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1.
BMJ Case Rep ; 13(3)2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234857

RESUMO

Management of sore throat requires robust decision-making to balance successfully the conflicting risks of unnecessary antibiotic use against those of untreated bacterial infection. We present a case of fulminant sepsis caused by Streptococcus constellatus, presenting as a sore throat, initially managed conservatively. Despite subsequent appropriate anti-microbial therapy and surgical drainage, contiguous spread ultimately involved the deep neck spaces, mediastinum and thoracic wall, and was complicated by severe aspiration pneumonia, pharyngocutaneous and bronchopleural fistulation. The complexity and widespread extent of the infected spaces, in conjunction with the catabolic response to sepsis, created a life-threatening situation. Surgical closure of the pharyngeal defect, using a pectoralis-major pedicle flap, was successfully undertaken to ensure source control of the infection and heralded a complete recovery. We describe our management of this case, discuss the current approach to the management of patients presenting with a sore throat, and review the literature on S. constellatus infections.


Assuntos
Faringite/microbiologia , Sepse/microbiologia , Infecções Estreptocócicas/microbiologia , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Adulto , Humanos , Masculino , Pescoço/diagnóstico por imagem , Pescoço/microbiologia , Faringite/terapia , Sepse/etiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/terapia , Streptococcus constellatus/isolamento & purificação
2.
Paediatr Drugs ; 22(3): 243-250, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342289

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by recurrent fever flares accompanied by symptoms and signs forming the disease acronym and alternating with asymptomatic periods. Despite the disease having a generally favorable outcome, with spontaneous remission after a few years, it does have a major impact on the quality of life of the child and his or her relatives. Beside symptomatic medications during fever flares, the most used treatment consists of a single dose of corticosteroids at flare onset to interrupt the attack; fever resolves usually within a few hours, but often with a shorter interval between the attacks. For these patients, colchicine has been shown to decrease the frequency of the flares. Other medications were also reported in case series of patients with PFAPA syndrome. These include the interleukin-1 blocker anakinra to treat flares, cimetidine (which showed no convincing effect), and other drugs with anecdotal use. The pediatrician faces a difficult question: should they wait for spontaneous disease resolution and only treat the flares medically, or should they propose tonsillectomy that may induce remission? Due to the lack of strong evidence, the answer will vary on an individual basis, depending on the impact on the patient's quality of life. The choice of the best therapeutic strategy will be based on the response to the flare-based therapy and on disease severity (quality of life, school performances); long-term data on the remission rate under the different therapeutic strategies are currently missing. More randomized controlled studies are needed to help the treating physician to choose the best therapy, as well as real-life long-term data to evaluate the long-term outcome of children with PFAPA syndrome.


Assuntos
Febre/terapia , Linfadenite/terapia , Faringite/terapia , Qualidade de Vida/psicologia , Estomatite Aftosa/terapia , Pré-Escolar , Feminino , Humanos , Masculino , Síndrome
3.
BMJ Open Qual ; 9(1)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32111608

RESUMO

OBJECTIVE: A National Health Service (NHS)-funded sore throat test and treat (STTT) service was introduced in selected pharmacies in two local health boards in Wales, as an extension to the national pharmacy common ailment scheme. The aim of this study was to evaluate the impact of STTT on provision and quality of patient care, namely antibiotic use, patient safety and general practitioner (GP) consultation rates. METHODS: Secondary analyses of STTT consultation data to describe service outcomes, and routine data to explore changes in antibiotic prescribing and the prevalence of complications. Data were also collected from one GP practice to explore the feasibility of measuring changes in sore throat consultation rates in general practice. RESULTS: Less than 20% of 1725 consultations resulted in antibiotic supply. The availability of STTT was associated with greater reductions in prescriptions for phenoxymethylpenicillin than in areas where STTT was not available (-3.8% and -3.4%, difference 0.4%). When pharmacy supplies were included, the reductions in the supply of the antibiotic were similar. No increase in the monthly number of incidents of quinsy was detected, and patients were appropriately referred to other healthcare professionals during pharmacy consultations. GP consultation rates since introduction of STTT were found to be lower than the equivalent monthly average since 2014. CONCLUSIONS: Data from the first 5 months of the STTT service suggest that it may have a role in safely rebalancing uncomplicated sore throat management from general practice to community pharmacies while continuing to promote antibiotic stewardship.


