Effect of erythritol and xylitol on Streptococcus pyogenes causing peritonsillar abscesses.

Polyols are effective against caries-causing streptococci but the effect on oropharynx-derived pyogenic streptococci is not well characterised. We aimed to study the effect of erythritol (ERY) and xylitol (XYL) against Streptococcus pyogenes isolated from peritonsillar abscesses (PTA). We used 31 clinical isolates and 5 throat culture collection strains. Inhibition of bacterial growth by polyols at 2.5%, 5% and 10% concentrations was studied and the results were scored. Amylase levels in PTA pus were compared to polyol effectivity scores (PES). Growth curves of four S. pyogenes isolates were analysed. Our study showed that XYL was more effective than ERY inhibiting 71-97% and 48-84% of isolates, respectively, depending of concentrations. 48% of clinical and all throat strains were inhibited by polyols in all concentrations (PES 3). PES was negative or zero in 26% of the isolates in the presence of ERY and in 19% of XYL. ERY enhanced the growth of S. pyogenes isolated from pus with high amylase levels. Polyols in all concentrations inhibited the growth in exponential phase. In conclusion, ERY and XYL are potent growth inhibitors of S. pyogenes isolated from PTA. Therefore, ERY and XYL may have potential in preventing PTA in the patients with frequent tonsillitis episodes.

Evaluation of the QUANTUM BLUE sCAL rapid test as a point of care tool to identify patients with peritonsillar abscess.

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.

Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study.

The present study aimed to specify diagnostics for peritonsillar abscesses (PTAs) and to clarify the role of minor salivary glands. This prospective cohort study included 112 patients with acute tonsillitis (AT) and PTA recruited at a tertiary hospital emergency department between February and October 2017. All patients completed a questionnaire concerning their current disease. Serum amylase (S-Amyl) and C-reactive protein (S-CRP) levels, tonsillar findings, and pus aspirate samples and throat cultures were analyzed. Eight of 58 PTA patients (13.8%) had no signs of tonsillar infection. The absence of tonsillar erythema and exudate was associated with low S-CRP (p<0.001) and older age (p<0.001). We also observed an inverse correlation between S-Amyl and S-CRP levels (AT, r = -0.519; PTA, r = -0.353). Therefore, we observed a group of PTA patients without signs of tonsillar infection who had significantly lower S-CRP levels than other PTA patients. These findings support that PTA may be caused by an etiology other than AT. Variations in the S-Amyl levels and a negative correlation between S-Amyl and S-CRP levels may indicate that minor salivary glands are involved in PTA development.

Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis.

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%.

Functional characterization of T-cells from palatine tonsils in patients with chronic tonsillitis.

The palatine tonsils, localized in the oropharynx, are easily accessible secondary lymphoid tissue in humans. Inflammation of the palatine tonsils, local and chronic in case of chronic tonsillitis (CT) or acute in the presence of a peritonsillar abscess (PTA), ranks among the most common diseases in otolaryngology. However, the functionality of tonsillar immune cells, notably T-cells, in the context of these immune pathologies is poorly understood. We have examined the functional status of human tonsillar T-cells in CT and compared it to the acute inflammatory setting of a PTA. Patients presenting with CT (n = 10) or unilateral PTA (n = 7) underwent bilateral tonsillectomy and a subgroup of 8 patients underwent additional blood sampling. T-cells were purified via automated magnetic selection and subjected to flow cytometry-based immunophenotyping. In addition, the response to T-cell receptor (TCR) stimulation was assessed at the level of proximal signaling, activation marker expression and proliferation. We observed no difference between the percentage of T helper (CD4(+)) cells from tonsil tissue in CT and PTA, but observed a trend towards a higher percentage of T helper cells in the blood of patients with PTA versus CT, probably reflecting an acute, systemic bacterial infection in the former cohort. Tonsils from CT harbored more PD-1(+) CD4(+) T-cells, pointing to T-cell exhaustion due to chronic infection. This notion was supported by functional studies that showed a tendency to weaker TCR responses of tonsillar T-cells from CT. Intriguingly, tonsillar T-cells recurrently featured a dampened response to T-cell receptor stimulation at the level of receptor proximal signaling steps compared to peripheral T-cells. In sum, our study documents distinct differences in tonsillar T-cell class distribution and function between the various pathological conditions. Our observations are consistent with the concept that tonsillar T-cells react to infections by eliciting specific immunological responses in chronic versus acute settings of inflammation.

