RESUMO
Background & objectives Acute tonsillitis is a disease that can often be cured with medical treatment. However, complications may occur during this disease process. One of these complications is peritonsillar abscess. In recent years, biomarkers have been frequently used in the diagnosis of diseases. The aim of the study was to reveal whether peritonsillar abscess develops after acute tonsillitis, and acute tonsillitis can be differentiated using biomarkers and which biomarker has higher predictive value for this differentiation. Methods The control group consisted of individuals who were operated for septoplasty in the otolaryngology clinic, and the acute tonsillitis group consisted of individuals diagnosed with acute tonsillitis in the same clinic. Both groups were statistically compared in terms of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII), infection discrimination index (IDI), plateletcrit (PCT) and lymphocyte to monocyte ratio (LMR) biomarkers. Statistically, significant biomarker values were compared between the subgroups in the tonsillitis group of those who had only acute tonsillitis and those who had peritonsillar abscess due to acute tonsillitis. Receiver operating characteristics (ROC) curve analysis was performed on biomarkers for their ability to predict the presence of peritonsillar abscess. Results When the individuals who had only acute tonsillitis and those who had acute tonsillitis with peritonsillar abscess were compared in terms of biomarkers, there was a statistically significant difference between the mean MPV, SII and PCT (P=0.010, 0.021, 0.023, respectively). ROC analysis was performed to calculate the sensitivity and specificity of MPV, PCT and SII for the diagnosis of acute tonsillitis with peritonsillar abscess (sensitivity-specificity for MPV 51.9-72.7%, for SII 94.2-32.7%, for PCT 71.2-50.9%, respectively). Interpretation & conclusions MPV, SII and PCT biomarkers may be useful to help clinicians predict peritonsillar abscess due to acute tonsillitis.
Assuntos
Biomarcadores , Linfócitos , Abscesso Peritonsilar , Curva ROC , Tonsilite , Humanos , Abscesso Peritonsilar/sangue , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/microbiologia , Abscesso Peritonsilar/patologia , Tonsilite/sangue , Tonsilite/complicações , Tonsilite/microbiologia , Tonsilite/patologia , Tonsilite/cirurgia , Biomarcadores/sangue , Feminino , Masculino , Adulto , Linfócitos/patologia , Doença Aguda , Neutrófilos , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Adolescente , Volume Plaquetário Médio , Pessoa de Meia-Idade , Monócitos , Plaquetas/patologia , Adulto JovemRESUMO
S100A8/A9 (Calprotectin) serves as a biomarker for various inflammatory diseases, such as for peritonsillar abscess (PTA). Recently, the PTA score was developed for reliable PTA identification. It uses a combination of characteristic clinical symptoms and elevated calprotectin levels in serum and saliva to determine this score. Although well-established point-of-care tests (POCT) to determine serum or faecal calprotectin levels exist, a reliable and rapid tool to analyse salivary calprotectin has not yet been described. In this study, we analysed the potential of the QUANTUM BLUE sCAL Test (QBT, BÜHLMANN Laboratories AG, Switzerland) to determine S100A8/A9 levels during outpatient management. These QBT measurements are combined with other clinical factors to determine the PTA score. Significantly higher calprotectin levels were determined by QBT in patients with PTA compared to healthy controls. The receiver operating characteristic (ROC) curves for the QBT revealed cut-off values of 2940 ng/ml (sensitivity = 0.88, specificity = 0.78) in serum and 5310 ng/ml (sensitivity = 0.80, specificity = 0.50) in saliva. By adding the QBT results to determine PTA values, a ROC analysis provided a statistical cut-off score of 2.5 points to identify the existence of a PTA with a sensitivity of 100% and a specificity of 89.3%. The QUANTUM BLUE sCAL Test (QBT) is an appropriate POCT to determine serum and salivary calprotectin levels. Thus, PTA scores can be determined within a short time frame by applying the QBT during outpatient management.
Assuntos
Abscesso Peritonsilar/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Biomarcadores/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/sangue , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Abscesso Peritonsilar/sangue , Abscesso Peritonsilar/metabolismo , Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos , Curva ROC , Saliva/metabolismo , Suíça , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to clarify the role of serum phosphorylcholine (PC)-specific immunoglobulin M (IgM) as a natural antibody against infectious diseases. METHODS: The relationship between serum PC-specific IgM level and C-reactive protein level or white blood cell counts was examined in patients with severe upper respiratory tract infections (ie, acute epiglottitis and peritonsillar abscess). RESULTS: PC-specific IgM level was significantly negatively correlated with C-reactive protein level and white blood cell count. In addition, C-reactive protein level and white blood cell count was significantly lower in women than in men, whereas PC-specific IgM level was significantly higher in women. CONCLUSIONS: PC-specific IgM is suggested to have protective and suppressive effects against the progression of infectious and inflammatory reactions. Higher levels of PC-specific IgM in women might be one of the reasons why the incidence and severity of acute epiglottitis and peritonsillar abscess are lower in women.
