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1.
Vestn Otorinolaringol ; 84(4): 61-66, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31579061

RESUMO

Here, we performed the comprehensive review of the peer-reviewed literature of the effect of chronic foci of streptococcal infection on the course of skin psoriasis, as well as an assessment of the effectiveness of tonsillectomy on the course of this pathology. A PubMed, Web of Science and Google Scholar search were performed with the keywords 'psoriasis' AND 'tonsillectomy' OR 'tonsillitis' OR 'streptococcal infection'. The reviewers identified and evaluated 197 reports published prior to August 2018, of which 153 were excluded from further analysis after review of titles and/or abstracts including four duplicate studies from the same authors in the same patient groups. In total, 44 reports were used and included in the review (including original studies, a description of clinical cases, literature reviews). Analysis of the original studies showed that the effectiveness of tonsillectomy in patients with psoriasis is from 11.4 to 78.6%. Among clinical cases, the rate was 20-100%. We did not conduct a meta-analysis and use the statistical methods because of the heterogeneity of the data. Data were analysed using a descriptive approach. Most studies came from Russia, USA, Japan. However, multiple limitations in the studies do not allow final conclusions about the effectiveness of tonsillectomy in patients with psoriasis.


Assuntos
Psoríase , Infecções Estreptocócicas , Tonsilectomia , Tonsilite , Humanos , Psoríase/complicações , Psoríase/cirurgia , Federação Russa , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/cirurgia , Tonsilite/complicações , Tonsilite/cirurgia
2.
Int J Pediatr Otorhinolaryngol ; 123: 47-50, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31063948

RESUMO

INTRODUCTION: Peritonsillar abscess (PTA) in pediatric patients is a challenging condition to diagnose and treat, and recurrence can occur in up to 15% of patients. This condition can be managed in various settings and there may be outcome differences depending on the choice of inpatient/outpatient management. The objective of this study was to evaluate immediate and long-term outcomes, specifically recurrence, after PTA management in the inpatient versus outpatient setting as well as specific patient characteristics leading to hospital management decisions. METHODS: We conducted a retrospective cohort study of all suspected cases of PTA seen at a tertiary pediatric hospital from 2008 to 2017, and 566 confirmed cases of PTA were included in this study. Demographics, PTA management, recurrence, and subsequent tonsillectomy (immediate or within 1 year of diagnosis) were ascertained from patient medical records. We compared characteristics of patients seen in the inpatient and outpatient setting using Chi-squared and Wilcoxon-Mann-Whitney tests. RESULTS: Patients treated in the outpatient setting were more likely to be older and have a lower rate of recurrent ear infections (p < 0.0001 and p = 0.01 respectively). Additionally, no differences in gender, Down Syndrome, or autism were found. Patients who were admitted were more likely to undergo immediate tonsillectomy within a month or tonsillectomy within one year (p < 0.0001 and p = 0.02 respectively), whereas patients in the outpatient setting were more likely to receive antibiotics alone (p < 0.0001). Outpatient management was associated with no differences in recurrence rate within 30 days (p = 0.56). However, recurrence was associated with older age, a history of recurrent tonsillitis, but not a history of ear infections (p = 0.005, p < 0.0001, and p = 0.49 respectively). A history of recurrent ear infections, recurrent tonsillitis and recurrent PTAs were associated with the decision to pursue a tonsillectomy (p = 0.003, p = 0.03, and p < 0.0001 respectively). CONCLUSIONS: Patients seen in the outpatient setting are more likely to receive antibiotics alone as their initial treatment, likely a result of certain clinical characteristics and presenting features as well as uncertain diagnosis. Inpatient status was associated with a younger age and a history of ear infections while recurrence was associated with a history of recurrent tonsillitis and older age. The recurrence rates for outpatient management were not statistically different than inpatient, suggesting that triaging and treatment of patients was occurring appropriately. The association of tonsillectomies in the inpatient group within 12 months is likely due to the higher rate of preexisting tonsil issues considering that recurrent tonsillitis, ear infections and a higher rate of PTA recurrence were all statistically correlated.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Hospitalização/estatística & dados numéricos , Abscesso Peritonsilar/tratamento farmacológico , Abscesso Peritonsilar/cirurgia , Tonsilectomia/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Otite/complicações , Abscesso Peritonsilar/complicações , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Tonsilite/complicações
3.
Medicine (Baltimore) ; 98(17): e15234, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027070

