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Indian Journal of Otolaryngology and... Jun 2023Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response....
Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response. Therefore, physicians should be careful about recurrent infections in patients under anti-tumor necrosis factor agents.
PubMed: 37274971
DOI: 10.1007/s12070-022-03203-0 -
Asian Journal of Surgery Oct 2023
Topics: Humans; Peritonsillar Abscess; Neck
PubMed: 37268469
DOI: 10.1016/j.asjsur.2023.05.086 -
Cureus Apr 2023Lemierre's syndrome (LS) is a rare medical condition that involves an acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein...
Lemierre's syndrome (LS) is a rare medical condition that involves an acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with embolic spread to organs like the kidneys, lungs, and large joints. Only very little literature has reported central nervous system involvement with LS. This is a case of 34-year-old woman with right-sided neck pain, swallowing difficulties, and a sore throat of 3 days duration at the time of presentation. CT of the neck with contrast showed a ruptured right peritonsillar abscess and thrombus in the right internal jugular vein suspicious of thrombophlebitis. The patient was managed for LS with IV antibiotics and anticoagulation. However, her clinical course was complicated by cranial nerve XII palsy, which is an extremely rare manifestation of LS.
PubMed: 37252571
DOI: 10.7759/cureus.38181 -
The Journal of Laryngology and Otology Sep 2023Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in... (Review)
Review
BACKGROUND
Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.
METHODS
A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.
RESULTS
Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.
CONCLUSION
Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.
Topics: Humans; Peritonsillar Abscess; Metronidazole; Penicillins; Penicillin V; Drainage; Anti-Bacterial Agents
PubMed: 37194922
DOI: 10.1017/S0022215123000804 -
Cureus Apr 2023Infectious mononucleosis (IM) is caused by Epstein-Barr virus (EBV), and the condition is characterized by sore throat, fever, lymphadenopathy, and atypical...
Infectious mononucleosis (IM) is caused by Epstein-Barr virus (EBV), and the condition is characterized by sore throat, fever, lymphadenopathy, and atypical lymphocytosis. These infections are common in early childhood, with a second peak occurring in late adolescence. EBV is spread by contact with oral secretions. Most cases of IM are self-limited. However, there are associated complications, some of which can be serious and fatal. We report the case of a 20-year-old man with splenic infarction and exuberant peritonsillar abscess secondary to an EBV infection. This case highlights the importance of accurate diagnoses and frequent monitoring in IM patients, given the risk of airway obstruction.
PubMed: 37182037
DOI: 10.7759/cureus.37414 -
Danish Medical Journal Apr 2023No Danish validated patient-reported outcome measure (PROM) exises for assessing throat-related quality of life in patients with recurrent acute tonsillitis (RT) and...
INTRODUCTION
No Danish validated patient-reported outcome measure (PROM) exises for assessing throat-related quality of life in patients with recurrent acute tonsillitis (RT) and chronic tonsillitis (CT). We aimed to translate and linguistically validate the Tonsillectomy Outcome Inventory 14 (TOI-14) into Danish and describe scores in RT and CT patients before and after tonsillectomy as well as in healthy controls.
METHODS
We followed the guideline for PROM translation and cultural adaption set out by the Quality of Life Special Interest Group - Translation and Cultural Adaptation group formed by ISPOR. We included RT and CT patients undergoing elective tonsillectomy, who answered the questionnaire pre- and post-operatively (six-month follow-up) as well as healthy controls who answered the questionnaire once.
RESULTS
A Danish version of the TOI-14 was developed according to the guideline. A total of 49 RT patients, 34 CT patients and 67 controls were included in the final analysis. Preoperatively, RT and CT patients had markedly higher TOI-14 scores than controls (mean total scores: RT: 45.6; CT: 21.7; controls: 8.9, both p less-than 0.001). Post-operatively, scores fell to levels similar to those of controls (RT: 10.2, p = 0.51; CT: 4.7, p = 0.05).
CONCLUSION
We translated, culturally adapted and linguistically validated the Danish version of the TOI-14, finding scores in RT patients, CT patients and controls similar to those recorded by previous studies in German, English and Finnish.
FUNDING
The Lundbeck Foundation, grant #R185-2014-2482.
TRIAL REGISTRATION
Central Denmark Region #1-16-02-723-20.
Topics: Humans; Tonsillectomy; Quality of Life; Tonsillitis; Peritonsillar Abscess; Translations; Surveys and Questionnaires; Chronic Disease; Reproducibility of Results
PubMed: 37125826
DOI: No ID Found -
Pediatric Rheumatology Online Journal Apr 2023Kawasaki disease (KD) is a systemic inflammatory condition primarily affecting young children. Although 90% of KD patients present with variable head and neck... (Review)
Review
BACKGROUND
Kawasaki disease (KD) is a systemic inflammatory condition primarily affecting young children. Although 90% of KD patients present with variable head and neck manifestations, especially cervical lymphadenopathy, peritonsillar, retropharyngeal and parapharyngeal involvement are uncommonly reported as initial manifestations of KD.
