tag:blogger.com,1999:blog-80417347716159768462024-03-24T14:52:19.211-07:00Tonsillitis UnderstoodThis site was created by Itzhak Brook MD. It explains the diagnosis, etiology, medical and surgical (tonsillectomy) treatment and complications of tonsillitis ( tonsillar abscess, Lemierre's syndrome). Dr. Brook is a Professor of Pediatrics at Georgetown University Washington D.C. Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-8041734771615976846.post-89228654875887830912022-06-01T12:09:00.000-07:002022-06-01T12:09:02.391-07:00Retropharyngeal abscess- An unusual complication in a COVID-19 patient<p> T<span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">he coronavirus disease 2019 (COVID-19) pandemic has generated many challenges for physicians, including multiple long-term effects that are still being studied. We report a CASE of patient who developed a retropharyngeal abscess post-COVID19 infection. </span></p><p><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"><a href="https://pubmed.ncbi.nlm.nih.gov/34957361/" target="_blank">Awobaio et al. from the </a></span><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"><a href="https://pubmed.ncbi.nlm.nih.gov/34957361/" target="_blank">University of Texas </a>Health Science Center at San Antonio, Texas,</span><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"> </span><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"> reported a CASE of a female who was diagnosed with COVID19 pneumonia and hospitalized for a week at an outside institute. Approximately 3 weeks post discharge she developed neck pain, dysphagia, voice change and odynophagia for which she went to an outside emergency department. A soft tissue neck CT was performed and was concerning for retropharyngeal abscess. The patient was then transferred to our institution. On arrival, a CT scan of the neck and nasopharyngoscopy were performed and biopsies of the epiglottis and right inferior tonsillar pole were taken. Biopsies of the epiglottis and tonsil showed acute inflammation, spongiosis, edema and marked dilation of the lymphatics. Her clinical course was complicated by persistent infection requiring multiple washouts, hyperglycemia, tube feed intolerance, dysphagia and deconditioning. A multi-disciplinary approach was instituted for appropriate management. </span></p><p><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">This case report highlights the necessity for close follow up after recovery from COVID-19 infection, particularly in patients with multiple comorbidities.</span></p><p><span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"><br /></span></p><p style="text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRpjmj8mPyA1xVOe3rxiWAp7NzWT_At-YyBfX-W6g2Q5N8Tp5LbAPV76Oj7bFUdf-v1sMLzXVJLDnkDsBq7qAdJD_r0YizVObQbdpns1RckhuMOCRIrL2Y-3eqUuy4ewTY0XtCL7OyYLUk6SYWrzakJ89J-XGUXtjQwKIllqQswfuZXf21lJJPVv8-/s971/Retroabscess10.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="971" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRpjmj8mPyA1xVOe3rxiWAp7NzWT_At-YyBfX-W6g2Q5N8Tp5LbAPV76Oj7bFUdf-v1sMLzXVJLDnkDsBq7qAdJD_r0YizVObQbdpns1RckhuMOCRIrL2Y-3eqUuy4ewTY0XtCL7OyYLUk6SYWrzakJ89J-XGUXtjQwKIllqQswfuZXf21lJJPVv8-/s320/Retroabscess10.JPG" width="264" /></a></div><br /><span style="background-color: white;"><span style="color: #212121; font-family: BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif;"><b>Retropharyngeal abscess</b></span></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-49869473376001986432021-10-18T17:20:00.001-07:002021-10-18T17:20:46.307-07:00Tonsillectomy and hematologic malignancy<p> <span style="background-color: white; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">Routine pediatric tonsillectomy ± adenoidectomy (T ± A) is one of the most common procedures for children worldwide, accounting for approximately 2000 procedures per year at our institution. To determine the utility of pathologic analysis of routine, nonsuspicious pediatric tonsil specimens, we investigated the incidence of hematologic and lymphoid malignancy diagnosed at the time of or following T ± A.</span></p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; line-height: 1.5; margin: 1.2rem 0px;">T<a href="https://pubmed.ncbi.nlm.nih.gov/34597876/" target="_blank">holen et al.performed </a>a retrospective review of patients 0-18 years undergoing T ± A between 2012 and 2020 with or without pathologic analysis. <strong class="sub-title" style="box-sizing: inherit;"> </strong>Included were 14,141 patients who underwent routine T ± A (mean age 11 ± 4.6 years, 48% female). Of these, tonsils of 2464 patients were sent to pathology, where zero were found to harbor malignancy. Seven patients (0.050%) developed malignancy after T ± A. Of these, 4 had unremarkable tonsils per pathology, and 3 did not have tonsils analyzed. There were 5 cases of Acute Lymphocytic Leukemia (ALL, 0.035%), 1 case of Acute Myeloid Leukemia (0.007%), and 1 case of Lymphoma (0.007%). The average length of time from T ± A to diagnosis was 2.4 ± 1.8 years.