RESUMO

RATIONALE: Glossopharyngeal neuralgia (GPN) is a rare type of neuralgia. Depending on the cause, it is classified as idiopathic GPN and secondary GPN. Secondary GPN can also be caused by a mass effect or inflammation of the tonsils, the innervation area of glossopharyngeal nerve. PATIENT CONCERNS: The patient was diagnosed idiopathic GPN 8 years ago. The patient had intermittent pain, but the pain was well controlled. From 5 months ago, the pain gradually worsened, the patient complained severe pain which impaired chewing and swallowing function. DIAGNOSES: Idiopathic GPN, secondary GPN, chronic tonsillitis INTERVENTIONS:: Percutaneous glossopharyngeal nerve block, glossopharyngeal neurolysis, and pulsed radiofrequency neuromodulation of glossopharyngeal nerve were performed. After the diagnosis of tonsillitis, antibiotic therapy was performed OUTCOMES:: Two weeks after the antibiotic treatment, the pain decreased simultaneously with the patient's tonsillitis recovery. LESSONS: In a Patient who had already been diagnosed with idiopathic GPN, both pain control and its cause should be considered when the pain is aggravated.


Assuntos
Doenças do Nervo Glossofaríngeo/complicações , Tonsilite/complicações , Idoso , Antibacterianos/uso terapêutico , Doença Crônica , Feminino , Doenças do Nervo Glossofaríngeo/cirurgia , Humanos , Bloqueio Nervoso , Tonsilite/tratamento farmacológico
4.
J Laryngol Otol ; 133(4): 324-328, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924432

RESUMO

BACKGROUND: The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise. METHOD: In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted. RESULTS: Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019). CONCLUSION: The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.


Assuntos
Complicações do Diabetes/microbiologia , Abscesso Peritonsilar/epidemiologia , Fumar/efeitos adversos , Doenças Estomatognáticas/microbiologia , Tonsilite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Abscesso Peritonsilar/etiologia , Estudos Retrospectivos , Doenças Estomatognáticas/complicações , Adulto Jovem
5.
Otolaryngol Head Neck Surg ; 160(2): 187-205, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30921525

