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Gram Staining for the Treatment of Peritonsillar Abscess  [PDF]
Yukinori Takenaka,Kazuya Takeda,Tadashi Yoshii,Michiko Hashimoto,Hidenori Inohara
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/464973
Abstract: Objective. To examine whether Gram staining can influence the choice of antibiotic for the treatment of peritonsillar abscess. Methods. Between 2005 and 2009, a total of 57 cases of peritonsillar abscess were analyzed with regard to cultured bacteria and Gram staining. Results. Only aerobes were cultured in 16% of cases, and only anaerobes were cultured in 51% of cases. Mixed growth of aerobes and anaerobes was observed in 21% of cases. The cultured bacteria were mainly aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. Phagocytosis of bacteria on Gram staining was observed in 9 cases. The bacteria cultured from these cases were aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. The sensitivity of Gram staining for the Gram-positive cocci and Gram-negative rods was 90% and 64%, respectively. The specificity of Gram staining for the Gram-positive cocci and Gram-negative rods was 62% and 76%, respectively. Most of the Gram-positive cocci were sensitive to penicillin, but some of anaerobic Gram-negative rods were resistant to penicillin. Conclusion. When Gram staining shows only Gram-positive cocci, penicillin is the treatment of choice. In other cases, antibiotics effective for the penicillin-resistant organisms should be used. 1. Introduction Peritonsillar abscess is a localized accumulation of pus within the peritonsillar tissues, which usually results from acute tonsillitis and subsequent peritonsillar cellulitis. This disease is one of the most commonly encountered conditions in ear, nose, and throat (ENT) emergencies. It is characterized by sore throat, trismus, muffed voice, dehydration, dysphagia, and intense pain. Therefore, admission to the hospital is required for some patients with peritonsillar abscess. Intensive therapy may be required in some cases because it may lead to fatal complications, such as deep neck abscess and descending necrotizing mediastinitis [1]. The treatment for peritonsillar abscess involves 2 steps: one is the removal of pus and the other is antibiotic therapy. For effective antibiotic therapy, we usually send the aspirates of the peritonsillar abscess for Gram staining and culture. However, previous reports have denied the effectiveness of bacteriologic studies [2–4]. The aim of this study was to examine the efficacy of bacteriological studies of the peritonsillar abscess, with focus on the Gram-staining characteristics of the bacteria, and determine the value of this method in clinical practice. 2. Materials and Methods A retrospective study was
Gram Staining for the Treatment of Peritonsillar Abscess  [PDF]
Yukinori Takenaka,Kazuya Takeda,Tadashi Yoshii,Michiko Hashimoto,Hidenori Inohara
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/464973
Abstract: Objective. To examine whether Gram staining can influence the choice of antibiotic for the treatment of peritonsillar abscess. Methods. Between 2005 and 2009, a total of 57 cases of peritonsillar abscess were analyzed with regard to cultured bacteria and Gram staining. Results. Only aerobes were cultured in 16% of cases, and only anaerobes were cultured in 51% of cases. Mixed growth of aerobes and anaerobes was observed in 21% of cases. The cultured bacteria were mainly aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. Phagocytosis of bacteria on Gram staining was observed in 9 cases. The bacteria cultured from these cases were aerobic Streptococcus, anaerobic Gram-positive cocci, and anaerobic Gram-negative rods. The sensitivity of Gram staining for the Gram-positive cocci and Gram-negative rods was 90% and 64%, respectively. The specificity of Gram staining for the Gram-positive cocci and Gram-negative rods was 62% and 76%, respectively. Most of the Gram-positive cocci were sensitive to penicillin, but some of anaerobic Gram-negative rods were resistant to penicillin. Conclusion. When Gram staining shows only Gram-positive cocci, penicillin is the treatment of choice. In other cases, antibiotics effective for the penicillin-resistant organisms should be used.
PERITONSILLAR ABSCESS IN CHILDREN – TEN-YEAR ANALYSIS OF DIAGNOSIS AND TREATMENT
Mila Bojanovic,Misko Zivic,Dusan Milisavljevic
Acta Medica Medianae , 2006,
Abstract: Peritonsillar abscess is the commonest complication of acute tonsillitis. The paper presents the cohort of 27 patients, younger than the age of 18, treated at the Clinic for Otorhinolaryngology, Clinical Center of Nis, in the period from 1995 to 2005. The patients were treated according the protocol typical of this institution. The surgical and medicament therapy was applied. The greatest number of patients was present in 1997 and 2005. The youngest patient was nine years old. Duration of symptoms was 4.2 days. Abscess was found on the right side in 13 patients, and on the left one in 14 patients. The treatment was in duration of 3-15 days, on average 5.65 days. The “interval” tonsillectomy was performed in nine patients one month after the appearance of tonsillar abscess.