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; line-height: 1.5; margin: 1.2rem 0px;">Because no cases of occult malignancy were identified in specimens from routine T ± A with pathologic analysis, even among patients who later developed malignancy the authors concluded that sending routine pediatric T ± A specimens for formal pathologic analysis is an inefficient use of resources without appreciably improving the quality and safety of patient care.</p><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; line-height: 1.5; margin: 1.2rem 0px;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOV4pB78zoidbVwr7NFgfCIeC3pucH3OEfOJ0q4wbDzwoP5PlyssqZ6CQFTHSMEIaMtVQHEwO9P-pLFLvJl300FeVz9fofr3kt7vsGR_LS9ytEWm9QKpCCC6sumLChbTeFqFbQzKjcZtI/s1126/tonsil-cancer-feature.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="1126" height="171" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOV4pB78zoidbVwr7NFgfCIeC3pucH3OEfOJ0q4wbDzwoP5PlyssqZ6CQFTHSMEIaMtVQHEwO9P-pLFLvJl300FeVz9fofr3kt7vsGR_LS9ytEWm9QKpCCC6sumLChbTeFqFbQzKjcZtI/s320/tonsil-cancer-feature.jpg" width="320" /></a></div><br /><p style="background-color: white; box-sizing: inherit; color: #212121; font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; line-height: 1.5; margin: 1.2rem 0px;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-13553482205468131522017-12-25T15:01:00.002-08:002017-12-25T15:06:29.603-08:00Treatment Challenges of Group A Beta-hemolytic Streptococcal Pharyngo-Tonsillitis<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "arial" , sans-serif;">Despite its in vitro efficacy, penicillin
often fails to eradicate Group A β-hemolytic streptococci (GABHS) from patients
with acute and relapsing pharyngo-tonsillitis (PT).</span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A review of the literature details the
<a href="https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0036-1584294">causes of penicillin failure to eradicate GABHS PT and the therapeuticmodalities</a> to reduce and overcome antimicrobial failure. <o:p></o:p></span></div>
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<ul>
<li>The causes of penicillin failure in
eradicating GABHS PT include:</li>
<li>The presence of β-lactamase producing
bacteria (BLPB) that "protect" GABHS from any penicillin</li>
<li>The absence of bacteria that interfere
with the growth of GABHS</li>
<li>Co-aggregation between GABHS and
<i>Moraxella catarrhalis</i></li>
<li>The poor penetration of penicillin into
the tonsillar tissues and the tonsillo-pharyngeal cells, which allows
intracellular GABHS and <i>Staphylococcus aureus</i> to survive. The inadequate
intracellular penetration of penicillin can allow intracellular GABHS and S.
aureus to persist.</li>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">In the treatment of <b>acute tonsillitis</b>,
the use of cephalosporin can overcome these interactions by eradicating aerobic
BLPB (including<i> M. catarrhalis</i>), while preserving the potentially interfering
organisms and eliminating GABHS.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">In treatment of <b>recurrent and chronic
PT</b>, the administration of clindamycin, or amoxicillin-clavulanic acid, can
eradicate both aerobic and anaerobic BLPB, as well as GABHS. The superior
intracellular penetration of cephalosporin and clindamycin also enhances their
efficacy against intracellular GABHS and <i>S. aureus.</i></span><o:p></o:p></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-28824981500777717422016-01-21T12:34:00.000-08:002016-01-21T12:34:14.529-08:00Probiotic for the treatment of recurring group A beta-hemolytic streptococci pharyngo-tonsillitis<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Arial",sans-serif;">A
recent retrospective study has shown that an oral preparation of Streptococcus
salivarius K12 (SsK12) may be a good option for treating patients who have
group A beta-hemolytic streptococci (GABHS), especially those patients who require frequent antibiotic therapy. The
study was completed by Giuseppe Gregori, MD and colleagues, of the Primary Care
Department, in the Department of Health Science at the University of Genoa, Italy,
and was published in Therapeutics and Clinical Risk Management on January 2016.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">The
study assess retrospectively if SsK12 use in pediatric patients with recurrent </span><span style="font-family: Arial, sans-serif;">group A beta-hemolytic streptococcal (</span><span style="font-family: Arial, sans-serif; line-height: 150%;">GABHS) tonsillitis (RPTI) reduce the occurrence of GABHS relapses during the treatment
period, and during the following 12 months as well as compared to a group of
children with GABHS RPTIs not being treated with SsK12.</span></div>
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were 130 children in this study, 76 were treated with SsK12, and 54 were the
control group. The investigators found that the reduction of infections observed
in the SsK12-treated children was statistically higher than the controls.