Assuntos
Farmácias/normas , Faringite/diagnóstico , Faringite/terapia , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmácias/estatística & dados numéricos , Farmácias/tendências , Projetos Piloto , Qualidade da Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/tendências , País de Gales
4.
Nutrients ; 12(2)2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32024037

RESUMO

Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, -20.31 h, 95% CI -27.06 to -13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37-0.71), pharyngitis (RR 0.31, 95% CI 0.12-0.83) and laryngitis (RR 0.44, 95% CI 0.29-0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.


Assuntos
Antibacterianos/uso terapêutico , Diarreia/prevenção & controle , Laringite/prevenção & controle , Faringite/prevenção & controle , Probióticos/uso terapêutico , Pré-Escolar , Diarreia/microbiologia , Diarreia/terapia , Feminino , Alimentos e Bebidas Fermentados/microbiologia , Humanos , Lactente , Fórmulas Infantis/microbiologia , Laringite/microbiologia , Laringite/terapia , Masculino , Faringite/microbiologia , Faringite/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Eur J Clin Microbiol Infect Dis ; 39(6): 1103-1107, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31984431

RESUMO

Group A streptococcal (GAS) pharyngitis is responsible for 20-30% of pharyngitis cases in children (Shulman et al. Clin Infect Dis 55(10):e86-e102, 2012). Recommendations for the diagnosis and treatment of GAS pharyngitis have been published by the Italian National Institute of Health guidelines in 2012 (ESCMID Sore Throat Guideline Group et al. Clin Microbiol Infect 18(Suppl 1):1-28, 2012). Adherence to such guidance is relevant for primary prevention of complications of GAS pharyngitis, above all rheumatic fever (RF). The aim of our study was to evaluate the application of Italian guidelines by the family pediatricians from the Abruzzo region. A validated questionnaire was completed by the family pediatricians and used for data collection. The 154 family pediatricians from Abruzzo (88% of the total number of family pediatricians) participated in the study. Out of the 1232 answers, 455 (37%) were wrong. Only 8% of the participants answered correctly all the questions, whereas 0.6% missed all the questions. Through the Spearman's correlation, our study found an inverse significant correlation between the questions regarding primary prophylaxis (Score B) and the work experience of pediatricians (Rho = - 0.276, p = 0.048). The majority of the family pediatricians from the Abruzzo region, in line with studies from other countries, have significant knowledge gaps about the diagnosis and treatment of GAS pharyngitis. Therefore, strategies to increase the pediatricians' awareness of the guidelines are needed, in order to reduce the RF incidence.


Assuntos
Pediatras/estatística & dados numéricos , Faringite/diagnóstico , Faringite/terapia , Streptococcus pyogenes/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Faringite/complicações , Faringite/microbiologia , Guias de Prática Clínica como Assunto , Febre Reumática/etiologia , Febre Reumática/prevenção & controle , Inquéritos e Questionários
6.
Food Funct ; 11(1): 270-284, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31957758

RESUMO

Lactobacillus salivarius AR809 is a newly discovered probiotic strain from a healthy human pharynx and has potential ability to adhere to the pharyngeal epithelium and inhibit Staphylococcus aureus (S. aureus)-induced inflammatory response. Pharyngeal spray administration of AR809 exhibited protective effects in a S. aureus-induced mouse model of pharyngitis. The inhibitory effect and underlying molecular mechanism of AR809 on S. aureus-stimulated pharyngitis were further investigated. AR809 significantly increased phagocytosis and bactericidal activity, reduced the production of inflammatory mediators (intracellular reactive oxygen species (ROS), prostaglandin E2 (PGE2), cyclooxygenase-2 (COX-2), nitric oxide (NO), inducible NOS (iNOS)) and the expression of inflammatory cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß)), and induced macrophages to adopt the M2 phenotype. AR809 also attenuated S. aureus-induced phosphorylations of protein kinase B (Akt) and rapamycin (mTOR), and elevated the autophagic protein (light chain 3 from II (LC3-II) and Beclin-1) level. Furthermore, AR809 inhibited nuclear transcription factor kappa-B (NF-κB) activation by suppressing the nuclear translocation of NF-κB p65. Likewise, 740Y-P (a PI3K activator) decreased the anti-inflammatory effect of AR809 against S. aureus-induced inflammatory response, while AR809 treatments with wortmannin (a PI3K inhibitor) markedly reversed this inflammatory response. AR809 prevents S. aureus-induced pharyngeal inflammatory response, possibly by regulating TLR/PI3K/Akt/mTOR signalling pathway-related autophagy and TLR/PI3K/Akt/IκB/NF-κB pathway activity, and therefore has potential for use in preventing pharyngitis and other inflammatory diseases.