Peritonsillar Abscess with Uvular Hydrops  [cached]
Mills, Lisa D,May, Karen,Mihlon, Frank
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2010,
Abstract: The use of ultrasound by emergency physicians has improved the evaluation of pharyngeal infections. We present a unique case of concomitant peritonsillar abscess and uvular hydrops in which ultrasound provided accurate, timely information in the evaluation. [West J Emerg Med. 2010; 11(1):83-85].
Association between Peritonsillar Abscess and Molar Caries  [cached]
M Shayani Nasab,F Behnod,F Farehani,F Hashemian
Journal of Research in Medical Sciences , 2006,
Abstract: Background: Peritonsillar abscess is the most common deep neck infections that are related with periodontal disease which has the same pathogenesis. We determined the relationship between peritonsillar infection and molar caries. Methods: In a cross-sectional study, 33 consecutive patients whom referred to Hamadan university clinic of otolaryngologic for peritonsillar abscess were examined by otolaryngologist and dentist who investigated relationship between peritonsillar infection and molar caries. Results: There were 27 males and 6 females with mean age 26.7+_7 years. The frequency caries on ipsilateral peritonsillar infection sides was in relation to molars caries on opposite sides (conterol group). This corrolation was significant with odds ratio 2.5. Conclusion: Molar caries were seen 2.5 times more likely to have peritonsillar infection compared with normal molar sides. Key Words: Peritonsillar abscess, Infection, Periodontal disease, Dental caries
Bilateral Peritonsillar Abscesses: A Case Presentation and Review of the Current Literature with regard to the Controversies in Diagnosis and Treatment
G. X. Papacharalampous,P. V. Vlastarakos,G. Kotsis,D. Davilis,L. Manolopoulos
Case Reports in Medicine , 2011, DOI: 10.1155/2011/981924
Abstract: Although unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis, bilateral peritonsillar abscesses are quite rare. The incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%, while the overall incidence of bilateral peritonsillar abscess is reported to reach 4.9%. Diagnosis can be based on clinical criteria or imaging techniques. As far as the treatment is concerned, it is generally accepted that the basic strategy consists of systemic antibiotics and drainage of the pus. We report the case of a 19-year-old girl, treated in the emergency room with a bilateral diagnostic needle aspiration followed by bilateral incision and drainage along with intravenous clindamycin plus anti-inflammatory agents and hydration. Following treatment, the patient progressively experienced a marked alleviation of her odynophagia. She was discharged 48 hours later on a 10-day course of clindamycin.
Traumatic Carotid Artery Pseudoaneurysm Mimicking A Peritonsillar Abscess  [PDF]
Nur Ebru MIH?I,Hülya Ayd?n GüNG?R,Eylem ?ZAYDIN,Kamil KARAAL?
Journal of Neurological Sciences , 2010,
Abstract: Carotid artery pseudoaneurysms can occur in many different etiologies including blunt or penetrating trauma and iatrogenic causes which happen during vascular procedures. Although there are no external signs of neck trauma in 50% of cases, neck hematoma, bruits, pulsatile neck mass, or a palpable thrill may be found on physical examination. Patients with pseudoaneurysm of the internal carotid artery are usually present with neurologic complaints which could be occurred for hours to weeks following the initial injury. Here, we report a case with a traumatic pseudoaneurysm of the internal carotid artery after blunt trauma which was initially misdiagnosed as a peritonsillar abscess.
