Peritonsillar Abscess
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Basics
Description
- Suppurative complication of tonsillitis where infection spreads outside the tonsillar capsule between the palatine tonsil and pharyngeal muscles
- Most common deep infection of the head and neck (incidence of 30/100,000 per year)
- In the U.S., 45,000 cases annually
- Occurs in all ages, more commonly in young adults (mean age 20–40 yr)
- Occurs most commonly November–December, April–May (coincides with highest incidence rates of streptococcal pharyngitis)
- Complications:
- Airway compromise (uncommon)
- Sepsis (uncommon)
- Recurrence (12–15%)
- Extension to lateral neck or mediastinum
- Spontaneous perforation and aspiration pneumonitis
- Jugular vein thrombosis (Lemierre syndrome)
- Poststreptococcal sequelae (glomerulonephritis, rheumatic fever)
- Hemorrhage from extension and erosion into carotid sheath
- Severe dehydration
- Intracranial extension (meningitis, cavernous sinus thrombosis, cerebral abscess)
- Dural sinus thrombosis
Etiology
- 2 theories explain the development of peritonsillar abscess (PTA):
- Direct bacterial invasion into deeper tissues in the patient with acute pharyngitis
- Acute obstruction and bacterial infection of small salivary glands (Weber glands) in the superior tonsil
- Smoking may be a risk factor
- Most common pathogens:
- Group-A Streptococcus
- Staphylococcal species, including methicillin-resistant Staphylococcus aureus (MRSA)
- Anaerobes (Prevotella, Peptostreptococcus, Fusobacterium)
- Polymicrobial
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Suppurative complication of tonsillitis where infection spreads outside the tonsillar capsule between the palatine tonsil and pharyngeal muscles
- Most common deep infection of the head and neck (incidence of 30/100,000 per year)
- In the U.S., 45,000 cases annually
- Occurs in all ages, more commonly in young adults (mean age 20–40 yr)
- Occurs most commonly November–December, April–May (coincides with highest incidence rates of streptococcal pharyngitis)
- Complications:
- Airway compromise (uncommon)
- Sepsis (uncommon)
- Recurrence (12–15%)
- Extension to lateral neck or mediastinum
- Spontaneous perforation and aspiration pneumonitis
- Jugular vein thrombosis (Lemierre syndrome)
- Poststreptococcal sequelae (glomerulonephritis, rheumatic fever)
- Hemorrhage from extension and erosion into carotid sheath
- Severe dehydration
- Intracranial extension (meningitis, cavernous sinus thrombosis, cerebral abscess)
- Dural sinus thrombosis
Etiology
- 2 theories explain the development of peritonsillar abscess (PTA):
- Direct bacterial invasion into deeper tissues in the patient with acute pharyngitis
- Acute obstruction and bacterial infection of small salivary glands (Weber glands) in the superior tonsil
- Smoking may be a risk factor
- Most common pathogens:
- Group-A Streptococcus
- Staphylococcal species, including methicillin-resistant Staphylococcus aureus (MRSA)
- Anaerobes (Prevotella, Peptostreptococcus, Fusobacterium)
- Polymicrobial
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