Assuntos
Autofagia , Lactobacillus salivarius , Faringite/terapia , Transdução de Sinais , Staphylococcus aureus/patogenicidade , Animais , Ciclo-Oxigenase 2/metabolismo , Citocinas/metabolismo , Dinoprostona/metabolismo , Inflamação/metabolismo , Macrófagos/citologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Óxido Nítrico/metabolismo , Faringite/microbiologia , Fosfatidilinositol 3-Quinases/metabolismo , Probióticos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Fator de Transcrição RelA/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
7.
Zhongguo Zhen Jiu ; 39(12): 1285-8, 2019 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-31820603

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture at Qianlianquan (Extra) and eight confluent points on chronic pharyngitis. METHODS: A total of 42 patients with chronic pharyngitis were randomized into an observation group and a control group, 21 cases in each one. In the observation group, acupuncture was applied at Qianlianquan (Extra) and eight confluent points [Neiguan (PC 6), Waiguan (TE 5), Lieque (LU 7), Houxi (SI 3), Gongsun (SP 4), Shenmai (BL 62), Zhaohai (KI 6) and Zulinqi (GB 41)], once a day, 6 days as one course, with an interval of 1 day between the courses, 4-course treatment was required. In the control group, Qinghou Liyan granules were taken orally 5 g each time, 3 times a day, 7 days as one course and 4 courses were required. Before and after treatment, symptoms and signs scores of chronic pharyngitis and the contents of IL-2 and TNF-a in serum were compared in the two groups. RESULTS: Compared before treatment, symptoms and signs scores of chronic pharyngitis and the contents of IL-2 and TNF-a in serum were improved in both groups (all P<0.05), and the changes in the observation group were superior to the control group (all P<0.05). The total effective rate was 90.5% (19/21) in the observation group, which was superior to 81.0% (17/21) in the control group (P<0.05). CONCLUSION: The therapeutic effect of acupuncture at Qianlianquan (Extra) and eight confluent points on chronic pharyngitis is superior to conventional Chinese patent medication treatment by Qing Liyan granules.


Assuntos
Terapia por Acupuntura , Faringite , Humanos , Faringite/terapia , Resultado do Tratamento
8.
Ann Ist Super Sanita ; 55(4): 380-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850866

RESUMO

Probiotics, defined as "living microorganisms that, whether ingested in useful amount, may have beneficial effects on human body", are widely used in various products for human use, such as dietary supplements, medical devices and pharmaceutical products. The European Directive on medical devices (MDs) (DDM 93/42), also includes those MDs containing live microorganisms, particularly probiotics, that may have various destinations of use, including that of assisting the therapy of several human pathologies. In this brief note we analyzed the use of probiotics in MDs and how probiotics administration could represent one of the new frontiers of scientific research on the prevention and treatment of various diseases. We'll analyze the literature on probiotics based MDs, to review their major targets in the therapy of some of the most common human pathologies: bacterial vaginosis and vaginitis, atopic dermatitis, infantile colic, obesity, type 2 diabetes, and pharyngotonsillitis.