Additionally, the children treated with SsK12 experienced significantly fewer
GABHS infections both during the initial 90 days of inclusion in the study, when
the treatment group received SsK12, and in the following 9 months.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">The
authors noted that even though treatment with SsK12 oral preparation made the
need for antibiotic therapy against GABHS infections four times less likely,
the retrospective, observational study has less validity than a double-blind,
controlled, prospective, and randomized investigation. They recommended that further
studies and additional investigations would be performed on this topic.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;"><b><span style="font-size: x-small;">Group A beta hemolytic streptococcal tonsillitis</span></b></span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-52191628786490867672015-09-09T08:05:00.002-07:002015-09-09T08:06:22.336-07:00Is tonsillectomy or adeno-tonsillectomy better than non-surgical approach for chronic/recurrent acute tonsillitis?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Arial",sans-serif;">Tonsillectomy
with or without adenoidectomy, is a common operation, but the indications for
surgery are controversial. A Cochrane updated review by Burtton et al. of randomized
controlled trials assessed the effectiveness of tonsillectomy (with and without
adenoidectomy) in children and adults with chronic/recurrent acute tonsillitis
in reducing the number and severity of episodes of tonsillitis or sore throat.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">The
review includes seven trials; five in children (987 participants) and two in
adults (156 participants). </span><span style="font-family: Arial, sans-serif; line-height: 150%;">The
authors concluded that adeno-/tonsillectomy leads to a reduction in the number
of episodes of sore throat and days with sore throat in children (5.1 fewer
days) in the first year after surgery compared to non-surgical treatment.
Children who were more severely affected were more likely to benefit as they
had a small reduction in moderate/severe sore throat episodes.</span></div>
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<span style="font-family: "Arial",sans-serif;">In
adults there were 3.6 fewer episodes (95% CI 7.9 fewer) in the group receiving
surgery within six months post-surgery. The pooled mean difference for number
of days with sore throat in a follow-up period of about six months was 10.6
days fewer in favor of the group receiving surgery (95% CI). Given the short
duration of follow-up and the differences between studies, the authors considered
the analysis found the evidence for adults to be of low quality. They concluded
that insufficient information is available on the effectiveness of
adeno-/tonsillectomy versus non-surgical treatment in adults to draw a firm
conclusion. <o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">The authors concluded that potential 'benefit' of surgery must be weighed against the risks
of the procedure as adeno-/tonsillectomy is associated with a small but
significant degree of morbidity in the form of primary and secondary
haemorrhage and, even with good analgesia, and is particularly uncomfortable
for adults.<o:p></o:p></span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-19370045580739844992013-01-29T13:58:00.000-08:002013-01-29T13:58:02.868-08:00Oral probiotic therapy with Streptococcus salivarius prevents recurrent streptococcal pharyngitis and/or tonsillitis <div dir="ltr" style="text-align: left;" trbidi="on">
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<i><span style="font-family: Arial, sans-serif; line-height: 150%;">Streptococcus salivarius</span></i><span style="font-family: Arial, sans-serif; line-height: 150%;"> K12 has been shown to inhibit the in-vitro
growth of </span><span style="font-family: Arial, sans-serif;">Group A beta hemolytic streptococcal (GABHS)</span><span style="font-family: Arial, sans-serif; line-height: 150%;"> due
to bacteriocins release. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23286823">Di Pierro and colleagues from Velleja Research</a> in
Mialno, Italy have tested the <i>Streptococcus
salivarius</i> K12 for its efficacy in preventing GABHS pharyngitis and/or tonsillitis in adults. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; line-height: 150%;">Forty
adults with a diagnosis of recurrent GABHS pharyngitis and/or tonsillitis were
enrolled in the study. Twenty of these subjects received one tablet containing <i>Streptococcus salivarius</i> K12
(Bactoblis®) a day for 90 days. The other 20 subjects served as untreated
