Peritonsillar abscess differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Peritonsillar_abscess]] | |||
{{CMG}} {{AE}} {{PTD}} | {{CMG}} {{AE}} {{PTD}} | ||
==Overview== | ==Overview== | ||
Peritonsillar abscess must be differentiated from other [[Upper Respiratory Disease|upper]] [[Respiratory disease|respiratory diseases]] and conditions that may cause throat pain and airway obstruction. These include; [[croup]]([[laryngotracheobronchitis]]), p[[Pharyngitis|haryngitis]], [[tonsilitis]], [[Retropharyngeal abscess|retropharyngeal abscess]] and [[epiglottitis]]. | |||
==Differential diagnosis== | ==Differential diagnosis== | ||
| Line 19: | Line 20: | ||
|- | |- | ||
|[[Peritonsillar abscess]] | |[[Peritonsillar abscess]] | ||
|Severe [[sore throat]], [[otalgia]] [[fever]], a "hot potato" or muffled voice, [[drooling]], and [[trismus]]<ref name="pmid18246890" /> | |Severe [[sore throat]], [[otalgia]] [[fever]], a "hot potato" or muffled voice, [[drooling]], and [[trismus]]<ref name="pmid18246890">{{cite journal| author=Galioto NJ| title=Peritonsillar abscess. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 2 | pages= 199-202 | pmid=18246890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18246890 }} </ref> | ||
|[[Streptococcus pyogenes|Aerobic and anaerobic]] | |[[Streptococcus pyogenes|Aerobic and anaerobic]] | ||
[[Streptococcus pyogenes|bacteria most common is]] | [[Streptococcus pyogenes|bacteria most common is]] | ||
| Line 25: | Line 26: | ||
[[Streptococcus pyogenes|Streptococcus]] | [[Streptococcus pyogenes|Streptococcus]] | ||
[[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356" /><ref name="pmid18039418" /><ref name="pmid1875138" /><ref name="pmid12092281" /> | [[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356 }} </ref><ref name="pmid18039418">{{cite journal| author=Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S| title=Changing trends in bacteriology of peritonsillar abscess. | journal=J Laryngol Otol | year= 2008 | volume= 122 | issue= 9 | pages= 928-30 | pmid=18039418 | doi=10.1017/S0022215107001144 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18039418 }} </ref><ref name="pmid1875138">{{cite journal| author=Snow DG, Campbell JB, Morgan DW| title=The microbiology of peritonsillar sepsis. | journal=J Laryngol Otol | year= 1991 | volume= 105 | issue= 7 | pages= 553-5 | pmid=1875138 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1875138 }} </ref><ref name="pmid12092281">{{cite journal| author=Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M| title=Peritonsillar abscess: a study of 724 cases in Japan. | journal=Ear Nose Throat J | year= 2002 | volume= 81 | issue= 6 | pages= 384-9 | pmid=12092281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12092281 }} </ref> | ||
|[[Contralateral]] deflection of the uvula, | |[[Contralateral]] deflection of the [[uvula]], | ||
the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]]. | the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]]. | ||
|The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890" /> | |The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890">{{cite journal| author=Galioto NJ| title=Peritonsillar abscess. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 2 | pages= 199-202 | pmid=18246890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18246890 }} </ref> | ||
|On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.<ref name="pmid15635144" /><ref name="pmid1642863" /><ref name="pmid26637999" /><ref name="pmid10435129" /><ref name="pmid15635144" /><ref name="pmid1642863" /> | |On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.<ref name="pmid15635144">{{cite journal| author=Lyon M, Blaivas M| title=Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. | journal=Acad Emerg Med | year= 2005 | volume= 12 | issue= 1 | pages= 85-8 | pmid=15635144 | doi=10.1197/j.aem.2004.08.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15635144 }} </ref><ref name="pmid1642863">{{cite journal| author=Boesen T, Jensen F| title=Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. | journal=Eur Arch Otorhinolaryngol | year= 1992 | volume= 249 | issue= 3 | pages= 131-3 | pmid=1642863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1642863 }} </ref><ref name="pmid26637999">{{cite journal| author=Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK| title=Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. | journal=Pediatr Radiol | year= 2016 | volume= 46 | issue= 7 | pages= 1059-67 | pmid=26637999 | doi=10.1007/s00247-015-3505-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26637999 }} </ref><ref name="pmid10435129">{{cite journal| author=Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA| title=Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. | journal=J Laryngol Otol | year= 1999 | volume= 113 | issue= 3 | pages= 229-32 | pmid=10435129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10435129 }} </ref><ref name="pmid15635144">{{cite journal| author=Lyon M, Blaivas M| title=Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. | journal=Acad Emerg Med | year= 2005 | volume= 12 | issue= 1 | pages= 85-8 | pmid=15635144 | doi=10.1197/j.aem.2004.08.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15635144 }} </ref><ref name="pmid1642863">{{cite journal| author=Boesen T, Jensen F| title=Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. | journal=Eur Arch Otorhinolaryngol | year= 1992 | volume= 249 | issue= 3 | pages= 131-3 | pmid=1642863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1642863 }} </ref> | ||
