Peritonsillar cellulitis
Background
- Peritonsillar cellulitis- inflammatory reaction between palatine tonsil and pharyngeal muscle with no discrete collection of pus.
- Peritonsillar abscess - collection of pus located between palatine tonsil and pharyngeal muscle.
Differential Diagnosis
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [1]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Evaluation
- Imaging may be necessary to differentiate peritonsillar abscess (PTA) from peritonsillar cellulitis, epiglottitis, deep space neck infection
- Intraoral or submandibular ultrasound distinguish PTA from cellulitis and guide needle aspiration
- Submandibular ultrasound may be superior to intraoral ultrasound when limited by trismus or pain.
- PTA will have echo-free cavity with irregular border
- Peritonsillar cellulitis appears as homogenous area with no fluid collection
- Do not recommend CT to differentiate PTA from cellulitis
- Recommend CT with IV contrast to identify deep space neck infection
Management
- Antibiotic therapy
- Oral
- Amoxicillin-clavulanate (45mg/kg per dose [max 875mg single dose]) x 12 hours in children; 875 mg x 12 hours in adults
- Clindamycin (10mg/kg [max 600mg single dose]) x8 hours in children; 300-450mg x 6 hours in adults
- Parenteral
- Ampicillin-sulbactam (no MRSA coverage) IV (50mg/kg per dose [max 3g single dose]) x 6 hours children; 3g x6 hours adults
- Clindamycin IV (13mg/kg per dose [max 900mg single dose]) x8 hours children; 600mg x6-8 hours adults
- If moderate to severe disease (toxic, temp>39C, drooling, respiratory distress) add IV vancomycin or linezolid to ampicillin-sulbactam or clindamycin
- Oral
Disposition
- Usually discharge
See Also
External Links
References
- Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
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