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Clinical Case Reports Sep 2022We present an unusual case of Ludwig's angina secondary to a left tonsillar phlegmon in a previously fit and well 50-year-old woman. This tonsillar phlegmon spread along...
We present an unusual case of Ludwig's angina secondary to a left tonsillar phlegmon in a previously fit and well 50-year-old woman. This tonsillar phlegmon spread along the peritonsillar/parapharyngeal plane to cause a diffuse cellulitis and collection in the submental, sublingual, and submandibular spaces despite empirical intravenous antibiotic therapy.
PubMed: 36172328
DOI: 10.1002/ccr3.6325 -
International Journal of Molecular... Sep 2022Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are...
Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ2 test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production.
Topics: Anti-Bacterial Agents; Biofilms; Humans; Peritonsillar Abscess; Prospective Studies; Staphylococcus aureus; Tonsillitis
PubMed: 36142185
DOI: 10.3390/ijms231810273 -
Clinical Infectious Diseases : An... Feb 2023Most pharyngotonsillitis guidelines focus on the identification of group A streptococci (GAS), guided by clinical scores determining whom to test with a rapid antigen...
Associations Between Findings of Fusobacterium necrophorum or β-Hemolytic Streptococci and Complications in Pharyngotonsillitis-A Registry-Based Study in Southern Sweden.
BACKGROUND
Most pharyngotonsillitis guidelines focus on the identification of group A streptococci (GAS), guided by clinical scores determining whom to test with a rapid antigen detection test. Nevertheless, many patients testing negative with this test are evaluated for group C/G streptococci (GCS/GGS) and Fusobacterium necrophorum, yet their importance remains debated. Our primary aim was to evaluate associations between complications and findings of F. necrophorum, GAS, or GCS/GGS in pharyngotonsillitis.
METHODS
This was a retrospective, registry-based study of pharyngotonsillitis cases tested for F. necrophorum (polymerase chain reaction) and β-hemolytic streptococci (culture) in the Skåne Region, Sweden, in 2013-2020. Patients with prior complications or antibiotics (within 30 days) were excluded. Data were retrieved from registries and electronic charts. Logistic regression analyses were performed with a dichotomous composite outcome of complications as primary outcome, based on International Classification of Diseases, Tenth Revision, codes. Cases with negative results (polymerase chain reaction and culture) were set as reference category. Complications within 30 days were defined as peritonsillar or pharyngeal abscess, otitis, sinusitis, sepsis or septic complications, recurrence of pharyngotonsillitis (after 15-30 days) or hospitalization.
RESULTS
Of 3700 registered cases, 28% had F. necrophorum, 13% had GCS/GGS, 10% had GAS, and 54% had negative results. The 30-day complication rates were high (20%). F. necrophorum (odds ratio, 1.8; 95% confidence interval, 1.5-2.1) and GAS (1.9; 1.5-2.5) were positively associated with complications, whereas GCS/GGS were negatively associated (0.7; 0.4-0.98).
CONCLUSIONS
Our results indicate that F. necrophorum is a relevant pathogen in pharyngotonsillitis, whereas the relevance of testing for GCS/GGS is questioned. However, which patient to test and treat for F. necrophorum remains to be defined.
Topics: Humans; Pharyngitis; Fusobacterium necrophorum; Retrospective Studies; Sweden; Fusobacterium Infections; Tonsillitis; Streptococcus pyogenes
PubMed: 36069108
DOI: 10.1093/cid/ciac736 -
Cureus Jul 2022Group A beta-hemolytic streptococcus (GAS) is a gram-positive bacteria found in the upper respiratory tract that can cause disease with a wide gamut of symptoms ranging...
Group A beta-hemolytic streptococcus (GAS) is a gram-positive bacteria found in the upper respiratory tract that can cause disease with a wide gamut of symptoms ranging from pharyngitis to peritonsillar abscess, pneumonia, meningitis, and acute rheumatic fever (ARF). The primary goal of antibiotic therapy is to prevent complications of the primary infection such as ARF. ARF is defined by the revised Jones criteria. The Jones criteria have been modified to account for the moderate- to high-risk populations. The mechanism of the development of ARF from pharyngitis is not well understood, but the leading theory is molecular mimicry. The host's own immune system that responds to bacterial virulence factors develops autoantibodies that attack the host tissue. ARF typically develops two to four weeks post pharyngitis. Markers such as antistreptolysin O rise by week 2-3. The rapid streptococcal antigen is often negative by the time ARF develops. We present a case of a 23-year-old male with no past medical history who presented with a chief complaint of fever and sore throat for one week associated with new-onset chest pain. The patient had a fever with normal blood pressure. Labs showed mild leukocytosis, elevated troponin I, and positive Group A strep polymerase chain reaction (PCR). He was initially treated with aspirin 81 mg, antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs) in the emergency room. The patient was subsequently started on prednisone 60 mg as he showed no clinical improvement. His initial echocardiography (ECHO) showed a left ventricular ejection fraction (LVEF) of 55%. Repeat ECHO showed LVEF of 45% with regional wall motion abnormalities (RWMA). His cardiac troponin continued to rise with EKG changes on day 7. With the addition of steroids, the patient's clinical symptoms, as well as EKG and ECHO findings, improved. The patient was discharged with penicillin benzathine for 12 weeks. Case reports of acute carditis presenting concomitantly with pharyngitis are limited. The diagnosis of post-streptococcus complications relies on antistreptolysin O titer (ASOT) serology. With the increased availability of more acute diagnostic markers such as PCR, troponin, and ECHO, GAS confirmation can potentially be obtained within one hour and maybe in the future in the diagnosis of early-onset ARF.