controls. The individuals were followed for 6-month to evaluate the effects of the
treatment. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; line-height: 150%;">The
20 adults who completed the 90-day course of Bactoblis® showed a reduction in
their episodes of streptococcal pharyngeal infection (about 80%). The 90 days
treatment was also associated with an approximately 60% reduction in the
incidence of reported pharyngitis in the 6-month period following use of the
product. The product was well tolerated by the subjects with no treatment-related
side effects or drop-outs reported. The study illustrated that the prophylactic
administration of <i>Streptococcus
salivarius</i> K12 to adults with a history of recurrent GABHS pharyngitis and/or
tonsillitis reduced the number of episodes of GABHS oral infections.<span style="font-size: x-small;"><o:p></o:p></span></span><br />
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com1tag:blogger.com,1999:blog-8041734771615976846.post-42555682919498103692012-10-25T10:04:00.002-07:002013-12-10T20:06:29.157-08:00New guideline for the treatment of pharyngitis <div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="background-position: initial initial; background-repeat: initial initial; color: #333333; font-size: 11pt; line-height: 150%;"><a href="http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full">New guideline</a> from the
Infectious Diseases Society of America (IDSA) recommend that physicians should
prescribe antibiotics only for patients with sore throats who have positive
test results for a group A streptococcal (GAS) infection</span><span style="font-size: 11pt; line-height: 150%;">.</span><span style="background-position: initial initial; background-repeat: initial initial; color: #333333; font-size: 11pt; line-height: 150%;"><o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">The recommendations include:<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">1. Because the clinical features alone do not
reliably differentiate between GAS and viral pharyngitis swabbing the throat
and testing for GAS by rapid antigen detection test (RADT) and/or culture
should be performed except when clear viral features like rhinorrhea, cough,
oral ulcers, and/or hoarseness are present. In children and adolescents (and
not in adults), negative RADT tests should be backed up by a throat culture. <o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">2. Diagnostic studies for GAS pharyngitis are generally
not indicated for children <3 years old and adults because acute rheumatic
fever is rare in these groups.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">3. Routine follow-up throat
cultures or RADT are not generally recommended.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">4. Diagnostic testing or
empiric treatment of asymptomatic household contacts of those with acute GAS
pharyngitis is not routinely recommended.</span><b><i><span style="color: #816d5b; font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></i></b></div>
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<span style="font-size: 11pt; line-height: 150%;">5. Those with acute GAS pharyngitis should be
treated with an appropriate antibiotic at an appropriate dose for duration likely
to eradicate the organism. Ten days treatment with penicillin or amoxicillin is
recommended for those non-allergic to them.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">6. Treatment of penicillin-allergic patients include a first generation cephalosporin (for
those not anaphylactically sensitive) for 10 days, clindamycin or
clarithromycin for 10 days, or azithromycin for 5 days.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">7. Adjunctive therapy with analgesic/antipyretic
agent may be useful in the management of GAS pharyngitis. Corticosteroid is not
recommended and aspirin should be avoided in children.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">8. GAS carriers do not generally require
antimicrobial therapy because they are unlikely to spread GAS pharyngitis to
their close contacts and are at little or no risk for developing suppurative or
nonsuppurative complications.<o:p></o:p></span></div>
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<span style="font-size: 11pt; line-height: 150%;">9. Tonsillectomy is not recommended solely to