The presence of minor salivary glands in the peritonsillar space.

Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.

[Clinical evaluation value of visual analogue scale combined with C-reactive protein for the prognosis of peritonsillar abscess].

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..

The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses / O papel do volume plaquetário médio e a relação neutrófilos/linfócitos em abscesso periamigdaliano

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.

The role of Fusobacterium necrophorum in pharyngotonsillitis - A review.

Fusobacterium necrophorum is a gram-negative anaerobic bacterium that is the causative agent of the invasive disease Lemierre's syndrome. In addition, it is also associated with peritonsillar abscess formation and otitis media in small children. Recent research has shown that F. necrophorum may be involved in pharyngotonsillitis especially in adolescent and young adults and that it may be the second most common bacterial cause of pharyngotonsillitis after Streptococcus pyogenes (Group A streptococci). Peritonsillar abscesses and Lemierre's syndrome due to F. necrophorum are also found in this age group, suggesting that they may be complications of F. necrophorum pharyngotonsillitis. In this review we present the present knowledge about the role of F. necrophorum in pharyngotonsillitis with special emphasis on the age distribution. We argue that F. necrophorum is an important pathogen involved in pharyngotonsillitis in the age group of 13-40 years of age and we urge clinical microbiology labs to set up the appropriate techniques to be able to detect F. necrophorum from throat swabs.

The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses.

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.

Comparison of medical versus surgical management of peritonsillar abscess: A retrospective observational study.

OBJECTIVES/HYPOTHESIS: To compare clinical characteristics and outcomes in patients presenting with peritonsillar abscess (PTA) treated with either initial medical or surgical management. STUDY DESIGN: Retrospective observational cohort. METHODS: A consecutive cohort of patients presenting between 2010 and 2014 with the final diagnosis of PTA (International Classification of Diseases, Ninth Revision code 475) were included. Comparisons between groups were evaluated using two-sample t, Wilcoxon rank sum, χ(2) , and Fisher exact tests. RESULTS: Among 297 patients who presented with PTA during the 5-year period, 97 (33%) underwent primary medical management, and 200 (67%) received surgical treatment. Patients who received initial surgical management had larger abscess size (2.6 vs. 1.3 cm, P < .001) and were and more likely to have muffled voice (79% vs. 47%, P < .001), drooling (29% vs. 17%, P = .03), peritonsillar bulge (91% vs. 66%, P < .001), trismus (65% vs. 22%, P < .001), and dysphagia (86% vs. 73%, P = .008). There was no difference in the rates of imaging (55% vs. 59%) or antibiotic administration (100% in both groups), length of hospital stay (median 2 vs. 1 day, P = .27) or complications (1% vs. 2%, P = .6). Patients treated medically were more likely to be admitted to the hospital (22% vs. 11%, P = .014) and less likely to receive steroids (78% vs. 95%, P < .001). There was no difference in return visits (20% medical vs. 14% surgical, P = .17) or failure rates (5% medical vs. 3% surgical, P = .30). CONCLUSIONS: Initial medical management can be considered in patients with less advanced symptoms or smaller abscess size without compromising outcome. Those with more advanced symptoms may benefit from surgical drainage. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1529-1534, 2016.

Descending mediastinitis in Epstein-Barr virus infection.

Our case report describes a previously healthy 34-year-old male who develops a descending mediastinitis as a complication of an Epstein-Barr virus (EBV) infection. The mediastinitis was suspected to have developed by a breakthrough of a peritonsillar abscess through the space between the alar and prevertebral space.