Assuntos
Epiglotite/sangue , Imunoglobulina M/sangue , Abscesso Peritonsilar/sangue , Fosforilcolina/imunologia , Adulto , Proteína C-Reativa/metabolismo , Epiglotite/imunologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Abscesso Peritonsilar/imunologia , Adulto JovemRESUMO
Peritonsillar abscess (PTA) is a very frequent reason for urgent outpatient consultation and otolaryngological hospital admission. Early, correct diagnosis and therapy of peritonsillar abscess are important to prevent possible life-threatening complications. Based on physical examinations, a reliable differentiation between peritonsillar cellulitis and peritonsillar abscess is restricted. A heterodimeric complex called calprotectin consists of the S100 proteins A8 and A9 (S100A8/A9) and is predominantly expressed not only in monocytes and neutrophils but also in epithelial cells. Due to its release by activated phagocytes at local sites of inflammation, we assumed S100A8/A9 to be a potential biomarker for peritonsillar abscess. We examined serum and saliva of patients with peritonsillitis, acute tonsillitis, peritonsillar abscess, and healthy controls and found significantly increased levels of S100A8/A9 in patients with PTA. Furthermore, we could identify halitosis, trismus, uvula edema, and unilateral swelling of the arched palate to be characteristic symptoms for PTA. Using a combination of these characteristic symptoms and S100A8/A9 levels, we developed a PTA score as an objective and appropriate tool to differentiate between peritonsillitis and peritonsillar abscess with a sensitivity of 92% and specificity of 93%.
Assuntos
Calgranulina A/sangue , Calgranulina B/sangue , Abscesso Peritonsilar/sangue , Adulto , Biomarcadores/sangue , Biomarcadores/metabolismo , Calgranulina A/metabolismo , Calgranulina B/metabolismo , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Abscesso Peritonsilar/metabolismo , Abscesso Peritonsilar/patologia , Saliva/metabolismoRESUMO
Objective:The aim of this study is to investigate the clinical value of visual analogue scale combined with serum C-reactive protein in evaluating the prognosis of peritonsillar abscess. Method:Thirty-one patients be hospitalized with peritonsillar abscess were enrolled in this study, who were treated by puncture and antibiotic from January 2016 to February 2017. VAS and CRP level were detected on the 1, 3, 5 day of hospitalization for all the patients. Result:Twenty-five patients were cured after 5 days. The 1, 3, 5 day's VAS of forty-seven patients were 8.20±1.25, 4.42±1.05, 1.41±0.55, respectively, and the CRP level were (62.41±8.61), (20.46±5.32), (5.41±1.95)mg/L, respectively (P<0.05) in the three days. The 1, 3 day's VAS of six patients were 8.41±1.44, 7.37±1.15, respectively, and the CRP level were (59.85±8.35), (45.33±7.46)mg/L, with no significant difference (P>0.05) in the two days. But the fifth day' VAS was 1.55±0.65, and the CRP level was 10.24±2.57 mg/L, with statistically significant difference (P<0.05)) compared with the first day. Conclusion:Subjective evaluation used by VAS and objective evaluation used by CRP level to assess the prognosis of peritonsillar. Therefore, VAS score combined with C-reactive protein detection is more accurate for the prognosis of tonsil abscess evaluation.î.
Assuntos
Proteína C-Reativa/análise , Abscesso Peritonsilar/sangue , Escala Visual Analógica , Humanos , Medição da Dor , Abscesso Peritonsilar/patologia , PrognósticoRESUMO
Abstract Introduction: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. Objective: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. Methods: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. Results: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p < 0.05), the platelet count was not significantly different among the patient and control groups (p > 0.05). Conclusion: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.