reduce the frequency of GAS pharyngitis.<o:p></o:p></span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-43958483857898705442012-08-17T08:25:00.001-07:002016-01-21T12:35:40.222-08:00Does Helicobacter pylori play a role in chronic tonsillitis?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';">Several studies confirmed the presence of <i><a href="http://en.wikipedia.org/wiki/Helicobacter_pylori">Helicobacter pylori</a></i> in chronically inflamed tonsils.. However, other reports did not find this organism. The difference in results in various studies might be due to different laboratory methods. A recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326956/?tool=pmcentrez">study by Farivar et al.</a> used a polymerase chain reaction (PCR) in evaluating the role of this organism in chronic tonsillitis.<o:p></o:p></span></div>
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<span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';">The authors detected <i>H. pylori</i> DNA in 21.35% of 103 specimens. There was no significant relationship between the presence of <i>H. pylori</i>, sex, age, and place of residence.<o:p></o:p></span></div>
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<span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN; mso-fareast-font-family: 'Times New Roman';">The finding of this organism in about 1 of 5 chronically inflamed tonsils require more studies that may shed light about the association of this organism with this condition. These include the use of antimicrobial effective against <i>H. pylori</i>, in treating this condition.<o:p></o:p></span></div>
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<em> </em><br />
<em> <span style="color: black;"><strong>Helicobacter pylori</strong></span></em></div>
Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-42926411236241209222012-04-10T14:36:00.003-07:002012-04-10T15:12:31.130-07:00Increasing incidence of methicillin-resistant staphylococcus aureus in retropharyngeal abs<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 6.0pt; vertical-align: baseline;"><span style="font-family: Arial, sans-serif;">Because of a recent increase in retropharyngeal abscess cases due to community-associated methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA), a retrospective evaluation of the microbiology, clinical manifestations and treatment outcome of </span> <span style="font-family: Arial, sans-serif;">retropharyngeal abscess</span> <span style="font-family: Arial, sans-serif;"> over the past 6-years (2004-2010) was <a href="http://www.blogger.com/goog_801308450">performed at </a></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: Arial, sans-serif;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22481424">Children's Hospital of Michigan,</a> Detroit, Michigan</span><span style="font-family: Arial, sans-serif;">. The Findings were compared to those of a previous 11 year study (1993-2003) period. <o:p></o:p></span></div><div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 6.0pt; vertical-align: baseline;"><span style="font-family: Arial, sans-serif;">One hundred eleven children with retropharyngeal abscess were treated representing a 2.8 fold increase in incidence (per 10,000 admissions) over the previous 11-year period. A total of 116 isolates (93 aerobes, 23 anaerobes) were isolated from 66 drained specimens (2/3 of the total). The study showed increased frequency of isolation of MRSA with an associated increase of <i>S. aureus</i> mainly CA-MRSA. <i>S. aureus</i> was recovered from 25 (38%) of 66 specimens compared to 2 (4.9%) of 41 in the previous 11 years; 16 (64%) of 25 were MRSA compared to none in the previous 11 years. Children whose abscess grew MRSA were younger (mean 11 months) than the others (mean 62 month) (p< 0.001). Five children had mediastinitis; all caused by MRSA. All MRSA isolates were susceptible to clindamycin.This is likely due to the overall increase in CA-MRSA infections in pediatric patients. Treatment with ceftriaxone and clindamycin in addition to surgical drainage was effective in most patients.<o:p></o:p></span></div><div class="MsoNormal" style="background: white; line-height: 150%; margin-bottom: 6.0pt; vertical-align: baseline;"><span style="font-family: Arial, sans-serif;"><br />
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</span></div></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-58934524213870540062012-03-04T11:46:00.000-08:002012-03-04T11:46:00.927-08:00Is recurrent tonsillitis in adults different from one in children?