Assuntos
Probióticos/administração & dosagem , Vaginose Bacteriana/terapia , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Cólica/terapia , Dermatite Atópica , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Equipamentos e Provisões/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Lactobacillus , Masculino , Obesidade/prevenção & controle , Obesidade/terapia , Faringite/terapia , Prebióticos/administração & dosagem , Prebióticos/efeitos adversos , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Supositórios , Simbióticos/administração & dosagem , Simbióticos/efeitos adversos , Tonsilite/terapia , Vaginite/microbiologia , Vaginite/terapia , Vaginose Bacteriana/microbiologia
9.
BMJ Open ; 9(11): e033817, 2019 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-31719097

RESUMO

OBJECTIVE: To assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis. DESIGN: Retrospective cohort study. SETTING: Data were retrieved from the VEGA register, a comprehensive regional cohort in Sweden. PARTICIPANTS: 1044 children (<15 years) and 2244 adults. INTERVENTION: Tonsillectomy/adenotonsillectomy compared with no surgical treatment. MAIN OUTCOME MEASURES: Changes in yearly mean rates of medical care visits due to pharyngitis/tonsillitis. RESULTS: In children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of -1.80 (-1.90 to -1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was -1.51 (-1.61 to -1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of -0.283 (-0.436 to -0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of -1.30 (-1.36 to -1.24), p<0.0001, compared with -1.18 (-1.24 to -1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was -0.111 (-0.195 to -0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up. CONCLUSION: In this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Faringite/epidemiologia , Tonsilectomia , Tonsilite/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Faringite/prevenção & controle , Faringite/terapia , Estudos Retrospectivos , Suécia/epidemiologia , Tonsilectomia/estatística & dados numéricos , Tonsilite/prevenção & controle , Tonsilite/terapia , Adulto Jovem
10.
Pediatr Ann ; 48(9): e343-e348, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505007

RESUMO

For pediatric practitioners, acute otitis media (AOM) and group A streptococcal pharyngitis are two of the most common infections seen in ambulatory practices. The purpose of this article is to review these conditions with the focus of highlighting evidence-based guidelines. AOM in children is a visual diagnosis and not one that can be made on history alone. The American Academy of Pediatrics (AAP) guidelines have clear criteria to aid clinicians in how to diagnose AOM. The pneumatic otoscope is the standard tool used to diagnose otitis media, and the AAP guidelines stress developing proficiency in distinguishing a normal tympanic membrane from otitis media with effusion or AOM. There are several components to appropriate management (treatment) of AOM including analgesia, education, antibiotics, and the option (for some) for observation. Group A streptococcal pharyngitis is the most common bacterial cause of sore throat in children but still only accounts for a minority of cases. History and physical examination help determine who should be tested. Testing is required to determine who to treat. Up to 15% of children in the United States are carriers, so indiscriminate testing can lead to inappropriate antibiotic use. If a patient's test is positive, treatment is recommended and penicillin or amoxicillin are appropriate for most cases. [Pediatr Ann. 2019;48(9):e343-e348.].


Assuntos
Otite Média , Faringite , Infecções Estreptocócicas , Streptococcus pyogenes , Doença Aguda , Adolescente , Criança , Pré-Escolar , Medicina Baseada em Evidências , Medicina Geral , Humanos , Lactente , Otite Média/diagnóstico , Otite Média/terapia , Pediatria , Faringite/diagnóstico , Faringite/terapia , Guias de Prática Clínica como Assunto , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/isolamento & purificação
12.
BMC Fam Pract ; 20(1): 75, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153357

RESUMO

BACKGROUND: The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline. METHODS: A cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients. RESULTS: In total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%). CONCLUSION: Danish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.


Assuntos
Clínicos Gerais , Fidelidade a Diretrizes , Faringite/diagnóstico , Padrões de Prática Médica , Infecções Estreptocócicas/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Antígenos de Bactérias/análise , Estudos Transversais , Dinamarca , Feminino , Medicina Geral , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Faringite/terapia , Guias de Prática Clínica como Assunto , Infecções Estreptocócicas/tratamento farmacológico
13.
Int J Rheum Dis ; 22(8): 1489-1497, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31131563

