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Infectious complication of tonsillitis or pharyngitis resulting in an accumulation of purulence in the tonsillar fossa; also referred to as “quinsy”
- Most common deep space infection of head and neck
- Seen most commonly in adolescents but occasionally in younger children
Abscess formation can often be prevented if appropriate antimicrobial therapy is initiated while the infection is still at the cellulitis stage.
- Infectious tonsillopharyngitis progresses from cellulitis to abscess.
- The infection starts in the intratonsillar fossa, which is situated between the upper pole and the body of the tonsil and eventually extends around the tonsil.
- The abscess is a suppuration outside the tonsillar capsule, in proximity to the upper pole of the tonsil, involving the soft palate.
- Purulence usually collects within one tonsillar fossa but it may be bilateral.
- The pterygoid musculature may become irritated by pus and inflammation, which leads to the clinical finding of trismus.
- Tonsillar and peritonsillar edema may lead to compromise of the upper airway.
- Most abscesses are polymicrobial.
- Group A β-hemolytic streptococci (GABHS) is the most common bacterium isolated.
- α-Hemolytic streptococci is the second most common bacterium reported in most studies.
- Staphylococcus aureus
- Anaerobic bacteria play an important role:
- Possible synergy between anaerobes and GABHS
- Gram-negatives such as Haemophilus influenzae and, more rarely, Pseudomonas species may be isolated.
Commonly Associated Conditions
- Tonsillitis or pharyngitis usually precedes its development.
- Peritonsillar cellulitis is often associated with infectious mononucleosis.