<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="line-height: 18pt; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span lang="EN" style="font-family: 'Times New Roman', serif; font-size: 12pt;"> <span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.blogger.com/goog_1915152127">B</a></span></span><span lang="EN" style="font-family: 'Times New Roman', serif; font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://docs.google.com/file/d/0B97F0spKl2OwZGVmMDIwYTUtNzBlZi00MThiLWE4NGYtOTJlNzBlZTBhYWFh/edit?pli=1">rook and Foote compared</a> the microbial flora of recurrently inflamed tonsils removed from 25 children with recurrent episodes of tonsillo-pharyngitis were compared to flora of tonsils removed from 23 adults suffering from similar illness. More bacterial isolates in each tonsil were found in adults (10.2 per tonsil) than in children (8.4 per tonsil). The difference between these groups was due to a higher recovery rate in adults of anaerobic Gram-negative bacilli. Conversely, Group A beta-hemolytic streptococci were isolated in seven (28%) children as compared to their isolation in only one (4%) adult. </span></span></div><div class="MsoNormal" style="line-height: 18pt; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span lang="EN" style="font-family: 'Times New Roman', serif; font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;">More isolates of beta-lactamase-producing organisms (BLPO) per tonsil were recovered in adults. Forty-three BLPO were detected in 21 (91%) of the 23 tonsils removed from adults as compared to only 16 (64%) of the children (1.2 isolates per patient) (<i>P</i>=0.04). </span></span></div><div class="MsoNormal" style="line-height: 18pt; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span lang="EN" style="font-family: 'Times New Roman', serif; font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;">These findings suggest that the cause of recurrent tonsillitis in adults may differ from that in children. The differences in the tonsillar microbiology may be due to the effect of many more courses of antimicrobials given over the years to adults and the changes in tonsillar tissue that occur in this age group.</span></span><br />
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</span></span></div></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-44745854010964497972012-03-01T07:00:00.003-08:002012-03-01T07:12:02.400-08:00Methicillin Resistant Staphylococcus aureus is isolated in greater frequency in tonsillitis<div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: Arial;"></span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0.25in 0in 0pt;"><span style="font-size: 11pt; line-height: 200%; mso-bidi-font-size: 10.0pt;">An increase in the recovery of methicillin resistant <i style="mso-bidi-font-style: normal;">S. aureus</i> (MRSA) was recently noted in various infections. The rate of recovery MRSA in tonsils that were removed because of recurrent Group A -</span><span style="font-family: Symbol; font-size: 11pt; line-height: 200%; mso-ascii-font-family: Arial; mso-bidi-font-size: 10.0pt; mso-char-type: symbol; mso-hansi-font-family: Arial; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">b</span></span><span style="font-size: 11pt; line-height: 200%; mso-bidi-font-size: 10.0pt;">-hemolytic streptococci (GABHS) tonsillitis was not previously reported. A recent study by <a href="https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B97F0spKl2OwZjdlZmVjNzgtMWE0YS00Yjg5LTg1NTYtYjIyZjFlMmY3YjYw&pli=1">Brook & <span style="mso-spacerun: yes;"> </span>Foote demonstrated</a> for the first time the recovery of MRSA from 16% of the tonsils removed from 44 children because of recurrent GABHS tonsillitis.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0.25in 0in 0pt;"><span style="font-size: 11pt; line-height: 200%; mso-bidi-font-size: 10.0pt;">The emergence of MRSA in the tonsillar flora in children with recurrent GABHS tonsillitis may contribute to the difficulty in eradicating GABHS with penicillins and other antimicrobials that are ineffective against this organism. MRSA are generally resistant to beta-lactam antimicrobials ( i.e. penicillins) and generally susceptible to clindamycin, trimethoprim-sulfamethoxazole, and vancomycin. The <span style="font-family: 'Arial','sans-serif'; font-size: 11pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">MRSA present in the tonsills may serve as a potential source for the spread of these organisms to other body sites as well to other individuals. </span></span></div><div class="MsoNormal" style="line-height: 24pt; margin: 0.25in 0in 0pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 11pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">Since most of the MRSA ( 5 of 7 isolated in the study) were also beta-lactamase producers their presence could potentially interfere with the eradication of GABHS by penicillin.<sup> </sup>MRSA that is also able to produce beta-lactamase can survive treatment with beta-lactam antibiotics and continue to “shield” GABHS from penicillins through the production of the enzyme beta-lactamase. Most of the <i style="mso-bidi-font-style: normal;">S. aureus</i> isolated from the tonsilar cores of our patients <span style="mso-spacerun: yes;"> </span>( 19 of 26 or 73% ) were, however, beta-lactamase producers and not MRSA. These organisms are susceptible to beta-lactamase resistant penicillins as well as most cephalosporins. </span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfCiA_h48J__HmygJST2oWNgBhzJp_DroTMTYO_omMk2ZWSutrwAstlVOp2n4mXbsgj_A1QwmTs1mAQk5RuzZtY0Oo-EnkcvfKmOcU-Pbt616jFyYmQygnbIf3aycFSKZeiy8UJuOnLQU/s1600/MRSA-0.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfCiA_h48J__HmygJST2oWNgBhzJp_DroTMTYO_omMk2ZWSutrwAstlVOp2n4mXbsgj_A1QwmTs1mAQk5RuzZtY0Oo-EnkcvfKmOcU-Pbt616jFyYmQygnbIf3aycFSKZeiy8UJuOnLQU/s1600/MRSA-0.jpg" uda="true" /></a></div></div></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-8041734771615976846.post-89254427410355310332012-02-18T12:31:00.003-08:002012-03-27T15:10:43.536-07:00Why does penicillin not work in Group A streptococcal tonsillitis?<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal"><span style="line-height: 150%;">Despite its excellent efficacy in the test tube, penicillin frequently does not work and fail to eradicate Group A beta-hemolytic streptococci (GABHS) from patients with acute and relapsing pharyngo-tonsillitis (PT) is cause for concern. Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000.<o:p></o:p></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik6dGUwJ6AeyfJRA29yeyc4nD_wcMTnbB8bbPYsnDv7McuGjpdULQmY9T34iyiv0lt3WKlZ_Lq5ufq3XT756-EN2CSLuN7nOJDFJ0ZKZlxKq8LV3uwOKK3BngLOPFm2_lSDchm_0r_tT8/s1600/pen.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik6dGUwJ6AeyfJRA29yeyc4nD_wcMTnbB8bbPYsnDv7McuGjpdULQmY9T34iyiv0lt3WKlZ_Lq5ufq3XT756-EN2CSLuN7nOJDFJ0ZKZlxKq8LV3uwOKK3BngLOPFm2_lSDchm_0r_tT8/s1600/pen.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
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</span></div><div class="MsoNormal" style="margin-right: -9.0pt; mso-hyphenate: none; tab-stops: -1.0in -.5in 0in .5in 1.0in 1.5in 2.0in 2.5in 3.0in 3.5in 4.0in 4.5in 5.0in 5.5in 6.0in 6.5in 7.0in 7.5in 8.0in 8.5in 9.0in 9.5in 10.0in 10.5in 11.0in 11.5in 11.75in 12.0in 12.5in 13.0in;"><span style="line-height: 150%;">Various explanations exist for the failure of penicillin to eradicate GABHS PT (see page). One possibility is the poor penetration of penicillin into the tonsillar tissues as well as into the epithelial cells. Other explanations relate to the bacterial interactions between GABHS and other members of the pharyngo-tonsillar bacterial flora. For example, it is hypothesized that beta-lactamase secreted by beta-lactamase-producing bacteria (BLPB), which colonize the pharynx and tonsils, may “shield” GABHS from penicillins. Another possibility is the coaggregation between <i>Moraxella catarrhalis</i> and GABHS, which can facilitate colonization by GABHS. Normal bacterial flora can interfere with the growth of GABHS, and the absence of such competitive bacteria makes it easier for GABHS to colonize and invade the pharyngo-tonsillar area.<o:p></o:p></span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-vSxp4Xoy58dQFC8hqjIpzUZkKSHDS71l2awTRUh6w3JsBtRkkodEUsC79dqFQUjb3TbNt0eCGEmlHWxigBwgNnUIfFJ0BW4RLLH2Cv51tGj_kXCfB9_YCaE3NoZUZVuGsDxPRQ7SkC8/s1600/beta+lact+pr.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-vSxp4Xoy58dQFC8hqjIpzUZkKSHDS71l2awTRUh6w3JsBtRkkodEUsC79dqFQUjb3TbNt0eCGEmlHWxigBwgNnUIfFJ0BW4RLLH2Cv51tGj_kXCfB9_YCaE3NoZUZVuGsDxPRQ7SkC8/s1600/beta+lact+pr.jpg" /></a></div><span style="line-height: 150%;"><br />
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<div style="text-align: center;"><span style="line-height: 150%;"><b>Beta-lactamase producing organisms "protecting" penicillin susceptible bacteria from penicillin</b></span></div><span style="line-height: 150%;"><br />
</span></div><div class="MsoNormal" style="margin-right: -9.0pt; mso-hyphenate: none; tab-stops: -1.0in -.5in 0in .5in 1.0in 1.5in 2.0in 2.5in 3.0in 3.5in 4.0in 4.5in 5.0in 5.5in 6.0in 6.5in 7.0in 7.5in 8.0in 8.5in 9.0in 9.5in 10.0in 10.5in 11.0in 11.5in 11.75in 12.0in 12.5in 13.0in;"><span style="line-height: 150%;">Therapeutic strategies that allow overcoming the above mechanisms are available and are based on extensive clinical research. This <a href="http://tonsilitisunderstood.blogspot.com/p/treatment-of-paryngo-tonsillitis.html">website describes </a>the research and therapeutic option for patients who fail penicillin therapy. <o:p></o:p></span><br />
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</div><div style="text-align: center;"><span style="line-height: 150%;"><b>Streptococcal tonsillitis </b></span></div><div style="text-align: center;"><span style="line-height: 150%;"><br />
</span></div></div></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0