PubMed: 36039237
DOI: 10.7759/cureus.27282 -
Hong Kong Medical Journal = Xianggang... Aug 2022
Topics: Airway Obstruction; Child; Humans; Intubation, Intratracheal; Laryngeal Masks
PubMed: 35989433
DOI: 10.12809/hkmj219435 -
Complicated peritonsillar abscess extending into the buccal space: an unusual clinical presentation.British Journal of Hospital Medicine... Jul 2022
Topics: Drainage; Humans; Peritonsillar Abscess; Tomography, X-Ray Computed
PubMed: 35938759
DOI: 10.12968/hmed.2021.0591 -
National Journal of Maxillofacial... 2022Descending mediastinal abscesses arising from oral (dental or peritonsillar abscess) or deep neck infections (DNIs) often become fatal without surgical drainage....
Descending mediastinal abscesses arising from oral (dental or peritonsillar abscess) or deep neck infections (DNIs) often become fatal without surgical drainage. Odontogenic origin was the most common cause of DNIs. We report the first clinical case of a patient with descending mediastinal abscess caused by DNI from Eggerthia catenaformis a Gram-positive anaerobic rod that can be rarely a human pathogen. The patient underwent the extraction of carious molars, cervical and thoracic surgical drainage, and targeted antibiotic therapy with resolution of the infection.
PubMed: 35911816
DOI: 10.4103/njms.njms_463_21 -
International Journal of Environmental... Jul 2022Background: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine,...
Background: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine, its role in the immune system has recently been studied. The current study aimed to test the impact of vitamin D deficiency on the rate of recurrent acute tonsillitis in children. Methods: According to Paradise criteria, two hundred forty-two children with recurrent acute tonsillitis were recruited. A group of healthy children (n = 262) was also recruited as controls. Poisson regression was run to predict the number of tonsillitis episodes per year based on vitamin D levels. The mean vitamin D level in the study group was lower than in the control group (p < 0.0001). Poisson regression of the rate of recurrent tonsillitis and vitamin D level (OR = 0.969 (95% CI, 0.962−0.975)) showed that for every single unit increase in vitamin D level, there was a 3.1% decrease in the number of tonsillitis episodes per year (p < 0.0001). Conclusions: Vitamin D deficiency is associated with higher rates of recurrent acute tonsillitis. Future controlled trials should investigate the role of vitamin D supplementation in reducing the rate of recurrent tonsillitis.
Topics: Case-Control Studies; Child; Humans; Jordan; Peritonsillar Abscess; Recurrence; Respiration Disorders; Tonsillitis; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 35886596
DOI: 10.3390/ijerph19148744 -
European Archives of... Jan 2023Several theories have been proposed regarding the origin of lateral neck cysts (LNC). Besides complete surgical resection ipsilateral tonsillectomy and dissection of a...
PURPOSE
Several theories have been proposed regarding the origin of lateral neck cysts (LNC). Besides complete surgical resection ipsilateral tonsillectomy and dissection of a tract or its remnants is sometimes recommended. In this retrospective trial we wanted to evaluate if patients, who received LNC resection only, develop complications or recurrence to justify this surgical strategy.
METHODS
Patients who received LNC resection between 2004 and 2017 at the Ear Nose and Throat Department of a university hospital were included. Data was collected from the clinic database and through a structured telephone interview.
RESULTS
A total of 126 patients met the inclusion criteria. In this collective, the diagnosis of a lateral neck cyst was confirmed histologically. Mean age at time of operation was 38 years (± 14.6). The median follow-up time was 7 years (range 3-18). None of the participants experienced recurrent unilateral pharyngitis or tonsillitis during follow-up. Furthermore, there was no case of postoperative peritonsillar, neck phlegmon or neck abscess. No patient reported recurrence of LNC.
CONCLUSIONS
Sole complete resection of LNCs is sufficient to avoid postoperative infections and recurrences. Therefore, ipsilateral tonsillectomy and tract dissection is not necessary in routine cases of LNC surgery.
Topics: Humans; Adult; Tonsillectomy; Retrospective Studies; Tonsillitis; Pharyngitis; Cysts; Peritonsillar Abscess; Recurrence
PubMed: 35852652
DOI: 10.1007/s00405-022-07542-0 -
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...
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 24 h 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.
PubMed: 35846592
DOI: 10.1016/j.otorri.2022.04.003