acute exudative tonsillitis requiring immediate surgical intervention. We profile the clinical presentation and highlight challenges in management.&#x0D; Materials and Methods: A retrospective analysis of all patients diagnosed with Quinsy at the departments of otorhinolaryngology of two-government referral hospital in northwest Nigeria from May 2014 to April 2017. These patients’ clinical records were retrieved from the health record department and data extracted were analyzed using Microsoft excel program.&#x0D; Results: A total of 147 adult patients had tonsillitis within the study period. Only eighteen patients with quinsy 13(72.2%) females and 5(27.8%) males with an M: F=1:2.6 were analyzed. Age range is between 18 years – 58 years with a mean age of 35.4 years. The highest incidence was 66.7% in patients within the age group 21-40 years. Odynophagia and trismus were the commonest presenting features in all the patients. Side of Quinsy involvement was on the left tonsils 12(66.7%). There was spontaneous rupture in 5(27.8%) while 13(72.2%) of patients had incision and drainage. All patients had broad-spectrum antibiotics. Interval tonsillectomy was carried out on 12(66.7%) of patients while 6(33.3%) of patients did not consent for tonsillectomy and were subsequently lost to follow up. No recurrence of symptoms or mortality recorded.&#x0D; Conclusion: Quinsy is a life threatening otorhinolaryngological emergency common amongst young female adults. Optimal management is still antibiotics therapy and drainage of abscess in our center.

Human adenovirus replication and persistence in hypertrophic adenoids and palatine tonsils in children.

The role of human adenovirus (HAdV) infection in different acute diseases, such as febrile exudative tonsillitis, conjunctivitis, and pharyngoconjunctival fever is well established. However, the relationships, if any, of HAdV persistence and reactivation in the development of the chronic adenotonsillar disease is not fully understood. The present paper reports a 3‐year cross‐sectional hospital‐based study aimed at detecting and quantifying HAdV DNA and mRNA of the HAdV hexon gene in adenoid and palatine tonsil tissues and nasopharyngeal secretions (NPS) from patients with adenotonsillar hypertrophy or recurrent adenotonsillitis. HAdV C, B, and E were detectable in nearly 50% of the patients, with no association with the severity of airway obstruction, nor with the presence of recurrent tonsillitis, sleep apnea or otitis media with effusion (OME). Despite the higher rates of respiratory viral coinfections in patients with HAdV, the presence of other viruses, including DNA and RNA viruses, had no association with HAdV replication or shedding in secretions. Higher HAdV loads in adenoids showed a significant positive correlation with the presence of sleep apnea and the absence of OME. Although this study indicates that a significant proportion (~85%) of individuals with chronic adenotonsillar diseases have persistent nonproductive HAdV infection, including those by HAdV C, B, and E, epithelial and subepithelial cells in tonsils seem to be critical for HAdV C production and shedding in NPS in some patients, since viral antigen was detected in these regions by immunohistochemistry in four patients, all of which were also positive for HAdV mRNA detection.

Tularemia in the differential diagnosis of exudative tonsillitis and skin manifestations in progress: two case reports

Tularemia is zoonotic infection diseases that caused by Francisella tularensis. Oropharyngeal tularemia has been seen the most frequently in our country. Oropharyngeal tularemia may be presented with fever, exudative tonsillitis/pharyngitis, lymphadenopathy, and ulcers in the oral mucosa. Secondary skin rashes may be seen in tularemia. Our cases were presented with fever, headache and sore throat. Physical examination of the patients demonstrated exudative tonsillitis, erythema nodosum and papular rash. Patients’ complaints and clinical findings decreased with initiation of early and appropriate treatment. Tularemia should be remembered in the differential diagnosis of exudative tonsillitis, especially in endemic areas. It should be noted that, secondary skin manifestations can be seen in the course of tularemia.

