Perithonsillar and parapharyngeal abscess: microbiological and morphological features

Abstract

Introduction. The most dangerous local complication of acute and exacerbations of chronic inflammatory diseases of the pharynx is the formation of abscesses in the structure of the cellular spaces of the neck. Paratonsillar abscess (PTA) is the most common abscessing lesion. In turn, parapharyngeal abscess (PFA) is often found in patients with PTA as its complication.Aim. To study the clinical, microbiological and pathomorphological features of parapharyngeal complications in patients with PTA.Materials and methods. The analysis of medical records of 50 patients with diagnoses of parathonsillar and parapharyngeal abscesses who underwent inpatient treatment at the otorhinolaryngological department of the N.I. Pirogov State Clinical Hospital No. 1 in the period from September 2021 to April 2023 was carried out. The studied patients were divided into 2 groups. In group 2 of patients (n = 25; F 10, M 15; average age -37.2 years ± 10.8 years) an isolated PTA was diagnosed. In the 2 group of patients (n = 25; F 10, M 15, the average age was 44.6 years ± 14.8 years) PTA was complicated by the development of PFA.Results and discussion. Associations of facultative anaerobic and obligate anaerobic microorganisms were found in all pus aspirates obtained from PTA and PFA. Monocultures of microorganisms were not isolated in any case. The detection of Fusobacterium necrophorum was associated with pronounced necrotic changes in the tissues of the tonsils and surrounding structures; Peptostreptococcus anaerobius with purulent melting of fiber tissue; Veillonella dispar with pronounced infiltrative processes in tissues combined with oral pathology in patients.Conclusions. The most common microorganisms in patients with PTA and PFA were Streptococcus pyogenes and Fusobacterium necrophorum. The activity of Fusobacterium necrophorum is associated with a more severe course of the inflammatory process in the near-pharyngeal space.