RESUMO

OBJECTIVE: This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children <15 years of age, based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. PURPOSE: The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing children under consideration for tonsillectomy and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to educate clinicians, patients, and/or caregivers regarding the indications for tonsillectomy and the natural history of recurrent throat infections. Additional goals include the following: optimizing the perioperative management of children undergoing tonsillectomy, emphasizing the need for evaluation and intervention in special populations, improving the counseling and education of families who are considering tonsillectomy for their children, highlighting the management options for patients with modifying factors, and reducing inappropriate or unnecessary variations in care. Children aged 1 to 18 years under consideration for tonsillectomy are the target patient for the guideline. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of nursing, anesthesiology, consumers, family medicine, infectious disease, otolaryngology-head and neck surgery, pediatrics, and sleep medicine. KEY ACTION STATEMENTS: The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should recommend watchful waiting for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years. (2) Clinicians should administer a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. (3) Clinicians should recommend ibuprofen, acetaminophen, or both for pain control after tonsillectomy. The guideline update group made recommendations for the following KASs: (1) Clinicians should assess the child with recurrent throat infection who does not meet criteria in KAS 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergies/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of >1 peritonsillar abscess. (2) Clinicians should ask caregivers of children with obstructive sleep-disordered breathing and tonsillar hypertrophy about comorbid conditions that may improve after tonsillectomy, including growth retardation, poor school performance, enuresis, asthma, and behavioral problems. (3) Before performing tonsillectomy, the clinician should refer children with obstructive sleep-disordered breathing for polysomnography if they are <2 years of age or if they exhibit any of the following: obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses. (4) The clinician should advocate for polysomnography prior to tonsillectomy for obstructive sleep-disordered breathing in children without any of the comorbidities listed in KAS 5 for whom the need for tonsillectomy is uncertain or when there is discordance between the physical examination and the reported severity of obstructive sleep-disordered breathing. (5) Clinicians should recommend tonsillectomy for children with obstructive sleep apnea documented by overnight polysomnography. (6) Clinicians should counsel patients and caregivers and explain that obstructive sleep-disordered breathing may persist or recur after tonsillectomy and may require further management. (7) The clinician should counsel patients and caregivers regarding the importance of managing posttonsillectomy pain as part of the perioperative education process and should reinforce this counseling at the time of surgery with reminders about the need to anticipate, reassess, and adequately treat pain after surgery. (8) Clinicians should arrange for overnight, inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe obstructive sleep apnea (apnea-hypopnea index ≥10 obstructive events/hour, oxygen saturation nadir <80%, or both). (9) Clinicians should follow up with patients and/or caregivers after tonsillectomy and document in the medical record the presence or absence of bleeding within 24 hours of surgery (primary bleeding) and bleeding occurring later than 24 hours after surgery (secondary bleeding). (10) Clinicians should determine their rate of primary and secondary posttonsillectomy bleeding at least annually. The guideline update group made a strong recommendation against 2 actions: (1) Clinicians should not administer or prescribe perioperative antibiotics to children undergoing tonsillectomy. (2) Clinicians must not administer or prescribe codeine, or any medication containing codeine, after tonsillectomy in children younger than 12 years. The policy level for the recommendation about documenting recurrent throat infection was an option: (1) Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and ≥1 of the following: temperature >38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus. DIFFERENCES FROM PRIOR GUIDELINE: Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply. There were 1 new clinical practice guideline, 26 new systematic reviews, and 13 new randomized controlled trials included in the current guideline update. Inclusion of 2 consumer advocates on the guideline update group. Changes to 5 KASs from the original guideline: KAS 1 (Watchful waiting for recurrent throat infection), KAS 3 (Tonsillectomy for recurrent infection with modifying factors), KAS 4 (Tonsillectomy for obstructive sleep-disordered breathing), KAS 9 (Perioperative pain counseling), and KAS 10 (Perioperative antibiotics). Seven new KASs: KAS 5 (Indications for polysomnography), KAS 6 (Additional recommendations for polysomnography), KAS 7 (Tonsillectomy for obstructive sleep apnea), KAS 12 (Inpatient monitoring for children after tonsillectomy), KAS 13 (Postoperative ibuprofen and acetaminophen), KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). Addition of an algorithm outlining KASs. Enhanced emphasis on patient and/or caregiver education and shared decision making.


Assuntos
Adenoidectomia/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Apneia Obstrutiva do Sono/etiologia , Tonsilectomia/normas , Tonsilite/complicações , Adenoidectomia/métodos , Adolescente , Criança , Pré-Escolar , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Masculino , Medição de Risco , Apneia Obstrutiva do Sono/fisiopatologia , Tonsilectomia/métodos , Tonsilite/diagnóstico , Tonsilite/cirurgia , Resultado do Tratamento , Estados Unidos
6.
Cochrane Database Syst Rev ; 3: CD001976, 2019 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-30839103

