Infectious Disease Compendium

Peritonsillar Abscess aka Quinsy

Diagnosis

Fevers, toxicity, severe pain, and dysphagia; marked asymmetry of retropharynx on exam. CT makes the diagnosis.

Epidemiologic Risks

Streptococcal pharyngitis.

NSAIDs are a risk as well (Pubmed).

Microbiology

Group A streptococci and other mouth organisms, anaerobes especially Fusobacterium.

Empiric Therapy

Drain it, then any beta-lactam that will nuke a group A strep.

Initially over-treat until cultures back as could be a mixed infection: (third-generation cephalosporins PLUS metronidazole ) OR penicillin/beta-lactamase inhibitors OR (quinolone PLUS metronidazole OR clindamycin) OR carbapenems.

Dexamethasone 10 mg iv single dose led to a more rapid symptomatic improvement without complications (PubMed).

Pearls

It killed Jack Klugman. Get it? He played Quincy on TV and he died of Quinsy? Now do you get it? Sigh. At least he didn't play a character called Gleet.

Last Update: 01/03/18.