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Büttner R, Schwermer M, Ostermann T, Längler A, Zuzak T. Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood. Complement Ther Med 2024; 81:103031. [PMID: 38432580 DOI: 10.1016/j.ctim.2024.103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. METHODS 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. RESULTS Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). CONCLUSION The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.
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Affiliation(s)
- Rebecca Büttner
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany
| | - Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany.
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany
| | - Tycho Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Faculty of Medicine, University of Duisburg-Essen, Germany
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Li X, Li C, Yang X. Deep cervical space abscess due to acute tonsillitis complicating mediastinal and pericardial abscess: A case report. Asian J Surg 2023; 46:4689-4690. [PMID: 37268469 DOI: 10.1016/j.asjsur.2023.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Xin Li
- The First Clinical Medical College, Gansu University of Traditional, Chinese Medicine, Lanzhou, China
| | - Cong Li
- The First Clinical Medical College, Gansu University of Traditional, Chinese Medicine, Lanzhou, China
| | - Xiaolong Yang
- Department of E.N.T., Gansu Provincial Hospital, Lanzhou, China.
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Ahmad S, Alzahrani AJ, Alsaeed M. Uncommon association: Pseudomonas luteola bacteremia in an immunocompetent individual with acute tonsillitis - A case report. IDCases 2023; 34:e01891. [PMID: 37701050 PMCID: PMC10493495 DOI: 10.1016/j.idcr.2023.e01891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023] Open
Abstract
Pseudomonas luteola, formerly known as Chryseomonas luteola, is an infrequently encountered aerobic gram-negative bacterium. While it has been identified as a potential human bacterial pathogen, its connection to specific clinical conditions remains limited. Here, we present an exceptional case of a 27-year-old immunocompetent man with acute tonsillitis, who developed P. luteola bacteremia. This unique correlation, not extensively documented in previous studies, sheds light on the potential pathogenicity of P. luteola in patients with acute tonsillitis.
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Affiliation(s)
- Sirine Ahmad
- Medicine Department, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Ahmad J. Alzahrani
- College of Medicine, Al-Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Laboratory Department, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Mohammed Alsaeed
- Medicine Department, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
- Medicine Department, Infectious Diseases Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
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Studemeister L, Pai S, Walsh K, Cooper J. Acute Tonsillitis Due To Monkeypox. J Emerg Med 2023; 64:211-213. [PMID: 36822985 PMCID: PMC9943563 DOI: 10.1016/j.jemermed.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/24/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND The emerging 2022 human mpox virus outbreak has presented with unique disease manifestations challenging prior case definitions. CASE REPORT We present a case of a 42-year-old transgender woman with human immunodeficiency virus controlled on antiretroviral therapy, presenting with sore throat, who, after three emergency department visits, was found to have acute tonsillitis complicated by airway obstruction secondary to mpox. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Sore throat is a common presentation to the emergency department. mpox should be placed on the list of differential diagnoses when evaluating patients who present with pharyngitis to avoid complications or a missed diagnosis.
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Affiliation(s)
- Lucy Studemeister
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Sushma Pai
- Department of Internal Medicine, O'Connor Hospital, San Jose, California
| | - Kristin Walsh
- Division of AIDS Medicine, Infectious Diseases, Mycobacterial Diseases and International Health, Santa Clara Valley Medical Center, San Jose, California
| | - Joseph Cooper
- Division of AIDS Medicine, Infectious Diseases, Mycobacterial Diseases and International Health, Santa Clara Valley Medical Center, San Jose, California
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Lochbaum R, Tewes S, Hoffmann TK, Greve J, Hahn J. [Typical emergencies in otorhinolaryngology-a monocentric analysis of the seasonal course]. HNO 2022; 70:601-608. [PMID: 35657418 PMCID: PMC9164187 DOI: 10.1007/s00106-022-01185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Inzidenz der Akutdiagnosen im Hals-Nasen-Ohren(HNO)-Bereich wird durch multiple Parameter beeinflusst, unter anderem meteorologische und saisonale Einflüsse. Durch ein besseres Verständnis dieser Faktoren könnten prophylaktische Ansätze entwickelt werden. Material und Methoden Über 6 Jahre erfolgte eine retrospektive Analyse aller Patienten, die sich aufgrund von typischen und weniger komplexen HNO-ärztlichen Krankheitsbildern wie Cerumen obturans, akuter Otitis externa und media, Nasenpyramidenfraktur, Epistaxis nasi, akuter Tonsillitis, akuter Rhinosinusitis oder eines Peritonsillarabszess in einer südwestdeutschen Universitätsklinik vorgestellt haben. Ergebnisse 32.968 Fälle wurden ausgewertet. Mit 24,5 % (8082 Fälle) war die Epistaxis nasi die häufigste Notfalldiagnose. Diese, wie auch die akute Otitis media und die akute Rhinosinusitis, traten signifikant häufiger in der kälteren Jahreshälfte auf. Es bestand keine signifikante Korrelation der Diagnose Nasenpyramidenfraktur mit besonderen Zeiten wie Feiertagen. Die akute Otitis externa korrelierte signifikant mit dem Zeitraum der Sommerferien. In Kalenderwoche 38 gab es die wenigsten und in der Kalenderwoche 52 die meisten Notfallvorstellungen. Schlussfolgerung Saisonale und meteorologische Faktoren spielen eine Rolle in der Krankheitsentstehung verschiedener HNO-ärztlicher Notfalldiagnosen.