RESUMO

AIM: The syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is a common inflammatory disease that presents with periodic fever. We aimed to establish more specific diagnostic criteria for PFAPA based on the clinical characteristics of PFAPA patients in our directory. METHOD: The clinical, laboratory, genetic, and family history details of 257 Japanese PFAPA patients treated at our and other affiliated hospitals between April 2000 and April 2018 were analyzed along with quantitative measurements of the number of CD64 molecules on neutrophils, and the levels of serum inflammatory cytokines. The sensitivity and specificity of the criteria were calculated for several diseases. RESULTS: Because recurrent fevers were crucial findings, they were defined as the required criterion. Tonsillitis/pharyngitis with white moss were important accompanying signs. Other symptoms associated with febrile episodes were cervical lymphadenitis with tenderness, aphthous stomatitis, sore throat, vomiting, and headache but not cough. A total of 159 (62%) patients had a family history of recurrent fevers, indicating autosomal dominant inheritance. C-reactive protein levels were extremely elevated during febrile attacks but normal in attack-free periods. Serum immunoglobulin D levels were high in 72 of the 199 tested patients. Oral glucocorticoid and cimetidine were extremely effective in all and 51.6% of the patients, respectively. We defined the above as supportive criteria. These criteria were sensitive and specific enough to distinguish PFAPA from other recurrent fever diseases. Raised serum interferon-γ levels and remarkable CD64 expression on neutrophils during flare-ups were recognized, indicating they contributed to diagnosis. CONCLUSION: Our new criteria are useful for diagnosing PFAPA.


Assuntos
Febre/diagnóstico , Doenças Hereditárias Autoinflamatórias/diagnóstico , Linfadenite/diagnóstico , Faringite/diagnóstico , Estomatite Aftosa/diagnóstico , Biomarcadores/sangue , Pré-Escolar , Citocinas/sangue , Feminino , Febre/sangue , Febre/imunologia , Febre/terapia , Glucocorticoides/uso terapêutico , Doenças Hereditárias Autoinflamatórias/sangue , Doenças Hereditárias Autoinflamatórias/imunologia , Doenças Hereditárias Autoinflamatórias/terapia , Hereditariedade , Antagonistas dos Receptores Histamínicos H2/uso terapêutico , Humanos , Lactente , Mediadores da Inflamação/sangue , Japão , Linfadenite/sangue , Linfadenite/imunologia , Linfadenite/terapia , Masculino , Proteína Cofatora de Membrana/sangue , Neutrófilos/imunologia , Linhagem , Faringite/sangue , Faringite/imunologia , Faringite/terapia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estomatite Aftosa/sangue , Estomatite Aftosa/imunologia , Estomatite Aftosa/terapia , Síndrome , Tonsilectomia , Resultado do Tratamento
14.
Rheumatol Int ; 39(6): 1099-1105, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31020337

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is a recurrent fever syndrome for which tonsillectomy is a therapeutic option curing the disease in most patients. Recurrence after remission with tonsillectomy is extremely rare. Increasing number of reports on diverse disease manifestations in PFAPA could give us clues about the disease etiopathogenesis. We aimed to describe a patient with recurrence of PFAPA syndrome after tonsillectomy and to review the previous studies including similar cases. We report a 17-year-old boy with PFAPA syndrome who experienced remission for 3 years after tonsillectomy and was later found to harbor an MEFV mutation when the disease relapsed. He responded well to colchicine treatment at relapse. The literature review revealed 14 articles describing 24 similar PFAPA patients. The therapeutic options include single-dose corticosteroids and nonsteroidal anti-inflammatory drugs during attacks, cimetidine, and resurgery. The presented case was the only one heterozygous for an MEFV mutation and treated with colchicine at disease relapse. Albeit rare, the reoccurrence of PFAPA after tonsillectomy could occur. The presence of such patients opposes with the hypothesis that the trigger or immune dysregulation in PFAPA pathogenesis resides in tonsils.


Assuntos
Colchicina/uso terapêutico , Febre/terapia , Linfadenopatia/terapia , Faringite/terapia , Estomatite Aftosa/terapia , Tonsilectomia , Moduladores de Tubulina/uso terapêutico , Adolescente , Febre/complicações , Heterozigoto , Humanos , Linfadenopatia/complicações , Masculino , Pescoço , Faringite/complicações , Pirina/genética , Recidiva , Estomatite Aftosa/complicações , Síndrome
15.
Eur Arch Otorhinolaryngol ; 276(3): 879-887, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30767047

RESUMO

PURPOSE: Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT. METHODS: Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up. RESULTS: We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment. CONCLUSIONS: We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.


