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Query: UMLS:C0040425 (tonsillitis)
 1,594 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritonsillar abscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and otalgia. Physical findings may include trismus and a muffled voice (also called "hot potato voice"). Drainage of the abscess, antibiotics, and supportive therapy for maintaining hydration and pain control are the foundation of treatment. Antibiotics effective against Group A streptococcus and oral anaerobes should be first-line therapy. Steroids may be helpful in reducing symptoms and speeding recovery. To avoid potential serious complications, prompt recognition and initiation of therapy is important. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess. (Am Fam Physician.
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PMID:Peritonsillar abscess. 1824 91

In this comment, the practice guideline 'Sore throat' (second revision) is discussed. This guideline, composed by the Dutch College of General Practitioners, offers general practitioners a well-appreciated overview of the common practices regarding diagnostic tests and treatment of pharyngitis and tonsillitis.
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PMID:[The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology]. 1836 Nov 91

A sore throat (also known as pharyngitis or tonsillitis) is most commonly caused by a contagious viral infection (such as the flu, cold, or mononucleosis), although more serious throat infections can be caused by a bacterial infection (such as strep, mycoplasma, or Haemophilus). Bacterial sore throats respond well to antibiotics, whereas viral ones do not. However, strep throat remains a leading cause for physician visits, and researchers have long struggled to determine how best to treat it. The current practice guidelines offer different management options for adult patients presenting with a sore throat. Thus, when a physician treats a patient with acute pharyngitis, the clinical decision that usually needs to be made is whether the pharyngitis is attributable to group A streptococci. The key concern is the degree to which the clinical possibility of a group A streptococcal infection should affect clinician's decisions. To determine the best treatment of pharyngitis, we conducted a multicriteria decision analysis using fuzzy reasoning for remote health service delivery between a healthcare provider and patients. The approach can be adopted for interactive phone use or online system application. Five alternative treatment options were considered, particularly: (a) no test no Rx, (b) rapid strep, (c) culture, (d) rapid strep and culture, and (e) empiric Rx. Fuzzy reasoning is used to examine the signs/symptoms and their ratings. The study includes seven criteria factors that can be rated according to each alternative clinical treatment using linguistic statements. The model shows that no test no Rx is the best option for the cases of low prevalence of group A streptococcal infection. Two strategies--culture and treat if positive and rapid strep with culture of negative results--are equally preferable for patients with moderate prevalence likelihood. Rapid strep and culture of negative results is the best management strategy for patients with high population prevalence of group A streptococcal infection. In conclusion, the best clinical management of patients with sore throat depends on both the clinical probability of group A streptococcal infection and clinical judgments that incorporate the importance ratings of the individual patients as well as practice circumstances.
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PMID:A remote fuzzy multicriteria diagnosis of sore throat. 1881 94

Acute pharyngitis and tonsillitis are one of the most freguent illnesses. Most of episodes of the sore throat are coused by viral agents.Groupe A beta - hemolitic streptococcus still dominantes emong bacterial pathogens in upper respiratory tract infections and their late sequelae like rheumatic ferer determines the necessity of intensive therapy. Diagnosis should be made basing on results of clinical manifestations in conjunction with microbiological and serological tests. An inereased serum antibody titers to streptolisin O (antistreptolisin O -ASO) is usually indicative of recent streptococcal infection not active rheumatic fever.
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PMID:[Streptococcal infection and antistreptolisine O]. 1948 62

Sore throat is most commonly caused by viruses, but when caused by bacteria, the most important is group A streptococcus (GAS). The aim of these guidelines is to determine optimal treatment for streptococcal sore throat and reasonable indications for tonsillectomy, as well as recommend how to differentiate streptococcal infection for which antibiotics are justified, from numerous other sore throats where antibiotics wont have a significant effect on disease course, but might contribute to bacterial resistance to antibiotics. The development of the guidelines was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of consensus between all interested professional societies and institutions. For streptococcal sore throat diagnostics, the Working Group recommends evaluation of clinical presentation according to Centor criteria and for patients with Centor score 0-1, antibiotic therapy is not recommended nor bacteriological testing, while for patients with Centor score 2-4 bacteriological testing is recommended (rapid test or culture) as well as antibiotic therapy in case of positive result. The drug of choice for the treatment of streptococcal tonsillopharyngitis is oral penicillin taken for ten days (penicillin V) or in case of poor patient compliance benzathine penicillin G can be administered parenterally in a single dose. Other antibiotics (macrolides, clindamycin, cephalosporins, co-amoxiclav) are administered only in case of hypersensitivity to penicillin or in recurrent infections. Tonsillectomy is a widely accepted surgical procedure that decreases the number of sore throats in children and should be performed only if indications for this procedure are established. Absolute indications include five or more streptococcal infections per year, tonsillitis complications, permanent respiratory tract obstruction, obstructive sleep apnea syndrome and suspected tonsillar malignancy. Relative indications include chronic tonsillitis and occlusion disturbances.
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PMID:[ISKRA guidelines on sore throat: diagnostic and therapeutic approach--Croatian national guidelines]. 1976 78

Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the 'clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this 'forgotten disease'.
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PMID:Neurological complications in two children with Lemierre syndrome. 2058 47

Sore throat is a common medical complaint seen by the emergency practitioner, internist, pediatrician, and otolaryngologist. The differential for sore throat is vast. However, with a directed history this can often be narrowed down to 2 to 3 possible diagnoses. By paying particular attention to the associated symptoms and duration of symptoms, common self-limited etiologies like viral pharyngitis and nonstreptococcal tonsillitis can be distinguished from those that require more investigation, such as supraglottitis and tonsillar cancer. A sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor.
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PMID:The patient with sore throat. 2073 4

Tularemia which is a multisystem disease of humans and some animals, is endemic in North America, some parts of Europe and Asia. The causative agent, Francisella tularensis, is a fastidious gram-negative, intracellular bacterium which requires supplementation with sulphydryl compounds (cysteine, cystine, thiosulphate, isoVitaleX) for growth on common laboratory media. In this report, a case of oropharyngeal tularemia diagnosed by the isolation of the causative agent on non-selective-common microbiological agar, has been presented. The patient was from Yozgat located in central Anatolia where tularemia has not been reported so far. Forty-two years old male was admitted to the hospital with two weeks history of sudden onset fever, headache, generalized aches, sore throat, and cervical tender lump on the left. Physical examination revealed bilateral exudative tonsillitis and tender posterior cervical lymphadenopathy. He has been empirically treated with amoxicilin-clavulanic acid for 7 days with initial diagnosis of acute tonsillopharyngitis. However, he was admitted to the hospital since the symptoms persisted and swelling increased despite antibiotic therapy. Microscopical examination of the Gram and Ehrlich-Ziehl-Neelsen stained smears prepared from the surgically drained lymph node revealed PMNL, with no evidence of bacteria. Routine cultures of the lymph node material yielded growth of gram-negative coccobacilli only on human blood agar and the cultures were negative for pyogenic bacteria, acid-fast organisms and fungi. Pathologic examination of the drainage material revealed suppurative inflammation. Lymph node aspirate and serum samples of the patient together with the isolated strain were sent to reference laboratory for further investigation in accordance to the clinical and laboratory findings compatible with tularemia. The isolate was confirmed as F.tularensis by slide agglutination and direct immunofluorescence antibody tests, and identified as F.tularensis subsp. holarctica by polymerase chain reaction. Microagglutination test performed on patient's serum yielded positive with an antibody titer of 1/5120. Gentamicin (5 mg/kg/day) was initiated, and the therapy was completed for two weeks. The patient recovered completely without sequela. This case was presented in order to call attention to the strain of F.tularensis which failed to demonstrate a requirement for cysteine and enriched medium on primary isolation, but grew well on conventional laboratory medium. Tularemia should be considered in the differential diagnosis of related infectious diseases since cases of tularemia have been reported from several parts of Turkey after the year 2004.
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PMID:[An oropharyngeal tularemia case diagnosed by the isolation of Francisella tularensis on human blood agar]. 2106 79

Acute lingual tonsillitis is a rarely diagnosed cause of sore throat. The patient with acute lingual tonsillitis typically has severe sore throat, dysphagia and pain at the level of hyoid bone, and it is interesting that patients with previous palatine tonsillectomy can present with almost normal oral examination findings. The diagnosis of potentially fatal epiglottitis should be excluded. Because the base of the tongue can not be visualized by intraoral examination, diagnosis must be made by indirect or transnasal fiberoptic laryngoscopy.
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PMID:[Acute lingual tonsillitis]. 2126 Oct 26

Necrobacillosis, often used synonymously with Lemierre's syndrome, is a form of abscess infection in the peritonsillar area associated with a thrombophlebitis and caused by the strict anaerobic species Fusobacterium necrophorum. The thrombosis formed affects the internal jugular vein, from which the bacteria are seeded out in the bloodstream and cause bacteremia. Septicemia is a common complication with an often fatal outcome. Necrobacillosis is very rare and is referred to as the 'forgotten disease'. It is probably frequently overlooked in clinical practice in its early and milder forms such as tonsillitis (sore throat) and peritonsillar abscess. F. necrophorum frequently participates in these infections and is thus suspected to have an etiological role in Lemierre's syndrome. Similarly, F. necrophorum seems to play an important role in noma (cancrum oris) and this disease is also included in the necrobacillosis complex. Diagnosis of infections of the necrobacillosis complex seeks to disclose F. necrophorum in swab samples or blood culture. The most commonly used therapy is metronidazole in combination with penicillin or amoxicillin. Clindamycin is also an option, especially in cases of penicillin allergy.
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PMID:Necrobacillosis in humans. 2134 70


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