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Implication of Fusobacterium necrophorum in recurrence of peritonsillar abscess
S Ahmed Ali1, Kevin J Kovatch1, Josh Smith2
1Department of Otolaryngology Head & Neck Surgery, Ann Arbor, Michigan, U.S.A.
Objective:
Peritonsillar abscess (PTA) is a common infectious complication of pharyngeal infection managed by otolaryngologists and emergency room physicians. Streptococcus and Fusobacterium (e.g., Fusobacterium necrophorum, FN) species are commonly isolated pathogens. The aim of this study was to determine the implication of culture results on abscess recurrence following drainage.
Methods:
Single-institution retrospective review of patients treated at the University of Michigan between 2000 and 2017. Demographic and clinical outcome data were analyzed, including treatment details, culture data, and recurrence.
Results:
One hundred fifty-six of the 990 patients in our study developed recurrence of their abscess (16%). The age ranges most susceptible to recurrence included adolescent (22.9%) and young adult groups (17.1%). Recurrent patients were more likely to have experienced acute progression of symptoms (79% vs. 71%, P = 0.03), trismus (67% vs. 55%, P = 0.006), voice changes (65% vs. 57%, P = 0.04), and dysphagia (72% vs. 61%, P = 0.01) compared to nonrecurrent patients. They were also more likely to have clinical lymphadenopathy noted on initial examination (67% vs. 56%, P = 0.009). Culture data was sent for 852 patients (86%). The presence of FN was significantly more prevalent in the recurrent group (P < 0.0001).
Conclusion:
There is a high observed prevalence of FN species within PTA aspirates in the recurrent PTA population. PTA aspirate should be sent for anaerobic growth to screen for Fusobacterium species. In addition, follow-up and lower threshold for subsequent tonsillectomy should be considered in this at-risk group.
Level Of Evidence:
3 Laryngoscope, 129:1567-1571, 2019.
Insights
Fusobacterium necrophorum (FN) in peritonsillar abscess (PTA) aspirates is linked to higher recurrence rates. Prompt identification and management of FN may reduce PTA reoccurrence.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Background:
- Peritonsillar abscess (PTA) is a common complication of pharyngeal infections.
- Streptococcus and Fusobacterium species, particularly Fusobacterium necrophorum (FN), are frequently isolated pathogens.
- Understanding factors influencing PTA recurrence is crucial for effective patient management.
Purpose of the Study:
- To investigate the impact of microbial culture results on peritonsillar abscess recurrence after drainage.
- To identify specific pathogens associated with recurrent PTA.
- To inform clinical decision-making regarding PTA management and follow-up.
Main Methods:
- Retrospective review of 156 patients with recurrent PTA and 990 total patients treated between 2000 and 2017.
- Analysis of demographic data, clinical outcomes, treatment details, and microbiological culture results.
- Statistical comparison of clinical and microbiological findings between recurrent and non-recurrent PTA cases.
Main Results:
- 16% of patients experienced PTA recurrence, with higher rates in adolescent and young adult groups.
- Recurrent PTA patients were more likely to present with acute symptom progression, trismus, voice changes, dysphagia, and lymphadenopathy.
- Fusobacterium necrophorum (FN) was significantly more prevalent in patients with recurrent PTA (P < 0.0001).
Conclusions:
- A high prevalence of FN in PTA aspirates is associated with abscess recurrence.
- Sending PTA aspirates for anaerobic culture to detect Fusobacterium species is recommended.
- Consider increased surveillance and a lower threshold for tonsillectomy in patients with recurrent PTA, especially those with FN identified.