Resumo Introdução: O abscesso periamigdaliano (APA) é uma doença infecciosa grave do tecido tonsilar. O seu tratamento geralmente requer uma abordagem medicamentosa e cirúrgica para o alívio dos sintomas. Recentemente, além do acompanhamento clínico, alguns marcadores inflamatórios, como o volume plaquetário médio (VPM) e a relação neutrófilos/linfócitos (RN/L), foram considerados marcadores de monitoramento adicionais em doenças inflamatórias. Objetivo: O objetivo deste estudo foi descrever o papel os VPM e a RN/L em pacientes com APA. Método: Estudo retrospectivo realizado com 88 pacientes com ATP e 88 indivíduos saudáveis. Analisamos a contagem de leucócitos, neutrófilos, linfócitos, plaquetas, proteína C-reativa (PCR), VPM e RN/L e a comparamos os valores entre o grupo de pacientes e grupo controle. Resultados: Os níveis de VPM eram significativamente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de corte de 8,7 para o VPM foi considerado ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 75, 65,9, 68 e 72%, respectivamente. Os níveis da RN/L eram significantemente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de 3,08 para a RN/L foi o valor de corte ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 90,9, 90,9, 90,9 e 90,9%, respectivamente. Enquanto a contagem dos valores de leucócitos, neutrófilos, linfócitos e PCR foi significantemente diferente entre os grupos de pacientes e controle (p<0,05), a contagem de plaquetas não foi (p>0,05). Conclusão: Os valores de VPM e RN/L sugerem que estes são parâmetros inflamatórios de acompanhamento rápido, barato e confiável, e que podem ser facilmente integrados à prática diária para o tratamento de APA, exceto pela contagem de plaquetas.
Assuntos
Humanos , Masculino , Feminino , Adulto , Abscesso Peritonsilar/sangue , Contagem de Linfócitos , Volume Plaquetário Médio , Neutrófilos , Biomarcadores/sangue , Abscesso Peritonsilar/patologia , Estudos de Casos e Controles , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. OBJECTIVE: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. METHODS: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. RESULTS: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p<0.05), the platelet count was not significantly different among the patient and control groups (p>0.05). CONCLUSION: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.
Assuntos
Contagem de Linfócitos , Volume Plaquetário Médio , Neutrófilos , Abscesso Peritonsilar/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Abscesso Peritonsilar/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The aim of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) can be used as a predictor for deep neck space infections (DNSIs) that occur as a complication of acute bacterial tonsillitis in the pediatric population. MATERIALS AND METHODS: We evaluated the NLR values of 180 pediatric patients diagnosed with acute bacterial tonsillitis with or without DNSI who presented to the Otolaryngology Department of Marmara University Hospital between 2010 and 2013. In cases in which DNSI was suspected, the patients underwent complete otolaryngological examination and radiological imaging including CT and MRI. NLR was calculated in all the subjects and was compared between the patients with acute bacterial tonsillitis without DNSI and those with DNSI. RESULTS: With regard to the tonsillitis-related complications, 17 patients had peritonsillar abscess (9.4%); five, parapharyngeal abscess (2.8%); and two, retropharyngeal abscess (1.1%). The mean NLR was significantly higher in the patients of acute bacterial tonsillitis with DNSI (P<0.05). The optimum cut-off value of NLR was determined to be 5.4. CONCLUSION: This study is the first to investigate the relationship between NLR and DNSI as a complication of acute bacterial tonsillitis. The results demonstrated that the NLR value could be a potential laboratory parameter for diagnosing DNSIs.
Assuntos
Infecções Bacterianas/complicações , Linfócitos/citologia , Neutrófilos/citologia , Abscesso Peritonsilar/sangue , Abscesso Retrofaríngeo/sangue , Tonsilite/complicações , Doença Aguda , Adolescente , Infecções Bacterianas/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Contagem de Leucócitos/métodos , Masculino , Pescoço/diagnóstico por imagem , Pescoço/patologia , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/etiologia , Valor Preditivo dos Testes , Radiografia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/etiologia , Estudos Retrospectivos , Tonsilite/sangueRESUMO
Peritonsillar abscess is a frequently encountered otorhinolaryngological emergency, but the characteristics of patients with this disease have not been described in detail. The objective of this study was to delineate prognostic factors associated with peritonsillar abscess and the effects of early surgical drainage for the treatment of peritonsillar abscess. We conducted a retrospective analysis of the medical records of 240 consecutive patients with PTA during the period from 2007 to 2013. Univariate analysis indicated that the period between symptom onset and relief was significantly longer in patients with high levels of C-reactive protein (CRP) (>8.53 mg/dL, p = 0.0073) and without early surgical drainage of pus (p < 0.0001). Multivariate analysis identified both of these values as independently associated with longer duration of symptoms (high CRP, P < 0.0001; no early drainage, P < 0.0001). Univariate analysis indicated that the duration between symptom onset and complete recovery from the disease was significantly longer with age ≥40 years (P = 0.0004), no history of recurrent tonsillitis (P = 0.022), high CRP level (P = 0.0017), and no early surgical drainage of the abscess (P = 0.0014). Multivariate analysis identified older age (P = 0.0004), high CRP level (P = 0.0001), and no early drainage (P < 0.0001) as independently associated with longer duration between symptom onset and complete recovery. Early surgical drainage of the abscess is important for the treatment of peritonsillar abscess. Patients ≥40 years old with peritonsillar abscess and high CRP levels should be recognized as a high-risk group.