RESUMO

BACKGROUND: Guttate psoriasis is a distinctive acute form of psoriasis which characteristically occurs in children and young adults. It is closely associated with preceding streptococcal sore throat or tonsillitis. Some authorities have claimed that ordinary (chronic plaque) psoriasis may also be made worse by infection at distant sites. Although many dermatologists have recommended using antibiotics for guttate psoriasis in particular, it is not clear whether they influence the course of either form of psoriasis. Some dermatologists have also recommended tonsillectomy for psoriasis in patients with recurrent streptococcal sore throat. OBJECTIVES: To assess the evidence for effectiveness of antistreptococcal interventions including antibiotics and tonsillectomy in the management of acute guttate and chronic plaque psoriasis. SEARCH METHODS: We searched the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966- September 1999), Embase (1988-September 1999), the Salford Database of Psoriasis Trials (to November 1999) and the European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms [STREPTOCOCC* or ANTIBIOTIC* or TONSIL*] and PSORIASIS using the Cochrane Skin Group search strategy. SELECTION CRITERIA: Randomised trials of one or more antistreptococcal interventions in patients with guttate or chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS: Two reviewers independently examined each retrieved trial for eligibility and quality. MAIN RESULTS: The one eligible trial we identified compared the use of two oral antibiotic schedules in 20 psoriasis patients, predominantly of guttate type, who had evidence of beta-haemolytic streptococcal colonisation. Either rifampicin or placebo was added to the end of a standard course of antistreptococcal antibiotic (phenoxymethylpenicillin or erythromycin). No patient in either arm of the study improved during the observation period.No randomised trials of tonsillectomy for psoriasis were identified. AUTHORS' CONCLUSIONS: Although it is well known that guttate psoriasis may be precipitated by streptococcal infection, there is no firm evidence to support the use of antibiotics either in the management of established guttate psoriasis or in preventing the development of guttate psoriasis following streptococcal sore throat.Although both antibiotics and tonsillectomy have frequently been advocated for patients with recurrent guttate psoriasis or chronic plaque psoriasis, there is to date no good evidence that either intervention is beneficial.


Assuntos
Antibacterianos/uso terapêutico , Psoríase/terapia , Infecções Estreptocócicas/prevenção & controle , Tonsilectomia , Doença Crônica , Humanos , Psoríase/microbiologia , Infecções Estreptocócicas/complicações , Tonsilite/complicações
7.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733246

RESUMO

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Anecdotally, there is concern that modern medical practice that counsels vigilance against overuse of antibiotics, could lead to increased complications of tonsillitis. We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. Despite antibiotic treatment he developed an intramural oesophageal abscess, to our knowledge, an unreported complication of tonsillitis.


Assuntos
Abscesso/diagnóstico por imagem , Doenças do Esôfago/diagnóstico por imagem , Tonsila Palatina/diagnóstico por imagem , Tonsilite/diagnóstico por imagem , Abscesso/etiologia , Antibacterianos/uso terapêutico , Doenças do Esôfago/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tonsilite/complicações , Tonsilite/tratamento farmacológico
9.
BMJ Case Rep ; 12(1)2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700448

RESUMO

Fusobacterium necrophorum is a rare infection most notable for causing Lemierre's syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre's syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre's syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre's disease is challenging.


Assuntos
Fusobacterium necrophorum/isolamento & purificação , Síndrome de Lemierre/complicações , Síndrome de Lemierre/diagnóstico , Faringite/complicações , Faringite/tratamento farmacológico , Sepse/complicações , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/microbiologia , Diagnóstico Diferencial , Drenagem , Humanos , Lactente , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/microbiologia , Síndrome de Lemierre/tratamento farmacológico , Masculino , Pescoço/diagnóstico por imagem , Pescoço/microbiologia , Radiografia Intervencionista , Sepse/diagnóstico , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tonsilite/complicações , Tonsilite/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia
11.
BMC Infect Dis ; 19(1): 65, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30654754