Epidemiology, clinical history and microbiology of peritonsillar abscess.

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA). A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken. A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5-78) years. Smokers comprised 22.0 % of the study group. The seasonal variation of PTA was statistically insignificant (p = 0.45). Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1-148.7, p = 0.001]. Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0-10.9, p = 0.0005) and had significantly longer hospital stay (p = 0.03). Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures. PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease. The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

Microarray identification of bacterial species in peritonsillar abscesses.

Peritonsillar abscess (PTA) is the most common otorhinolaryngological infection, requiring management at the special healthcare level. The microbiological findings vary due to geographical, etiological, and methodological factors. This study aimed to identify the bacterial species of PTAs by using a novel polymerase chain reaction (PCR)- and microarray-based assay, and to find causative cofactors among patients with different pathogens. We determined the bacterial findings of aspirates of pus prospectively collected from 180 PTA patients. Samples were pretreated prior to nucleic acid extraction and analyzed with a PCR- and microarray-based assay or DNA sequencing. Both methods were based on the gyrB/parE topoisomerase genes. Patients answered symptom questionnaires at admission, and their medical records were reviewed later. Altogether, 160 (89 %) aspirates of pus tested positive for bacteria, and a bacterial species was identified in 149 (83 %) of the samples. A polybacterial species was detected in 20 (13 %) and anaerobic bacteria in 77 (52 %) of the 149 samples. Fusobacterium necrophorum patients were younger (p < 0 .001) and had more severe symptoms (p = 0.04) than patients with other pathogens. Gender, smoking, or preadmission antibiotics showed no correlation with any of the pathogens. Although requiring some optimization, this microarray assay seems feasible and fast for bacterial identification directly from pus samples, and confirms the diversity of PTA pathogens. Young patients with more severe symptoms may require special attention. Species-specific antibiotic treatment of PTA remains challenging due to bacterial variations; the present assay may aid in specifying PTA antibiotic treatment in the future.

Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature.

Unsuspected tonsillar malignancy in routine tonsillectomy specimens is rare. A potentially increased risk of unsuspected tonsillar malignancy in adult patients presenting with peritonsillar abscess (PTA) was noted in a recent review. Furthermore, a literature search revealed several case reports concerning tonsillar malignancy presenting as PTA. Thus, the aim of the current study was to explore the prevalence of tonsillar malignancy in adult patients with PTA. A retrospective review of all adult patients undergoing tonsillectomy due to PTA from January 2001 to December 2012 at the Ear-Nose-Throat Department was performed. In 275 consecutive adult patients with PTA (median age 40 years, range 30-89 years), we identified one patient with unsuspected tonsillar malignancy (prevalence 0.3 %); a 40-year-old, previously healthy, male was diagnosed with acute myeloid leukaemia. Reviewing the literature, we identified 13 cases of tonsillar malignancy presenting as PTA (median age 49 years, range 2-66 years). Our data represents the only series of histological examined tonsillectomy specimens from PTA patients reported in the literature. We identified one case of unsuspected tonsillar malignancy in this relatively small series. We find it important to stress, that we had no knowledge of this patient before designing the study. Hence, the prevalence of 0.3 % is unbiased in this respect. More, and preferably, larger studies are needed to determine the prevalence with greater certainty. At present, no definitive conclusions can be made, but clinicians should be aware that PTA infrequently masquerade tonsillar malignancy.

[Pleomorphic adenoma causing a peritonsillar abscess]. / Pleomorft adenom som årsag til peritonsillær abscess.

Pleomorphic adenoma located in the soft palate is extremely rare. We report a 42-year-old woman, who presented to the ear nose & throat department with a mucosal swelling of the right soft palate mimicking a peritonsillar abscess. Drainage was attempted several times without significant results. Emergency tonsillectomy was carried out, which showed a tumour intraorally beside the right tonsil. The tumour and the tonsil were radically excised. Histological analysis of the tumour revealed a pleomorphic adenoma. At three-month follow-up the patient was doing well and MRI scan revealed a residual tumour of 6 mm.