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inflammation of the tonsils (especially the palatine tonsils)

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扁桃腺炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/08 17:15:33」(JST)

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Tonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection whose symptoms include sore throat and fever. The overwhelming majority of patients recover completely with or without medication. In 40%, symptoms have resolved in three days and within one week in 85%, regardless of whether streptococcal infection (an important cause) is present or not.^[1]

Symptoms

Common signs and symptoms include:^[2]^[3]^[4]^[5]

sore throat
red, swollen tonsils
pain when swallowing
high temperature (fever)
headache
tiredness
chills
a general sense of feeling unwell (malaise)
white pus-filled spots on the tonsils
swollen lymph nodes (glands) in the neck
pain in the ears or neck

Less common symptoms include:

nausea
stomach ache
vomiting
furry tongue
bad breath (halitosis)
voice changes
difficulty opening the mouth

In cases of acute tonsillitis, the surface of the tonsil may be bright red and with visible white areas or streaks of pus.^[6]

Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.^[7]

Causes

The most common cause is viral infection and includes adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus.^[2]^[3]^[4]^[5] It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV.^[2]^[3]^[4]^[5] The second most common cause is bacterial infection of which the predominant is Group A β-hemolytic streptococcus (GABHS), which causes strep throat.^[2]^[3]^[4]^[5] Less common bacterial causes include: Staphylococcus aureus (including methicillin resistant Staphylococcus aureus or MRSA ),^[8]Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.^[2]^[3]^[4]^[5] A coexisting GABHS and influenza A virus pharyngotonsillitis has been reported.^[9]

Anaerobic bacteria have been implicated in tonsillitis and a possible role in the acute inflammatory process is supported by several clinical and scientific observations.^[10]

Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils.^[11]^[12] Within the tonsils, white blood cells of the immune system destroy the viruses or bacteria by producing inflammatory cytokines like Phospholipase A2,^[13] which also lead to fever.^[11]^[12] The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx.^[14]

Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent angina.^[15]

Laboratory tests

The diagnosis of GABHS tonsillitis can be confirmed by culture of samples obtained by swabbing both tonsillar surfaces and the posterior pharyngeal wall and plating them on sheep blood agar medium. The isolation rate can be increased by incubating the cultures under anaerobic conditions and using selective media. A single throat culture has a sensitivity of 90%-95% for the detection of GABHS. A small percentage of false-negative results are part of the characteristics of the tests used but are also possible if the patient has received antibiotics prior to testing. Identification requires 24 to 48 hours by culture but rapid screening tests (10–60 minutes), which have a sensitivity of 85-90%, are available. Older antigen tests detect the surface Lancefield group A carbohydrate. Newer tests identify GABHS serotypes using nucleic acid (DNA) probes or polymerase chain reaction. Bacterial culture should be performed in cases of a negative rapid streptococcal test.^[16]

True infection with GABHS, rather than colonization, is defined as the presence of >10 colonies of GABHS per blood agar plate. However, this method is difficult to implement because of the overlap between carriers and infected patients. An increase in antistreptolysin O (ASO) streptococcal antibody titer 3–6 weeks following the acute infection can provide retrospective evidence of GABHS infection.^[17] ASO titers are considered definitive proof of GABHS infection.

When GAHBS is not isolated, the clinician should seek other potential pathogens. However, many of these organisms are part of the normal flora residing in the pharynx, making interpretation of the results difficult. A finding of a membrane in the throat should prompt a search for corynebacteria. Culture should be obtained from beneath the membrane, and use of a special moisture-reducing transport medium is necessary. The material may be inoculated on a Loeffler slant, tellurite plate, or blood agar plate. Identification by fluorescent antibody technique is also possible. Viral cultures are available, as well as rapid tests for some viruses (e.g., respiratory syncytial viruses). A heterophile slide test or other rapid test for infectious mononucleosis can provide a specific diagnosis.

Tonsillitis and Rheumatic Fever

Since the advent of Penicillin in the 1940's, a major preoccupation in the treatment of streptococcal tonsillitis has been the prevention of rheumatic fever, and it's major effects on the nervous system (Sydenham's chorea) and heart. Recent evidence would suggest that the rheumatogenic strains of group A beta hemolytic strep have become markedly less prevalent and are now only present in small pockets such as in Salt Lake City.^[18] This brings into question the rational for treating tonsillitis.