RESUMO

BACKGROUND: Herpes simplex virus (HSV) has various presentations, depending on the patient's immune status, age, and the route of transmission. In adults, HSV type 1 is found predominantly in the oral area, and HSV type 2 (HSV-2) is commonly found in the genital area. HSV-2 infection without genital lesions is uncommon. Herein we report a unique case of pharyngotonsillitis as an initial manifestation of disseminated HSV-2 infection without genital involvement. CASE PRESENTATION: A 46-year-old male was admitted to our hospital with a 1-week history of fever and sore throat. His past medical history included hypereosinophilic syndrome diagnosed at age 45 years. Physical examination revealed throat congestion, bilaterally enlarged tonsils with exudates, tender cervical lymphadenopathy in the left posterior triangle, and mild epigastric tenderness. The laboratory data demonstrated bicytopenia, elevated liver enzyme levels, and hyperferritinemia. A bone marrow smear showed hypocellular marrow with histiocytes and hemophagocytosis. The diagnosis of HLH was confirmed, and the patient was treated with methylprednisolone pulse therapy on days 1-3. On day 5, despite initial improvement of the fever and sore throat, multiple, new, small bullae developed on the patient's face, trunk, and extremities. Additional testing showed that he was positive for HSV-specific immunoglobulin M and immunoglobulin G. Disseminated HSV infection was suspected, and intravenous acyclovir (10 mg/kg every 8 h) was begun. A subsequent direct antigen test of a bulla sample was positive for HSV-2. Moreover, tonsillar and esophageal biopsies revealed viral inclusion bodies. Immunohistochemical staining and a quantitative real-time polymerase chain reaction (PCR) assay confirmed the presence of HSV-2. Disseminated HSV-2 infection with multiple bullae, tonsillitis, esophagitis, and suspected hepatic involvement was diagnosed. After a 2-week course of intravenous acyclovir, his hematological status and liver function normalized, and his cutaneous skin lesions resolved. He was discharged on day 22 in good general health and continued taking oral valacyclovir for viral suppression due to his immunosuppressed status. CONCLUSION: Disseminated HSV-2 infection should be considered as one of the differential diagnoses in patients with pharyngotonsillitis and impaired liver function of unknown etiology even if there are no genital lesions.


Assuntos
Esofagite/diagnóstico , Herpes Simples/diagnóstico , Herpesvirus Humano 2/isolamento & purificação , Linfo-Histiocitose Hemofagocítica/diagnóstico , Tonsilite/diagnóstico , Aciclovir/uso terapêutico , Esofagite/complicações , Esofagite/tratamento farmacológico , Esofagite/virologia , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Herpes Simples/virologia , Humanos , Hospedeiro Imunocomprometido , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/virologia , Masculino , Pessoa de Meia-Idade , Faringite/diagnóstico , Faringite/tratamento farmacológico , Faringite/virologia , Tonsilite/complicações , Tonsilite/tratamento farmacológico , Tonsilite/virologia , Sistema Urogenital/virologia
14.
Clin Exp Rheumatol ; 37(4): 546-551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30620277

RESUMO

OBJECTIVES: Group A streptococcal (GAS) tonsillitis is reported as an uncommon cause of acute non-rheumatic fever (non-RF) myocarditis. The aim of this research was to study the occurrence, diagnosis, management and prognosis of this condition. METHODS: We conducted a retrospective computerised search through medical records of patients admitted to our tertiary medical center between 1998-2016 with the diagnosis of either acute rheumatic fever or non-RF streptococcal myocarditis based on criteria we developed and review the relevant literature from 1973-2016. RESULTS: We identified 283 cases diagnosed with acute myocarditis. Eight patients with non-RF GAS-myocarditis were identified, 7 of whom were men. Average age was 28.5 (22-35) years, and average latency period between onset of sore throat and chest pain 4.8 (3-10) days. Most patients presented with ST-segment elevations on the ECG and 2 underwent coronary catheterisation with presumed diagnosis of myocardial infarction. Three patients had heart failure, as documented by echocardiogram. All patients were treated with antibiotics and 6 patients received non-steroidal anti-inflammatory drugs (NSAIDs). All patients recovered with no evidence of heart failure a few months after the initial infection. One patient had a recurrent episode. CONCLUSIONS: Non-RF GAS myocarditis typically affects healthy young males and represents about 3% of all hospitalised patients with myocarditis. These patients may be mistakenly diagnosed with an acute rheumatic fever or myocardial infarction. The prognosis in generally good following treatment with antibiotics and possibly NSAIDs.