|[[Ampicillin-sulbactam|Ampicillin-sulbactam,]] [[Clindamycin]], [[Vancomycin]] or [[Linezolid]] | |[[Ampicillin-sulbactam|Ampicillin-sulbactam,]] [[Clindamycin]], [[Vancomycin]] or [[Linezolid]] | ||
|- | |- | ||
| Line 35: | Line 36: | ||
|Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]] | |Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]] | ||
|[[Parainfluenza virus]] | |[[Parainfluenza virus]] | ||
|Suprasternal and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760" /> Inspiratory [[stridor]] | |[[Suprasternal notch|Suprasternal]] and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760">{{cite journal| author=Johnson D| title=Croup. | journal=BMJ Clin Evid | year= 2009 | volume= 2009 | issue= | pages= | pmid=19445760 | doi= | pmc=2907784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19445760 }} </ref> Inspiratory [[stridor]], expiratory [[wheezing]], [[Sternal]] wall retractions<ref name="pmid19457602">{{cite journal| author=Giordano S, Adamo P, Monaci F, Pittao E, Tretiach M, Bargagli R| title=Bags with oven-dried moss for the active monitoring of airborne trace elements in urban areas. | journal=Environ Pollut | year= 2009 | volume= 157 | issue= 10 | pages= 2798-805 | pmid=19457602 | doi=10.1016/j.envpol.2009.04.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19457602 }} </ref> | ||
|Mainly 6 months and 3 years old | |Mainly 6 months and 3 years old | ||
rarely, adolescents and adults<ref name="pmid8769531" /> | rarely, adolescents and adults<ref name="pmid8769531">{{cite journal| author=Tong MC, Chu MC, Leighton SE, van Hasselt CA| title=Adult croup. | journal=Chest | year= 1996 | volume= 109 | issue= 6 | pages= 1659-62 | pmid=8769531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8769531 }} </ref> | ||
|[[Steeple sign]] on neck X-ray | |[[Steeple sign]] on neck X-ray | ||
|[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]] | |[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]] | ||
|- | |- | ||
|[[Epiglottitis]] | |[[Epiglottitis]] | ||
| | |[[Stridor]] and [[drooling]] [[Difficulty breathing|but no cough. Other symptoms include difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of [[voice]] | ||
|[[Hemolysis|H. influenza type b,]] | |[[Hemolysis|H. influenza type b,]] | ||
[[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' | [[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' | ||
[[fungi]] and [[viruses]]. | [[fungi]] and [[viruses]]. | ||
|[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], | |[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], [[Inflamed]] [[epiglottis]] | ||
|Used to be mostly found in | |Used to be mostly found in | ||
pediatric age group between 3 to 5 years, | pediatric age group between 3 to 5 years, | ||
| Line 53: | Line 54: | ||
however, recent trend favors adults | however, recent trend favors adults | ||
as most commonly affected individuals | as most commonly affected individuals | ||
with a mean age of 44.94 years | with a mean age of 44.94 years | ||
|[[Thumbprint sign]] on neck x-ray | |[[Thumbprint sign]] on neck x-ray | ||
|Airway maintenance, | |[[Airway]] maintenance, [[Parenteral|parenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. [[Adjuvant therapy]] includes [[corticosteroids]] and [[racemic]] [[Epinephrine]].<ref name="pmid15983574">{{cite journal| author=Nickas BJ| title=A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy. | journal=J Emerg Nurs | year= 2005 | volume= 31 | issue= 3 | pages= 234-5; quiz 321 | pmid=15983574 | doi=10.1016/j.jen.2004.10.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15983574 }} </ref><ref name="pmid12557859">{{cite journal| author=Wick F, Ballmer PE, Haller A| title=Acute epiglottis in adults. | journal=Swiss Med Wkly | year= 2002 | volume= 132 | issue= 37-38 | pages= 541-7 | pmid=12557859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557859 }} </ref> | ||
|- | |- | ||
|[[Pharyngitis]] | |[[Pharyngitis]] | ||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[ | |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[abdominal pain]], [[nausea]] and [[vomiting]] | ||
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | |[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | ||
[[Group A beta-hemolytic streptococci|streptococcus]]. | [[Group A beta-hemolytic streptococci|streptococcus]]. | ||