THE INCIDENCE OF GROUP A BETA HEMOLYTIC STREPTOCOCCI IN PATIENTS WITH ACUTE EXUDATIVE TONSILITIS IN ISTANBUL, A 14-YEAR PERIOD

Background: Empiric antibiotic therapy is still habitually prescribed to patients with acute exudative tonsillitis in many out-patient clinics in Turkey, despite many studies worldwide showed low group A beta hemolytic streptococci (GABHS) and high viral infection incidence in those patients. In this study, we tried to show the real frequency of GABHS in acute exudative tonsillitis in Istanbul over a 14-year period. Methods: In this retrospective study, we looked through the patient files with acute exudative tonsillitis who had admitted internal medicine and ear-nose-throat out-patient clinics of our hospital in Istanbul, Turkey between 2000 and 2014. We included all patients with the diagnosis of exudative tonsillitis who had a throat swap and culture. We obtained data from the results of throat swab cultures for GABHS. Demographic data and microbiological results were analyzed. Results: Results of throat swab cultures of 967 patients were enrolled in this study (525 male, 442 female; mean age 21±7 years; range 14 to 70 years). In our retrospective analysis GABHS was isolated in only 105 (10.8%) of all patients. Of those patients in whom GABHS were isolated, 56 (5.7%) were male and 49 (5.06%) were female. There was no significant difference between men and women with respect to infection rate (p>0.05). Conclusion: The incidence of GABHS was also low in acute exudative tonsillitis in Istanbul over a 14-year period. Acute exudative tonsillitis was caused by GABHS in only about 10% of all our patients. Tests such as throat culture and rapid antigen test must be performed as soon as possible to confirm diagnosis when there is a suspicion of GABHS infection but routine or immediate antibiotic therapy for acute exudative tonsillitis in adults is not necessary. Key Words: group A beta-hemolytic streptococci; incidence; exudative tonsillitis

A Case Of Fatal Diphtheria In A Paediatric Patient

The introduction of diphtheria immunisation into the Expanded Program of Immunisation in the 1970s has markedly reduced the incidence of diphtheria diseases. We report a case of fatal diphtheria in a 2 year-old girl whose immunisation status was not known. She had presented with acute exudative tonsillitis and was treated with intravenous amoxicillin-clavulanate but showed progressive signs of upper airway obstruction; stridor, drooling of saliva and bull-neck appearance, with bilateral facial swelling around the parotid region that extended to submental and submandibular regions. Initial cultures from blood, throat, nasal and oral cavity revealed no significant organisms. Corynebacterium diphtheriae subspecies gravis which was resistant to penicillin, was isolated from pus specimen a day after her demise. Clinical suspicion is important to aid diagnosis, microbiological confirmation and management of diphtheria, as the disease is rare in the era of successful immunisation programs. Microbiological vigilance plays an important role in early detection of infection as well as outbreaks. Early institution of diphtheria antitoxin may save lives, while delay in diagnosis may increase mortality and the risk of transmission. This case reaffirms the vital role of immunisation and the importance of efforts to ensure a high uptake of the scheduled immunisations.

Acute exudative tonsillitis in adults: the use of the Centor scoreand some laboratory tests

The aim of our study was to determine the usefulness of the Centor score and some basic laboratory tests (complete blood count and C-reactive protein) for the differential diagnosis of exudative tonsillitis due to Group A &beta;-hemolytic streptococcus (GABHS) or due to non-GABHS agents. The data of clinical and laboratory characteristics of the patients diagnosed with exudative tonsillitis were collected and statistically compared between those having positive GABHS throat culture result and those who were negative for any bacterial agent. Totally 899 adult patients were included in our study; 56 (6.2%) of them were positive for GABHS, while 34 (3.8%) of the cases had a bacterial cause other than GABHS. The remaining 809 (90%) were accepted as non-GABHS cases. The percentages of patients having Centor score of 3 or greater, neutrophilia, lymphocytopenia, and CRP values of greater than 5-fold normal upper reference range were significantly higher in GABHS patients. Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis.