Gahleitner, Constanze; Hofauer, Benedikt; Stark, Thomas; Knopf, Andreas
Predisposing factors and management of complications in acute tonsillitis.
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.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.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.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.