| | |[[Inflamed]] [[pharynx]] with or without [[exudate]] | ||
|Mostly in children and young adults, | |Mostly in children and young adults, | ||
with 50% of cases identified | with 50% of cases identified | ||
between the ages of 5 to 24 years | between the ages of 5 to 24 years | ||
|_ | |_ | ||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]]. | |[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]]. | ||
|- | |- | ||
|[[Tonsilitis]] | |[[Tonsilitis]] | ||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]] | |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], and [[cough]] | ||
|Most common cause is | |Most common cause is | ||
viral including [[adenovirus]], | [[viral]] including [[adenovirus]], | ||
[[rhinovirus]], [[influenza]], | [[rhinovirus]], [[influenza]], | ||
| Line 88: | Line 89: | ||
''[[Group A streptococcal infection|Group A streptococcal]]'' | ''[[Group A streptococcal infection|Group A streptococcal]]'' | ||
''[[Group A streptococcal infection|bacteria]]'' | ''[[Group A streptococcal infection|bacteria]]''<ref name="pmid3601520">{{cite journal| author=Putto A| title=Febrile exudative tonsillitis: viral or streptococcal? | journal=Pediatrics | year= 1987 | volume= 80 | issue= 1 | pages= 6-12 | pmid=3601520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3601520 }} </ref> | ||
|[[Fever]], especially 100°F or higher. | |[[Fever]], especially 100°F or higher. [[Erythema]], [[edema]] and [[exudate]] of the [[tonsils]],<ref name="pmid25587367">{{cite journal| author=Stelter K| title=Tonsillitis and sore throat in children. | journal=GMS Curr Top Otorhinolaryngol Head Neck Surg | year= 2014 | volume= 13 | issue= | pages= Doc07 | pmid=25587367 | doi=10.3205/cto000110 | pmc=4273168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25587367 }} </ref> cervical [[lymphadenopathy]], and [[Dysphonia]].<ref name="urlTonsillitis - Symptoms - NHS Choices" </ref> | ||
|Primarily affects children | |Primarily affects children | ||
between 5 and 15 years old.<ref name=" | between 5 and 15 years old. | ||
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518" /><ref name="pmid25946659" /><ref name="pmid25945805" /> | |Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518 }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659 }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805 }} </ref> | ||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases. | |Primarily affects children | ||
between 5 and 15 years old. | |||
|Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518 }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659 }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805 }} </ref> | |||
||[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases. | |||
|- | |- | ||
|[[Retropharyngeal abscess]] | |[[Retropharyngeal abscess]] | ||
|[[Neck pain]], [[stiff neck]], [[torticollis]] | |[[Neck pain]], [[stiff neck]], [[torticollis]], [[fever]], [[malaise]], [[stridor]], and barking [[cough]] | ||
[[fever]], [[malaise]], [[stridor]], and barking [[cough]] | |||
|Polymicrobial infection. | |Polymicrobial infection. | ||
Mostly; [[Streptococcus pyogenes|Streptococcus]] | Mostly; [[Streptococcus pyogenes|Streptococcus]] | ||
[[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory anaerobes (example; Fusobacteria, [[Prevotella species|Prevotella]], | [[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory [[anaerobes]] (example; Fusobacteria, [[Prevotella species|Prevotella]], | ||
and Veillonella species)<ref name="pmid23520072" /><ref name="pmid22481424" /><ref name="pmid18948832" /><ref name="pmid15573356" /><ref name="pmid18427007" /><ref name="pmid2235179" /> | and Veillonella species)<ref name="pmid23520072">{{cite journal| author=Cheng J, Elden L| title=Children with deep space neck infections: our experience with 178 children. | journal=Otolaryngol Head Neck Surg | year= 2013 | volume= 148 | issue= 6 | pages= 1037-42 | pmid=23520072 | doi=10.1177/0194599813482292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23520072 }} </ref><ref name="pmid22481424">{{cite journal| author=Abdel-Haq N, Quezada M, Asmar BI| title=Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus. | journal=Pediatr Infect Dis J | year= 2012 | volume= 31 | issue= 7 | pages= 696-9 | pmid=22481424 | doi=10.1097/INF.0b013e318256fff0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22481424 }} </ref><ref name="pmid18948832">{{cite journal| author=Inman JC, Rowe M, Ghostine M, Fleck T| title=Pediatric neck abscesses: changing organisms and empiric therapies. | journal=Laryngoscope | year= 2008 | volume= 118 | issue= 12 | pages= 2111-4 | pmid=18948832 | doi=10.1097/MLG.0b013e318182a4fb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948832 }} </ref><ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356 }} </ref><ref name="pmid18427007">{{cite journal| author=Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ| title=Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 4 | pages= 408-13 | pmid=18427007 | doi=10.1001/archotol.134.4.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18427007 }} </ref><ref name="pmid2235179">{{cite journal| author=Asmar BI| title=Bacteriology of retropharyngeal abscess in children. | journal=Pediatr Infect Dis J | year= 1990 | volume= 9 | issue= 8 | pages= 595-7 | pmid=2235179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2235179 }} </ref> | ||