Assuntos
Miocardite , Infecções Estreptocócicas , Tonsilite/complicações , Adulto , Eletrocardiografia , Feminino , Humanos , Masculino , Miocardite/etiologia , Estudos Retrospectivos , Febre Reumática , Infecções Estreptocócicas/complicações , Tonsilite/microbiologia
15.
Clin Med (Lond) ; 18(5): 400-402, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30287435

RESUMO

We present the case of a 41-year-old Australian woman with a 3-day history of fevers and migratory polyarthritis. Three weeks prior she had been treated by her GP with phenoxymethylpenicillin for acute tonsillitis. Examination confirmed synovitis. Systemic assessment including cardiovascular, neurological and skin examination was unremarkable. Abnormal investigations included a leucocytosis with neutrophilia, C-reactive peptide of 116 mg/L, erythrocyte sedimentation rate of 103 mm/hour and acute transaminitis. The antistreptolysin O titre was 304 IU, which increased to 1,250 IU after 2 weeks. Troponin T, electrocardiogram and echocardiography were all normal. The patient was treated for acute rheumatic fever with corticosteroids and a 10-day course of cephalexin. After 8 weeks, she made a full recovery and had normalised inflammatory markers and liver biochemistry. She was then commenced on monthly prophylactic intramuscular benzathine penicillin. This case study aims to raise awareness of the presentation, diagnosis and management of acute rheumatic fever.


Assuntos
Febre Reumática , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Artrite/diagnóstico , Artrite/tratamento farmacológico , Artrite/etiologia , Feminino , Febre/etiologia , Humanos , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico , Febre Reumática/etiologia , Tonsilite/complicações , Tonsilite/tratamento farmacológico
16.
Wiad Lek ; 71(4): 861-864, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30099424

RESUMO

OBJECTIVE: Introduction: Chronic diseases of the upper respiratory tract in children and teenagers, such as chronic tonsillitis is quite common in pediatric populations, accompanied by changes in reactivity, causing a risk of complications. Due to the fact that the child's body resistance to acute infectious diseases depends on the sufficiency of trace elements, then at present stage greatly increased interest in deeper study of exchange of macro- and microelements in the human body in normal and pathological conditions. The aim: To study the dynamics of zinc, iron, potassium and magnesium in adolescents with disorders of the cardiovascular system with chronic tonsillitis. PATIENTS AND METHODS: Materials and methods: It was examined 63 patients with chronic tonsillitis, among them- 31 children suffer from chronic tonsillitis off-damage to the cardiovascular system (I group), 32 patients with disorders of the cardiovascular system against the background of chronic tonsillitis (II group). The content of trace elements zinc, iron, minerals potassium and magnesium was analyzed. The measurement and calculation were done according to AAS-SPECTR program. Analysis and statistics treatment was done on using application programs STATISTICA 7.0 and MS Excel XP. RESULTS: Results: In result of investigation it was found a violation of trace element composition in the blood serum. Thus, in patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum. In patients with chronic tonsillitis without cardiovascular system damage during hospitalization was observed a significant decrease in the concentration of iron to (15,47 ± 1,12) mmol/l. Similar changes were observed with the concentration of zinc in the blood serum of patients of I groups during hospitalization (10,89 ± 0,57mmol/l) and was significantly lower compared with the data of healthy children (18,40 ± 0,71 mmol/l (p <0.05)). CONCLUSION: Сonclusions: It should be noted that children with tonsillogene cardiac lesions during hospitalization have a significant decreasing in the level of magnesium compared with indicators of children without pathology of the cardiovascular system. After treatment, the normalization of trace elements iron, zinc, magnesium did not happen, moreover, significant changes were observed in patients with heart disease against the background of chronic tonsillitis.