Absceso y flegmón periamigdalino Lo estamos haciendo bien? Abscess and cellulitis peritonsillar Are we doing it right?  [cached]
César Gómez V,Edda Pruzzo Ch,Eduardo Reyes S,María de los Angeles Contreras R
Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello , 2006,
Abstract: El flegmón (celulitis) y el absceso periamigdalino son infecciones difusas o una colección ubicada entre la cápsula fibrosa de la amígdala palatina, las fibras horizontales del músculo constrictor superior de la faringe y las verticales del músculo palatofaríngeo. Constituye la infección de tejidos y espacios profundos del cuello más frecuente. Material y método: Revisión retrospectiva de las fichas de pacientes adultos y ni os hospitalizados con diagnóstico de absceso o flegmón periamigdalino en el Servicio de Otorrinolaringología del Hospital San Juan de Dios entre los a os 1995 y 2001. Resultados y discusión: Se analizaron 124 pacientes. Se observó un acierto del diagnóstico clínico en 85,5% de los casos. El 100% de los pacientes presentó evolución clínica favorable según la modalidad terapéutica Indicada. La mayoría de los pacientes con absceso periamigdalino fue tratado con drenaje y antimicrobiano, y los con flegmón periamigdalino con antimicrobiano. El antibiótico utilizado con mayor frecuencia fue penicilina. No existió diferencia significativa al usarlo en esquema asociado. La penicilina sódica sigue siendo un antimicrobiano de primera elección para este cuadro y no requeriría de asociaciones; dosis de 3 millones de Ul cada 6 horas endovenosa pueden ser recomendadas. El tratamiento en el Servicio de Otorrinolaringología del Hospital San Juan de Dios se ci e a las reglas internacionales Cellulitis and abscess peritonsillar are a diffuse infection or a collection located between the fibrous capsule of the palatine tonsil, the horizontal fibers of the superior constrictor muscle of the pharynx and the vertical ones of the palatopharyngeal muscle. It is most frequently an infection of deep tissue and spaces of the neck. Material and method: Retrospective review of the index cards of adult patients and children hospitalized with diagnosis of abscess or peritonsillar phlegmon cellulitis at the Otolaryngology Service of Hospital San Juan de Dios between years 1995 and 2001. Results and discussion: 124 patients were analyzed. In 85% of the cases good judgment of the clinical diagnosis was noticed. 100% of the patients showed favorable clinical evolution according to the therapeutic mode indicated. The majority of the patients with peritonsillar abscess were treated with drainage and antimicrobial, and those with peritonsillar phlegmon with antimicrobial. The antibiotic most frequently used was penicillin. No significant difference was observed when using it in associated scheme. Sodium penicillin continues to be a first selection antimicrobial for this
Diagnosis and treatment of prostatic abscess
Oliveira, Paulo;Andrade, Juarez A.;Porto, Helder C.;Pereira Filho, José E.;Vinhaes, Ant?nio F. J.;
International braz j urol , 2003, DOI: 10.1590/S1677-55382003000100006
Abstract: objectives: present and discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. materials and methods: we have retrospectively studied the medical records of 9 patients diagnosed and treated for prostatic abscess, between march 1998 and december 2000, assessing age, context, associated diseases, and diagnostic and therapeutic methods. we have compared the data found with those described in literature, based on medline data. results: mean age was 52.6 years. three patients had previous diabetes mellitus diagnosis, and one was infected by hiv virus. transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 7 cases in which it was performed. all cases received antibiotic treatment, and 77.8% needed concomitant surgical treatment. two cases of microabscess were treated only with antibiotics. four patients were submitted to perineal catheter drainage, 2 were submitted to transurethral resection of the prostate (turp), and one patient required both procedures. mean hospitalization time was 11.2 days, and most frequent bacterial agent was s. aureus. all patients were discharged from the hospital, and there was no death in this series. conclusions: prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or turp). microabscess may heal without surgery.
Diagnosis and treatment of prostatic abscess  [cached]
Oliveira Paulo,Andrade Juarez A.,Porto Helder C.,Pereira Filho José E.
International braz j urol , 2003,
Abstract: OBJECTIVES: Present and discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. MATERIALS AND METHODS: We have retrospectively studied the medical records of 9 patients diagnosed and treated for prostatic abscess, between March 1998 and December 2000, assessing age, context, associated diseases, and diagnostic and therapeutic methods. We have compared the data found with those described in literature, based on Medline data. RESULTS: Mean age was 52.6 years. Three patients had previous diabetes mellitus diagnosis, and one was infected by HIV virus. Transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 7 cases in which it was performed. All cases received antibiotic treatment, and 77.8% needed concomitant surgical treatment. Two cases of microabscess were treated only with antibiotics. Four patients were submitted to perineal catheter drainage, 2 were submitted to transurethral resection of the prostate (TURP), and one patient required both procedures. Mean hospitalization time was 11.2 days, and most frequent bacterial agent was S. aureus. All patients were discharged from the hospital, and there was no death in this series. CONCLUSIONS: Prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or TURP). Microabscess may heal without surgery.
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