Assuntos
Terapia Biológica/métodos , Probióticos/uso terapêutico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae , Streptococcus oralis , Streptococcus salivarius , Tonsilite/terapia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Sprays Orais , Faringite/microbiologia , Faringite/terapia , Probióticos/administração & dosagem , Recidiva , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Tonsilite/microbiologia
16.
Rheumatol Int ; 39(6): 957-970, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30798384

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is a recurrent fever syndrome of early childhood with increasing number of adult-onset cases. Although it is a self-limited disease, it may negatively affect the quality of life. The aim of this review is to present a detailed analysis of PFAPA syndrome and an algorithm for diagnosis, therapeutic options, and evaluation of outcome. A comprehensive literature search was conducted through the Cochrane Library, Scopus, and MEDLINE/PubMed databases. The main topics covered are the epidemiology, clinical manifestations, diagnosis, differential diagnosis, etiopathogenesis, genetics, management, disease course and prognosis, disease in adults, unsolved issues, and unmet needs in PFAPA. The diagnosis of PFAPA is mainly based on clinical classification criteria. The most relevant hypothesis for pathogenesis is that dysregulated immune system in a genetically predisposed individual responds to a yet unidentified trigger in an exaggerated way. The pedigree analyses suggest a genetic background for the disease with an autosomal dominant pattern of inheritance. For management, single-dose corticosteroids during attacks and tonsillectomy remain the most effective therapies, while colchicine is a promising option to decrease attack frequency. There remain unsolved issues in PFAPA such as the exact etiopathogenesis and genetic background, the reason why the inflammation is restricted to the oropharyngeal lymphoid tissue, reasons for clock-work regularity of attacks, and self-limited disease course. There is need for a valid diagnostic criteria set with a high performance for both children and adults and consensus on management of PFAPA.


Assuntos
Febre/imunologia , Inflamação/imunologia , Linfadenite/imunologia , Faringite/imunologia , Estomatite Aftosa/imunologia , Corticosteroides/uso terapêutico , Febre/complicações , Febre/diagnóstico , Febre/terapia , Humanos , Inflamação/diagnóstico , Inflamação/terapia , Linfadenite/complicações , Linfadenite/diagnóstico , Linfadenite/terapia , Pescoço , Faringite/complicações , Faringite/diagnóstico , Faringite/terapia , Recidiva , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/terapia , Síndrome , Tonsilectomia
17.
Clin Microbiol Infect ; 25(6): 673-680, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30616011

RESUMO

BACKGROUND: Sore throat resulting from pharyngotonsillitis is one of the commonest reasons for primary care consultation and inappropriate antibiotic prescription and finding effective alternative treatments is important. OBJECTIVES: To review the evidence for using the probiotic Streptococcus salivarius K12 (SsK12) for the prevention or treatment of pharyngotonsillitis. DATA SOURCES: PubMed, Embase, CINAHL and Cochrane Library. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs). PARTICIPANTS: Adults or children. INTERVENTIONS: SsK12 as active treatment or prophylaxis, against pharyngotonsillitis. METHODS: Literature search. RESULTS: Four articles were identified (1846 participants). All were deemed to be of poor quality using the Cochrane risk-of-bias assessment. Two trials studied SsK12 prophylaxis for streptococcal pharyngitis (children without history of recurrence). One compared daily administration of SsK12 to no treatment over 6 months (n = 222, age 33-45 months), reporting significantly lower incidence in the SsK12 group (16.2% vs. 48.6%, p < 0.01), whereas another placebo-controlled RCT over four school terms (n = 1314, 5-14 years) found no significant difference (7.8% vs. 8.8%, p 0.34) with SsK12 (administered on school days). Another trial found daily SsK12 to significantly protect children (n = 250, 6-7 years) against chronic adenoiditis exacerbation over 3 months compared to no treatment (71.7% vs. 100%, p < 0.0001). The one placebo-controlled RCT in adults that studied the use of SsK12 for acute pharyngotonsillitis (concurrently with penicillin) showed no significant benefit. In all trials, SsK12 was safe and well tolerated. CONCLUSIONS: SsK12 appears safe and well tolerated. However, further RCTs are required to establish its role as a prophylactic therapy, particularly among patients experiencing frequent exacerbations of pharyngitis. In the acute setting, SsK12 is unlikely to be effective if given concurrently with antibiotics; however, further RCTs should establish its role as an alternative to antibiotics in nonsevere cases or when prescribed after antibiotic therapy for the prevention of disease recurrence and/or secondary infection.


