Peritonsillar

Case report:

A 18 year old patient comes into practice and complains of increasing left-sided severe sore throat with increased difficulty in swallowing and an increased body temperature to 38.5 � C. A history of the patient reports of frequent tonsillitis; the current disease have, however, started with symptoms of common cold and related disorders of the upper respiratory tract. For several days, however, the symptoms are localized in the left-sided neck region and have become very violent in the past 48 hours.
The physical examination of the patient confirms the subfebrile temperature increase, persistent tachycardia at 100 / min .; the inspection of the pharynx results on the left side peritonsillar a massive swelling and redness without a purulent covering with but distinct narrowing also the rear Pharynxbereichs. An abscess or fluctuation are undetectable. The uvula is swollen and displaced to the opposite side.

Diagnosis and Etiology:

The history of recurrent tonsillitis, the unilateral typical localization and the local findings suggest a pronounced peritonsillitis with incipient peritonsillar. The strong pain in swallowing are quite conclusive for this infection. When bacterial pathogens dominating b-hemolytic streptococci of group A, but mostly there is also a mixed infection of anaerobic pathogens such as Bacteroides species. Being close to the jugular veins and also because of the possible distal spread of infection is not justified an expectant behavior in this situation.

Therapy:

At the slightest clues for a surgical incision abscess or a tonsillectomy with abscess is necessary. This should however be done under antibiotic therapy. In general are quite penicillin G (penicillin G JENAPHARM etc.) or penicillin V (ISOCILLIN others) still in effect, however, because of the increasing beta-lactamase formation of anaerobes involved is now increasingly the treatment with a beta-lactamase inhibitor plus Aminobenzylpenicillin such as Sulbactam / ampicillin (UNACID) or amoxicillin plus clavulanic acid (Augmentin), recommended. An effective alternative is also Clindamycin (SOBELIN). The duration of therapy should be eight to twelve days. Often after the acute phase of the image due to frequent recurrences of such Peritonsillarabszesse a tonsillectomy appears about six weeks later.