Assuntos
Doenças Cardiovasculares/metabolismo , Tonsilite/metabolismo , Oligoelementos/deficiência , Adolescente , Doenças Cardiovasculares/complicações , Criança , Cobre/metabolismo , Feminino , Humanos , Magnésio/metabolismo , Masculino , Tonsilite/complicações , Oligoelementos/metabolismo , Zinco/metabolismo
17.
J Laryngol Otol ; 132(7): 615-618, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29888695

RESUMO

OBJECTIVE: To assess the diagnostic role of mean platelet volume in tonsillitis with and without peritonsillar abscess. METHODS: Mean platelet volume and other laboratory data were retrospectively investigated. RESULTS: Mean platelet volume was significantly lower in the tonsillitis group (7.8 per cent ± 0.7 per cent) than in the control group (8.7 per cent ± 0.6 per cent; p < 0.0001), and it was significantly lower in the abscess group (7.5 per cent ± 0.6 per cent) than in the no abscess group (8.0 per cent ± 0.7 per cent; p = 0.0277). White blood cell counts and C-reactive protein levels were not significantly different between patients with an abscess and those without. The mean platelet volume cut-off values for the diagnosis of tonsillitis and peritonsillar abscess were 7.95 fl and 7.75 fl, respectively. CONCLUSION: Our results suggest that a decreased mean platelet volume is associated with the development and severity of tonsillitis. This finding provides useful diagnostic information for physicians treating patients with tonsillitis.


Assuntos
Volume Plaquetário Médio/estatística & dados numéricos , Abscesso Peritonsilar/diagnóstico , Tonsilite/diagnóstico , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Peritonsilar/etiologia , Valores de Referência , Estudos Retrospectivos , Índice de Gravidade de Doença , Tonsilite/complicações
18.
Int J Pediatr Otorhinolaryngol ; 110: 57-60, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29859588

RESUMO

INTRODUCTION: Diagnostic tonsillectomy is performed to exclude malignancy. It is associated with a post-operative hemorrhage rate of 3.5%, (1) which is more dangerous in small children. No previous case series for asymmetrical tonsils have detected tonsil lymphoma.(2-6) We aimed to review our local diagnostic tonsillectomy practice. METHOD: The authors reviewed the clinical notes and histological results for all diagnostic tonsillectomies carried out from June 2013 to June 2016. RESULTS: We recorded data for 168 patients. There were four post-operative bleeds and one return to theatre. Bilateral tonsillectomies accounted for 152 operations (90.5%). Lymphoid hyperplasia accounted for 95% of histological diagnosis with no malignancies found. Pre-operative tonsil grading demonstrated no statistically significant association with histological tonsil weight difference (ANOVA p = 0.10). Actinomyces colonisation had little affect on tonsil weight difference when we compared patients with bilateral colonisation and no colonisation (t-test p = 0.540) and between tonsils in patients with unilateral tonsil Actinomyces colonisation (paired t-test p = 0.448). Recurrent tonsillitis was more prevalent in patients with Actinomyces colonisation than OSA/sleep disordered breathing (39% vs 15%). CONCLUSION: A literature search yielded five smaller case series of palatine tonsil asymmetry in children with no malignancy found.(2-6) Case-control studies report tonsillar asymmetry as the most common presenting symptom (73%) in tonsillar lymphoma.(7) This enlargement usually occurs rapidly within 6 weeks with new obstructive or systemic B-type symptoms.(3) A Turkish epidemiological study found asymmetrical tonsils in 1.7% of the healthy paediatric population.(8) We therefore estimate there to be over 210,000 children with asymmetrical tonsils in the UK. With an unreliable grading system, we believe asymmetrical tonsils in isolation, unchanged for over 6 weeks may not warrant tonsillectomy.


Assuntos
Linfoma/diagnóstico , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Hemorragia Pós-Operatória/etiologia , Neoplasias Tonsilares/diagnóstico , Tonsilectomia , Tonsilite/diagnóstico , Actinomyces/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Diferencial , Técnicas de Diagnóstico por Cirurgia , Humanos , Hiperplasia/diagnóstico , Hiperplasia/etiologia , Hiperplasia/patologia , Tamanho do Órgão , Estudos Retrospectivos , Síndromes da Apneia do Sono/complicações , Tonsilectomia/efeitos adversos , Tonsilite/complicações , Tonsilite/microbiologia
19.
J Dermatol ; 45(7): 812-823, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29732605