Assuntos
Faringite/prevenção & controle , Faringite/terapia , Probióticos/administração & dosagem , Streptococcus salivarius/crescimento & desenvolvimento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Placebos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Am J Emerg Med ; 37(1): 109-113, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29754963

RESUMO

OBJECTIVES: We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis. METHODS: A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included. Cases were identified using a text-search module followed by manual review. We excluded immunocompromised patients and those with lymphadenopathy felt to be not directly infected (i.e. reactive) or that was not acute (symptom duration >28 days). Data collected included: age, gender, duration of symptoms, highest recorded temperature, physical exam findings, laboratory and imaging results, and surgical findings. A DSA was defined as >1.5 cm in diameter on imaging. We performed binary logistic regression to determine independent clinical predictors of a DSA. RESULTS: Three hundred sixty-one patients met inclusion criteria. Three hundred six patients (85%) had a CT scan, 55 (15%) had an ultrasound and 33 (9%) had both. DSA was identified in 71 (20%) patients. Clinical features independently associated with a DSA included absence of clinical pharyngitis, WBC >15,000/mm3, age ≤3 years, anterior cervical chain location, largest palpable diameter on exam >3 cm and prior antibiotic treatment of >24 h. The presence of fever, skin erythema, or fluctuance on examination, was not found to be predictive of DSA. CONCLUSIONS: We identified independent predictors of DSA among children presenting with cervical adenitis. Risk can be stratified into risk groups based on these clinical features.


Assuntos
Drenagem/métodos , Serviços Médicos de Emergência , Linfadenite/diagnóstico , Faringite/diagnóstico , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Linfadenite/terapia , Masculino , Faringite/terapia , Estudos Retrospectivos , Supuração , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
19.
Clin Rheumatol ; 38(1): 11-17, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30488366

RESUMO

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most frequent non-hereditary autoinflammatory disorder in childhood: Its onset is usually observed before 5 years, though reports regarding adulthood are increasing. The pathogenesis of the syndrome is not completely understood, but a multifactorial origin, probably based on a polygenic pattern of susceptibility, is the most probable rational pathogenetic hypothesis. Treatment of PFAPA syndrome relies on the administration of low-dose corticosteroids, which promptly abort flares but cannot prevent subsequent disease episodes over time. Tonsillectomy with or without adenoidectomy has proved to be successful in some pediatric patients, as proven by different studies. On the other hand, colchicine, cimetidine, nonsteroidal anti-inflammatory drugs, and interleukin-1 inhibitors have shown efficacy, which require further definite confirmations. This review is aimed at summarizing all the recent evidence about treatment options available for PFAPA syndrome both in pediatric and adult patients.


Assuntos
Febre/terapia , Linfadenite/terapia , Faringite/terapia , Estomatite Aftosa/terapia , Adulto , Criança , Humanos , Pescoço , Periodicidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome
20.
Emerg Med Clin North Am ; 37(1): 95-107, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454783

RESUMO

Infection of the neck is a relatively common emergency department complaint. If not diagnosed and managed promptly, it may quickly progress to a life-threatening infection. These infections can result in true airway emergencies that may require fiberoptic or surgical airways. This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities.


Assuntos
Infecções/diagnóstico , Pescoço , Emergências , Epiglotite/diagnóstico , Epiglotite/terapia , Humanos , Infecções/terapia , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Angina de Ludwig/diagnóstico , Angina de Ludwig/terapia , Mediastinite/diagnóstico , Mediastinite/terapia , Parotidite/diagnóstico , Parotidite/terapia , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Faringite/diagnóstico , Faringite/terapia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/terapia
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