Abstract
Peritonsillar abscess (PTA) is conventionally considered to be a complication of acute tonsillitis, but no pathogenical association has been demonstrated. To investigate the precipitating factors in the pathogenesis of PTA, the clinical status of 117 patients with PTA and 78 patients with peritonsillar cellulitis (PC) were reviewed, comparing them with 188 cases of acute tonsillitis as a control group. The period between the onset of symptoms and the date of starting hospitalized medication was 4 to 5 days in all the three groups, with no significant differences. Higher prevalence of smoking habit was noted in the PTA group (odds ratio, 1.92; 95% confidence interval, 1.17–3.16). Bacteriological culture revealed that 55 of 67 aerobic isolates were Streptococcus subspecies, with the Streptococcus milleri group (SMG) as the most common (20 isolates). Twenty-three anaerobic species were isolated. Only 51% of the patients with neither the SMG nor anaerobic bacteria were smokers, whereas 90% of the patients with both the SMG and anaerobic bacteria were smokers. We hypothesize that delay or failure to receive medical care do not contribute to the pathogenesis of PTA or PC, and that smoking is positively correlated with the occurrence of PTA, as well as the bacteriological character.
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References
Passy V (1994) Pathogenesis of peritonsillar abscess. Laryngoscope 104(2):185–190
Herzon FS, Martin AD (2006) Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep 8(3):196–202
Brook I (2004) Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 62(12):1545–1550
Dilkes MG, Dilkes JE, Ghufoor K (1992) Smoking and quinsy. Lancet 339(8808):1552
Lehnerdt G, Senska K, Fischer M, Jahnke K (2005) Smoking promotes the formation of peritonsillar abscesses. Laryngorhinootologie 84(9):676–679, (in German)
Kilty SJ, Gaboury I (2008) Clinical predictors of peritonsillar abscess in adults. Laryngorhinootologie J Otolaryngol Head Neck Surg 37(2):161–163
Gossling J (1988) Occurrence and pathogenicity of the Streptococcus milleri group. Rev Infect Dis 10(2):275–285
Han JK, Kerschner JE (2001) Streptococcus milleri: an organism for head and neck infections and abscess. Arch Otolaryngol Head Neck Surg 127(2):650–654
Udaka T, Hirai N, Shimori T et al (2007) Eikenella corrodens in head and neck infections. J Infection 54(4):343–348
Shinzato T, Saito A (1994) A mechanism of pathogenicity of “Streptococcus milleri group” in pulmonary infection: synergy with an anaerobe. J Med Microbiol 40(2):118–123
Torre V, Bucolo S, Giordano C et al (2005) Palatine tonsils in smoker and non-smoker patients: a pilot clinicopathological and ultrastructural study. J Oral Pathol Med 34(7):390–396
Ministry of Health, Labour and Welfare of Japan (2007) Japan Health Promotion & Fitness Foundation: Tobacco or health. Tokyo. Available from: http://www.health-net.or.jp/tobacco/front.html. Cited July 14, 2009
Mueller KM, Krohn BR (1980) Smoking habits and their relationship to precancerous lesions of the larynx. J Cancer Res Clin Oncol 96(2):211–217
Brook I, Frazier EH, Thompson DH (1991) Aerobic and anaerobic microbiology of peritonsillar abscess. Laryngoscope 101(3):289–292
Jousimies-Somer H, Savolainen S, Makitie A, Ylikoski J (1993) Bacteriologic findings in peritonsillar abscesses in young adults. Clin Infect Dis 16(Suppl 4):S292–S298
Hirai T, Kimura S, Mori N (2005) Head and neck infections caused by Streptococcus milleri group: an analysis of 17 cases. Auris Nasus Larynx 32:55–58
Hasegawa J, Hidaka H, Tateda M, Kudo T, Sagai S, Miyazaki M, Katagiri K, Nakanome A, Ishida E, Ozawa D, Kobayashi T (2010) An analysis of clinical risk factors of deep neck infection. Auris Nausus Larynx, Jul 5. [Epub ahead of print]
Jacobs JA, Pietersen HG, Stobberingh EE, Soeters PB (1995) Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius: clinical relevance, hemolytic and serologic characteristics. Am J Clin Pathol 104(1):547–553
Fried MP, Forrest JL (1981) Peritonsillitis: evaluation of current therapy. Arch Otolaryngol 107(5):283–286
Georgalas C, Kanagalingam J, Zainal A, Ahmed H, Singh A, Patel KS (2002) The association between periodontal disease and peritonsillar infection: a prospective study. Otolaryngol Head Neck Surg 126(1):91–94
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We thank Dr Hideaki Suzuki (Department of Otolaryngology, University of Occupational and Environmental Health) for his comments on the earlier version of this manuscript.
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Hidaka, H., Kuriyama, S., Yano, H. et al. Precipitating factors in the pathogenesis of peritonsillar abscess and bacteriological significance of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis 30, 527–532 (2011). https://doi.org/10.1007/s10096-010-1114-9
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DOI: https://doi.org/10.1007/s10096-010-1114-9