CASE REPORT
Eight-year-old girl with prolonged fever, clinical and a radiological picture suggestive of retropharyngeal abscess, unresponsive to three changes in the antibiotic regimen and surgical drainage. The disease progressed with the development of additional signs and symptoms as non-purulent conjunctivitis (with uveitis), mucosal involvement (strawberry tongue and cracked lips), edema of her hands and feet, and arthritis. A diagnosis of Kawasaki disease was reached with complete remission after Intravenous Immunoglobulin (IVIG) treatment. In addition, we present a literature review of similar cases reported in the last thirty years.
CONCLUSION
Kawasaki disease requires a high index of suspicion and awareness of unusual presentations. It should be kept in mind as one of the differential diagnosis of patients with febrile inflammation of the retropharyngeal and parapharyngeal spaces who do not respond to antibiotic treatment in the relevant clinical context.
Topics: Child; Female; Humans; Child, Preschool; Mucocutaneous Lymph Node Syndrome; Retropharyngeal Abscess; Fever; Inflammation; Neck; Anti-Bacterial Agents
PubMed: 37046311
DOI: 10.1186/s12969-023-00812-z -
Ear, Nose, & Throat Journal Apr 2023The purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and...
OBJECTIVE
The purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and parapharyngeal abscesses.
METHODS
A retrospective chart review of patients diagnosed with retropharyngeal or parapharyngeal abscess from 2001 to 2021 was performed. Epidemiological characteristics, clinical signs, investigations, medical treatment, and surgical interventions were analyzed for each patient.
RESULTS
A total of 30 patients with retropharyngeal or parapharyngeal abscess were identified. Computed tomography was performed in all cases, and magnetic resonance imaging was performed in three cases. Twelve patients had a "pure" retropharyngeal abscess, nine patients had a prestyloid abscess, one patient had a prestyloid abscess associated with a peritonsillar abscess, three patients had a retrostyloid abscess, and five patients had a prestyloid abscess associated with a retropharyngeal abscess or a retrostyloid abscess. The median long axis of the abscess was 42 cm. All patients received intravenous antibiotics for a median period of 8 days [4-30]. Seventeen patients required surgical trans-cervical drainage. Other patients underwent transoral or transnasal drainage. The pus culture revealed no growth in six cases, (four cases), methicillin-sensitive (two cases), (two cases), (one case), Fungi (two cases), and (a twelve-year-old boy). It was not documented in twelve cases. Histological examination revealed caseofollicular tuberculosis in a 53-year-old man. In 25 patients, no adverse events were observed during follow-up. Five patients had an unfavorable outcome.
CONCLUSION
We have found an increase in the incidence of these infections in recent years. Computed tomography is the best imaging examination for the diagnosis and follow-up of retropharyngeal and parapharyngeal abscess. Early drainage and antimicrobial therapy are essential for rapid recovery and prevention of complications of these abscesses.
PubMed: 37019663
DOI: 10.1177/01455613231169232 -
Cureus Feb 2023Background Peritonsillar abscess is one of the most common deep-space infections of the head and neck, accounting for significant healthcare costs in the United States....
Background Peritonsillar abscess is one of the most common deep-space infections of the head and neck, accounting for significant healthcare costs in the United States. Contributing to this expenditure is the trend of increased usage of computed tomography (CT), particularly in the emergency department. However, CT can be falsely positive for peritonsillar abscess, prompting unnecessary drainage attempts that yield no purulence. The false positive findings question the accuracy of CT in diagnosing peritonsillar abscess. Objectives The objective of the study was to compare the accuracy of CT with clinical exam to assess if CT is warranted in peritonsillar abscess diagnosis. Methods A retrospective study was performed of patients presenting to eight Orlando emergency departments with throat pain from January 1, 2013, to April 30, 2013. Patients with clinical diagnoses of peritonsillar abscesses were reviewed. A note was made whether CT was performed and if peritonsillar abscess was seen. The reads were compared to the results of procedural intervention for abscess drainage to assess the accuracy of CT in diagnosing peritonsillar abscess. Results There were 116 patients diagnosed with peritonsillar abscess, of which 99 underwent CT scans to aid in diagnosis. Among these 99 patients, 23 received procedural intervention, with 16 having a return of purulence (69.6%), and seven remaining without purulence (30.4%). Conclusion This study highlights the potential inaccuracies of CT scan in diagnosing peritonsillar abscess, as 30.4% of scans interpreted as abscess lacked purulence on intervention. Given these findings, clinicians could serve as better fiscal stewards by using history and exam to guide management in the majority cases with infectious processes of the oropharynx.
PubMed: 36919070
DOI: 10.7759/cureus.34820 -
Acta Otorrinolaringologica Espanola 2023This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological... (Review)
Review
INTRODUCTION
This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI).
MATERIALS AND METHODS
In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded.
RESULTS
From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases.
CONCLUSIONS
The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.
Topics: Humans; Pandemics; Retrospective Studies; Tonsillectomy; COVID-19; Communicable Disease Control; Peritonsillar Abscess; Tonsillitis; Delivery of Health Care
PubMed: 36906064
DOI: 10.1016/j.otoeng.2022.04.003