Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA; Department of Otolaryngology/ENT, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA.
Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA.
Am J Otolaryngol. 2020 Nov-Dec;41(6):102716. doi: 10.1016/j.amjoto.2020.102716. Epub 2020 Sep 10.
To describe this new clinical entity, diagnosis, and potential management of pediatric intratonsillar/peritonsillar abscesses in children affected by infectious mononucleosis.
After institutional review board approval, a retrospective chart review of patients who underwent testing for infectious mononucleosis and also had a computed tomography scan of the head and neck was completed. Those who did not have imaging showing the palatine tonsils and those with insufficient testing to diagnose infectious mononucleosis were excluded.
One hundred patients were included in the study; 15 had a peritonsillar abscess and 29 had an intratonsillar abscess. Four of the patients with a peritonsillar abscess (26.7%) had a positive Monospot or Epstein-Barr virus IgM result, and two of 15 (13.3%) had positive rapid strep or culture results. Of the 29 patients with an intratonsillar abscess, eight (27.6%) had a positive Monospot or Epstein-Barr virus IgM result while two (6.9%) had a positive rapid strep or culture result. Of those with bilateral intratonsillar abscess, five of 12 (41.7%) patients showed laboratory markers for infectious mononucleosis compared with three of 17 (17.6%) with unilateral intratonsillar abscess. This difference was not statistically significant (Fischer's, p = 0.218).
In our cohort of patients undergoing computed tomography scan and acute infectious mononucleosis testing, patients with intratonsillar and peritonsillar abscess tested positive for mononucleosis markers more commonly than for streptococcus markers. Recognizing uncomplicated intratonsillar and peritonsillar abscess in the setting of infectious mononucleosis in these pediatric patients may help tailor management in this population.
描述患有传染性单核细胞增多症的儿童的扁桃体下/扁桃体周围脓肿的这种新的临床实体、诊断和潜在治疗方法。
在获得机构审查委员会批准后，对接受传染性单核细胞增多症检测且头颈部计算机断层扫描的患者进行了回顾性图表审查。排除了那些影像学检查未显示腭扁桃体或检测结果不足以诊断传染性单核细胞增多症的患者。
本研究纳入了 100 名患者；15 名患者患有扁桃体周围脓肿，29 名患者患有扁桃体下脓肿。4 名扁桃体周围脓肿患者（26.7%）的 Monospot 或 EBV IgM 结果阳性，15 名患者中有 2 名（13.3%）快速链球菌或培养结果阳性。29 名扁桃体下脓肿患者中，8 名（27.6%）的 Monospot 或 EBV IgM 结果阳性，2 名（6.9%）的快速链球菌或培养结果阳性。双侧扁桃体下脓肿患者中，12 名患者中有 5 名（41.7%）的实验室标志物显示为传染性单核细胞增多症，而单侧扁桃体下脓肿患者中有 3 名（17.6%）。差异无统计学意义（Fischer 检验，p=0.218）。
在接受计算机断层扫描和急性传染性单核细胞增多症检测的患者队列中，扁桃体下和扁桃体周围脓肿患者的单核细胞增多症标志物检测阳性率高于链球菌标志物检测阳性率。在这些儿科患者中，认识到传染性单核细胞增多症合并单纯性扁桃体下和扁桃体周围脓肿可能有助于针对该人群进行治疗管理。