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Affiliation(s)
- R Lochbaum
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - S Tewes
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Greve
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Hahn
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
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Mendes N, Miguéis C, Lindo J, Gonçalves T, Miguéis A. Retrospective study of group A Streptococcus oropharyngeal infection diagnosis using a rapid antigenic detection test in a paediatric population from the central region of Portugal. Eur J Clin Microbiol Infect Dis 2021; 40:1235-1243. [PMID: 33452546 DOI: 10.1007/s10096-021-04157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
Group A Streptococcus (GAS) is one of the most important agents of oropharyngeal infection. To avoid unnecessary antibiotic prescription, it is recommended the confirmation of GAS infection in pharyngeal swabs using culture or rapid antigen detection test (RADT). This study aimed to retrospectively analyse the incidence of GAS oropharyngeal infection, detected by RADT, in a paediatric population in the Centre of Portugal. Data was collected from the database of the Paediatric Hospital Emergency Department (ED) regarding patients admitted with symptoms suggesting acute pharyngitis, from January 2013 to December 2018, in a total of 18,304 cases. Among these, 130 clinical files were searched for symptoms, complications and additional visits to the ED. The results showed an average GAS infection prevalence of 33%, with seasonal variation. In preschool children, especially in patients less than 3 years old, where the guidelines do not routinely encourage RADT, GAS tonsillitis assumed an unexpected importance, with 731 positive tests in a total of 3128 cases. Scarlatiniform rash and oral cavity petechiae had significant correlation with streptococcal aetiology (p < 0.05). The statistical analysis also showed that different signs and symptoms assume different weights depending on the age group of the patient. The main conclusion is that the incidence of GAS infection in the studied population is higher than generally described in preschool children, suggesting the need for a more cautious approach to children under 3 years presenting acute pharyngitis, and that RADT in this age group would contribute to a decrease in the number of unnoticed cases.
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Affiliation(s)
- Nuno Mendes
- University Clinic of Otorhinolaryngology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Serviço de Otorrinolaringologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmo Miguéis
- University Clinic of Otorhinolaryngology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Serviço de Otorrinolaringologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Lindo
- University Clinic of Otorhinolaryngology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Microbiology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Teresa Gonçalves
- Institute of Microbiology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - António Miguéis
- University Clinic of Otorhinolaryngology, FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Serviço de Otorrinolaringologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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Popovych V, Koshel I, Malofiichuk A, Pyletska L, Semeniuk A, Filippova O, Orlovska R. A randomized, open-label, multicenter, comparative study of therapeutic efficacy, safety and tolerability of BNO 1030 extract, containing marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark, dandelion herb in the treatment of acute non-bacterial tonsillitis in children aged 6 to 18 years. Am J Otolaryngol 2019; 40:265-273. [PMID: 30554882 DOI: 10.1016/j.amjoto.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
Seventy to 95% of acute tonsillitis episodes are caused by viral infection, therefore why antibiotic therapy is not indicated in majority of cases. In such cases, acetaminophen or ibuprofen are used to alleviate the symptoms. The objective of this study was assessment of efficacy of phytoneering extract BNO 1030 (Imupret®) in patients with acute non-bacterial tonsillitis. METHODS This randomized, open-label, multicenter, comparative study randomised 238 outpatients aged 6-18 years to receive either BNO 1030 (Imupret®) as a supplement to standard symptomatic therapy, or standard therapy. Assessment criteria were as follows: sore throat dynamics at rest and at swallowing, throat irritation associated with cough, general condition, day of withdrawal of antipyretics, the share of treatment responders, as well as assessment of "therapeutic benefit" from the use of BNO 1030. RESULTS Decreased intensity of acute tonsillitis symptoms to 1 point and lower, assessed using 4-point scale starting from the day 5 of treatment (p < 0.005), alleviation of local symptoms and general condition starting from day 2 of the disease (р < 0.001), withdrawal of antipyretics starting from day 4 of treatment (p < 0.005), increase of the number of treatment responders to 81.6% (p < 0.005) versus the control were reported. "Therapeutic benefit" was 4.2 days. All patients tolerated phytotherapy well, and no adverse reactions were seen. CONCLUSION BNO 1030 (Imupret®) is a safe and effective product for treatment of acute non-bacterial tonsillitis in children aged 6-18 years, assuring therapeutic benefit when prescribed additionally to the standard symptomatic therapy.
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Kaltiainen E, Wikstén J, Aaltonen LM, Ilmarinen T, Hagström J, Blomgren K. The presence of minor salivary glands in the peritonsillar space. Eur Arch Otorhinolaryngol 2017; 274:3997-4001. [PMID: 28900734 DOI: 10.1007/s00405-017-4738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Abstract
Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.
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