|Child may be unable to open the mouth widely. May have enlarged | |Child may be unable to open the mouth widely. May have enlarged [[cervical]] [[lymph nodes]] and neck mass. | ||
[[cervical]] [[lymph nodes]] and neck mass. | |Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558">{{cite journal| author=Craig FW, Schunk JE| title=Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 6 Pt 1 | pages= 1394-8 | pmid=12777558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777558 }} </ref><ref name="pmid1876473">{{cite journal| author=Coulthard M, Isaacs D| title=Neonatal retropharyngeal abscess. | journal=Pediatr Infect Dis J | year= 1991 | volume= 10 | issue= 7 | pages= 547-9 | pmid=1876473 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1876473 }} </ref> | ||
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558" /><ref name="pmid1876473" /> | |On CT scan, a mass impinging on the posterior [[pharyngeal]] wall with rim enhancement is seen<ref name="pmid15667676">{{cite journal| author=Philpott CM, Selvadurai D, Banerjee AR| title=Paediatric retropharyngeal abscess. | journal=J Laryngol Otol | year= 2004 | volume= 118 | issue= 12 | pages= 919-26 | pmid=15667676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667676 }} </ref><ref name="pmid12761699">{{cite journal| author=Vural C, Gungor A, Comerci S| title=Accuracy of computerized tomography in deep neck infections in the pediatric population. | journal=Am J Otolaryngol | year= 2003 | volume= 24 | issue= 3 | pages= 143-8 | pmid=12761699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12761699 }} </ref> | ||
|On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<ref name="pmid15667676" /><ref name="pmid12761699" /> | |||
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]]. | |Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]]. | ||
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[[Category:Infectious disease]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Surgery]] | |||
Latest revision as of 23:40, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Peritonsillar abscess must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction. These include; croup(laryngotracheobronchitis), pharyngitis, tonsilitis, retropharyngeal abscess and epiglottitis.
Differential diagnosis
Peritonsillar abscess must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction as shown in the table below:
| Disease/Variable | Presentation | Causes | Physical exams findings | Age commonly affected | Imaging finding | Treatment |
|---|---|---|---|---|---|---|
| Peritonsillar abscess | Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[1] | Aerobic and anaerobic | Contralateral deflection of the uvula,
the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema. |
The highest occurrence is in adults between 20 to 40 years of age.[1] | On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[6][7][8][9][6][7] | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid |
| Croup | Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Parainfluenza virus | Suprasternal and intercostal indrawing,[10] Inspiratory stridor, expiratory wheezing, Sternal wall retractions[11] | Mainly 6 months and 3 years old
rarely, adolescents and adults[12] |
Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine |
| Epiglottitis | Stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | H. influenza type b, | Cyanosis, Cervical lymphadenopathy, Inflamed epiglottis | Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals with a mean age of 44.94 years |
Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[13][14] |
| Pharyngitis | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Group A beta-hemolytic | Inflamed pharynx with or without exudate | Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years |
_ | Antimicrobial therapy mainly penicillin-based and analgesics. |
| Tonsilitis | Sore throat, pain on swallowing, fever, headache, and cough | Most common cause is
viral including adenovirus, coronavirus, and Second most common causes are bacterial; |
Fever, especially 100°F or higher. Erythema, edema and exudate of the tonsils,[16] cervical lymphadenopathy, and Dysphonia.[17][18] | Primarily affects children
between 5 and 15 years old. |
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[19][17][18] | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. |
| Retropharyngeal abscess | Neck pain, stiff neck, torticollis, fever, malaise, stridor, and barking cough | Polymicrobial infection.
Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, |
Child may be unable to open the mouth widely. May have enlarged cervical lymph nodes and neck mass. | Mostly between 2-4 years, but can occur in other age groups.[25][26] | On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[27][28] | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. |
References
- ↑ 1.0 1.1 Galioto NJ (2008). "Peritonsillar abscess". Am Fam Physician. 77 (2): 199–202. PMID 18246890.
- ↑ 2.0 2.1 Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
- ↑ Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S (2008). "Changing trends in bacteriology of peritonsillar abscess". J Laryngol Otol. 122 (9): 928–30. doi:10.1017/S0022215107001144. PMID 18039418.
- ↑ Snow DG, Campbell JB, Morgan DW (1991). "The microbiology of peritonsillar sepsis". J Laryngol Otol. 105 (7): 553–5. PMID 1875138.
- ↑ Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M (2002). "Peritonsillar abscess: a study of 724 cases in Japan". Ear Nose Throat J. 81 (6): 384–9. PMID 12092281.
- ↑ 6.0 6.1 Lyon M, Blaivas M (2005). "Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department". Acad Emerg Med. 12 (1): 85–8. doi:10.1197/j.aem.2004.08.045. PMID 15635144.
- ↑ 7.0 7.1 Boesen T, Jensen F (1992). "Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis". Eur Arch Otorhinolaryngol. 249 (3): 131–3. PMID 1642863.
- ↑ Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK (2016). "Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections". Pediatr Radiol. 46 (7): 1059–67. doi:10.1007/s00247-015-3505-7. PMID 26637999.
- ↑ Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA (1999). "Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis". J Laryngol Otol. 113 (3): 229–32. PMID 10435129.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ Giordano S, Adamo P, Monaci F, Pittao E, Tretiach M, Bargagli R (2009). "Bags with oven-dried moss for the active monitoring of airborne trace elements in urban areas". Environ Pollut. 157 (10): 2798–805. doi:10.1016/j.envpol.2009.04.020. PMID 19457602.
- ↑ Tong MC, Chu MC, Leighton SE, van Hasselt CA (1996). "Adult croup". Chest. 109 (6): 1659–62. PMID 8769531.
- ↑ Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
- ↑ Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
- ↑ Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
- ↑ Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
- ↑ 17.0 17.1 Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections". Laryngoscope. 125 (11): 2604–7. doi:10.1002/lary.25313. PMID 25946659.
- ↑ 18.0 18.1 Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J; et al. (2015). "Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess". Laryngoscope. 125 (12): 2799–804. doi:10.1002/lary.25354. PMID 25945805.
- ↑ Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
- ↑ Cheng J, Elden L (2013). "Children with deep space neck infections: our experience with 178 children". Otolaryngol Head Neck Surg. 148 (6): 1037–42. doi:10.1177/0194599813482292. PMID 23520072.
- ↑ Abdel-Haq N, Quezada M, Asmar BI (2012). "Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus". Pediatr Infect Dis J. 31 (7): 696–9. doi:10.1097/INF.0b013e318256fff0. PMID 22481424.
- ↑ Inman JC, Rowe M, Ghostine M, Fleck T (2008). "Pediatric neck abscesses: changing organisms and empiric therapies". Laryngoscope. 118 (12): 2111–4. doi:10.1097/MLG.0b013e318182a4fb. PMID 18948832.
- ↑ Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ (2008). "Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess". Arch Otolaryngol Head Neck Surg. 134 (4): 408–13. doi:10.1001/archotol.134.4.408. PMID 18427007.
- ↑ Asmar BI (1990). "Bacteriology of retropharyngeal abscess in children". Pediatr Infect Dis J. 9 (8): 595–7. PMID 2235179.
- ↑ Craig FW, Schunk JE (2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
- ↑ Coulthard M, Isaacs D (1991). "Neonatal retropharyngeal abscess". Pediatr Infect Dis J. 10 (7): 547–9. PMID 1876473.
- ↑ Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess". J Laryngol Otol. 118 (12): 919–26. PMID 15667676.
- ↑ Vural C, Gungor A, Comerci S (2003). "Accuracy of computerized tomography in deep neck infections in the pediatric population". Am J Otolaryngol. 24 (3): 143–8. PMID 12761699.