Assuntos
Proteína C-Reativa/metabolismo , Drenagem , Abscesso Peritonsilar/sangue , Abscesso Peritonsilar/cirurgia , Adulto , Fatores Etários , Análise de Variância , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: Infection markers are appreciated supplements in the clinical diagnosis of ear, nose and throat (ENT) infections. We aimed to examine the differential diagnostic usefulness of C-reactive protein (CRP), white blood cell count (WBC) and absolute neutrophil count (ANC) according to severity of middle ear and tonsillar infections. MATERIAL AND METHODS: This was a retrospective study including all patients admitted to the ENT Department, Aarhus University Hospital, from January 2001 to December 2008 and diagnosed with acute otitis media, mastoidismus, acute mastoiditis, acute tonsillitis, peritonsillar abscess, parapharyngeal abscess and necrotizing fasciitis. RESULTS: A total of 1,773 patients were included. Between the tonsil subgroups, significant differences were found in CRP (p < 0.001), WBC (p < 0.001) and ANC (p < 0.001) levels. However, sensitivities and specificities related to differential diagnostics were low. In the middle ear group, no differences in CRP (p = 0.84), WBC (p = 0.46), and ANC (p = 0.72) levels were found. The number of CRP levels above the reference value was significantly higher than the corresponding number of WBC and ANC levels. A trend (non-significant) was found towards lower parameter levels in acute tonsillitis and peritonsillar abscess patients who grew Staphylococcus aureus compared with patients infected with other bacteria. CONCLUSION: CRP and ANC levels were related to severity of tonsillar-derived infections, but no such relation was found in infections with middle ear origin. None of the infection markers studied were useful for differential diagnostics. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.
Assuntos
Proteína C-Reativa/metabolismo , Fasciite Necrosante/diagnóstico , Mastoidite/diagnóstico , Neutrófilos , Otite Média/diagnóstico , Abscesso Peritonsilar/diagnóstico , Tonsilite/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Pré-Escolar , Diagnóstico Diferencial , Fasciite Necrosante/sangue , Fasciite Necrosante/microbiologia , Feminino , Infecções por Fusobacterium/sangue , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/microbiologia , Infecções por Haemophilus/sangue , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/microbiologia , Humanos , Lactente , Contagem de Leucócitos , Masculino , Mastoidite/sangue , Mastoidite/microbiologia , Pessoa de Meia-Idade , Otite Média/sangue , Otite Média/microbiologia , Gravidade do Paciente , Abscesso Peritonsilar/sangue , Abscesso Peritonsilar/microbiologia , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Tonsilite/sangue , Tonsilite/microbiologia , Adulto JovemRESUMO
The state of the proinflammatory cytokines tumor necrosis factor-alpha, interleukin (IL)-1 beta, and IL-6, and the anti-inflammatory cytokine IL-10 was studied in patients with bacterial quinsy over time. There were significant and heterodirectional changes in the plasma level of proinflammatory and anti-inflammatory cytokines with the normalization of their content in the period of late convalescence. The regular shifts of proinflammatory cytokines in patients with quinsy depended on the period and clinical forms of the disease, its severity, complications, comorbidity, and the plenitude of recovery. The paper discusses a role and implication of cytokines.
Assuntos
Infecções Bacterianas/sangue , Citocinas/sangue , Faringite/sangue , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Feminino , Humanos , Interleucina-10/sangue , Interleucina-1beta/sangue , Masculino , Abscesso Peritonsilar/sangue , Abscesso Peritonsilar/tratamento farmacológico , Abscesso Peritonsilar/etiologia , Faringite/complicações , Faringite/tratamento farmacológico , Fator de Necrose Tumoral alfa/sangueRESUMO
Leukocytic intoxication index (LII) was calculated according to Ya. Ya. Kalf-Kalif formula in 184 patients with tonsillar affections. It grew from follicular and lacunar angina to paratonsillitis and paratonsillar abscesses early in the disease and fell on the treatment day 6. In chronic decompensated tonsillitis before and after tonsillectomy LII was not informative. To predict outcomes in anginas, paratonsillitis and paratonsillar abscesses, follow-up of LII is recommended.