Predisposing factors and management of complications in acute tonsillitis.
CONCLUSIONS
RPA and NF was diagnosed with a sensitivity/specificity of 100%/94% in patients with acute tonsillitis and without suspicion for disease complication after ENT examination, but an age >35 years and serum CRP >15.5mg/dl.


BACKGROUND
Acute tonsillitis represents a frequent disease in the otorhinolaryngology. Some patients exhibit disease aggravations resulting in (descending) peritonsillar abscess (PTA, dPTA), para-/retropharyngeal abscess (PPA, RPA), or necrotising fasciitis (NF). The study analyses the underlying predisposing factors.


METHODS
The retrospective cohort study includes a total of 1636 patients comprising 852 outpatients with acute bacterial tonsillitis, 279 in-patients with acute bacterial tonsillitis, 452 patients with PTA, 31 patients with dPTA/PPA, 12 patients with RPA, and 10 patients with NF. Patients were analysed for disease-related data.


RESULTS
While leucocytes do not distinguish the sub-groups, C-reactive protein demonstrated a significant increase resulting in the highest level for RPA and NF (p < 0.0001). PTA and RPA are usually caused by streptococcus, dPTA/PPA by anaerobic bacterias, and NF mixed infections (p < 0.0001). Patients with PTA were younger than dPTA/PPA (p = 0.002) or RPA/NF (p < 0.0001). Subsequently, the rate of internistic comorbidities was significantly increased in RPA/NF (p < 0.0001). ROC-analysis identified cut-offs for age <36 years and CRP <15.5mg/dl to distinguish acute bacterial tonsillitis from RPA.
a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany.
Constanze
C
Gahleitner
a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany.
Benedikt
B
Hofauer
a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany.
Thomas
T
Stark
a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany.
Andreas
A
Knopf
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D000039:Peritonsillar Abscess / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D017703:Retropharyngeal Abscess / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014069:Tonsillitis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D055815:Young Adult
D000900:Anti-Bacterial Agents
Tonsillitis; complication; necrotising fasciitis; parapharyngeal abscess; therapy