RESUMO

Pustulosis palmaris et plantaris (PPP) and pustulotic arthro-osteitis (PAO) are tonsil-related diseases. Treatment outcome of tonsillectomy and prognostic factors influencing the outcome have not been analyzed quantitatively. We evaluated those using the Palmoplantar Pustulosis Area and Severity Index (PPPASI). At 1, 3, 6, 12, 24 and more than 24 months post-tonsillectomy, 20 (31%), 34 (48%), 70 (60%), 57 (80%), 36 (95%) and 23 (96%) patients realized 80% or more improvement of PPP skin lesions, respectively, and eight (17%), 23 (36%), 30 (50%), 38 (79%), 12 (100%) and four (100%) patients showed 80% or more improvement of PPPASI (i.e. PPPASI% ≥ 80%), respectively. At 1, 3, 6, 12 and more than 12 months post-tonsillectomy, 19 (73%), 21 (66%), 27 (73%), 19 (79%) and 15 (83%) patients realized a disappearance of PAO-induced arthralgia, respectively. Kaplan-Meier analysis of 80 patients with PPP revealed that, at 12 and 24 months post-tonsillectomy, lesions disappeared (i.e. PPPASI = 0) in 38% and 66% of patients, respectively, and lesions improved by 80% or more (i.e. PPPASI% ≥ 80%) in 71% and 95% of patients, respectively. The log-rank test and univariate and multivariate analyses showed that smoking cessation post-tonsillectomy and PAO were significant predictive factors for the early disappearance of skin lesions. This report is the first demonstrating objective evidence of the great efficacy of tonsillectomy to improve PPP skin lesions. Even post-tonsillectomy, smoking inhibited the early disappearance of the lesions.


Assuntos
Artrite/diagnóstico , Osteíte/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Tonsilectomia/estatística & dados numéricos , Tonsilite/cirurgia , Adolescente , Adulto , Idoso , Artrite/etiologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Osteíte/etiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Dermatopatias Vesiculobolhosas/etiologia , Fumar/efeitos adversos , Abandono do Hábito de Fumar , Tonsilite/complicações , Tonsilite/microbiologia , Resultado do Tratamento , Adulto Jovem
20.
Am J Trop Med Hyg ; 98(6): 1653-1660, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29663902

RESUMO

This study was conducted to explore the experiences of community members, particularly mothers, concerning their beliefs about the causes, treatment practices, and preferences for World Health Organization-defined neonatal danger signs in northwest Ethiopia. A phenomenological qualitative study was conducted in three districts of north Gondar Zone, Amhara region, Ethiopia, from March 10 to 28, 2016. Twelve focus group discussions were conducted involving 98 individuals. In-depth interviews were conducted with six health extension workers and 30 women who were either pregnant or who delivered in the past 6 months. Six subthemes emerged explaining the causes of neonatal danger signs. The causes varied from danger sign to danger sign and from person to person. Most of the perceived causes of danger signs in neonates do not align with the current biomedical science. Causal assumptions and perceived seriousness of danger signs influenced treatment practices and preferences. Four subthemes also emerged for treatment practices and preferences. In some cases, respondents indicated that non-biomedical sources of treatment were superior in outcome compared with biomedical treatment options. Unsatisfactory outcomes were mentioned as major reasons to opt for treatments from non-biomedical sources. Religious and cultural reasons were reported to be major impediments for treatment seeking for newborn danger signs. There is an urgent need to introduce or expand locally modified program interventions, such as community-based newborn care, to educate the community on the causes of neonatal danger signs and the need for prompt care seeking from qualified providers.


Assuntos
Mortalidade Infantil , Doenças do Recém-Nascido/etiologia , Adolescente , Adulto , Agentes Comunitários de Saúde , Etiópia/epidemiologia , Olho/patologia , Feminino , Febre/etiologia , Grupos Focais , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Entrevistas como Assunto , Pessoa de Meia-Idade , Mães , Gravidez , Religiosos , Transtornos Respiratórios/etiologia , Convulsões/etiologia , Cônjuges , Luz Solar , Inquéritos e Questionários , Gravação de Fita , Tonsilite/complicações , Cordão Umbilical/patologia , Úvula/patologia , Vento , Adulto Jovem
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