Treatment

Treatments to reduce the discomfort from tonsillitis symptoms include:^[2]^[3]^[4]^[5]^[14]^[19]^[20]

pain relief, anti-inflammatory, fever reducing medications (acetaminophen/paracetamol and/or ibuprofen)
sore throat relief (warm salt water gargle, lozenges, and iced/cold liquids)

If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line.^[21] Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.^[22] A macrolide such as erythromycin is used for people allergic to penicillin. Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria^[23] such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.^[24] When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, symptoms may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment.^[25]

Causes of penicillin failure in the treatment of GABHS tonsillitis

Despite its excellence in vitro efficacy, the frequently reported inability of penicillin to eradicate GABHS from patients with acute and relapsing tonsillitis is a cause for concern. Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000.^[26]

There are several explanations for the failure of penicillin to eradicate GABHS tonsillitis (Table 1). One explanation is the poor penetration of penicillin into the tonsillar tissues as well as into the epithelial cells.^[27] Other explanations relate to the bacterial interactions between GABHS and the other members of the pharyngo-tonsillar bacterial flora. It is hypothesized that the enzyme beta-lactamase which is secreted by beta-lactamase-producing aerobic and anaerobic bacteria, that colonize the pharynx and tonsils, may "shield" GABHS from penicillins.^[28] These organisms include S. aureus, Haemophillus influenzae, and Prevotella, Porphyromonas and Fusobacterium spp.,^[29] A recent increase was noted in the recovery of MRSA which was isolated from 16% of tonsils, making it more difficult to eradicate this and other beta-lactamase producing organisms.^[30] Another possibility is the coaggregation between Moraxella catarrhalis and GABHS, which can facilitate colonization by GABHS.^[31] Normal bacterial flora can interfere with the growth of GABHS,^[32]^[33] and the absence of such competitive bacteria makes it easier for GABHS to colonize and invade the pharyngo-tonsillar area.^[34] GABHS can also be reacquired from a contact or an object (i.e., toothbrush or dental braces)^[35]

Table 1. Causes of Antibiotics Failure in Therapy of GABHS Tonsillitis

The presence of beta-lactamase–producing organisms that "protect" GABHS from penicillins^[36]
Coaggregation between GABHS and M. catarrhalis^[31]
Absence of members of the oral bacterial flora capable of interfering with the growth of GABHS (through production of bacteriocins and/or competition on nutrients)^[32]^[33]
Poor penetration of penicillin into the tonsillar cells and tonsillar surface fluid ( allowing intracellular survival of GABHS)^[27]
Resistance (i.e., erythromycin) or tolerance (i.e., penicillin) to the antibiotic used
Inappropriate dose, duration of therapy, or choice of antibiotic
Poor compliance
Reacquisition of GABHS from a contact or an object (i.e., toothbrush or dental braces)^[35]
Carrier state, not disease^[37]

Implications of microbial interactions on therapy

Penicillin is recommended by some guidelines as the antibiotic of choice,^[38] although other antibiotics are more effective in the bacteriologic and clinical cure of acute and recurrent GABHS tonsillitis.^[39]^[40]^[41]^[42]^[43] Lincomycin, clindamycin, and amoxicillin-clavulanate are more effective in relapsing GABHS tonsillitis.^[39]^[40]^[41] Cephalosporins are superior to penicillins in both acute and relapsing GABHS tonsillitis.^[44]^[45] In those who failed penicillin, the goal of therapy is to eradicate the beta-lactamase-producing bacteria that "shield" GABHS from penicillin, while preserving whatever "protective" interfering organisms (i.e., alpha hemolytic streptococci) that may colonize the tonsils. Cephalosporins have been successful in eradicating GABHS better,^[46] and in some instances even faster^[47] than penicillins. Their efficacy is explained by their activity against beta-lactamase producing aerobic bacteria, and sparing of interfering organisms.^[17] Over 35 randomized studies had demonstrated cephalosporins of all generations to have a much higher success rate in eradicating GABHS than penicillin (a third of the failure rate of penicillin),^[46] and 12 studies found equal or better success rate in 5 to 7 days of therapy as compared with 10 days of penicillin.^[48]^[49]

Complications

Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.^[2]^[3]^[4]^[5]^[14]

An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).

In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),^[50]^[51]^[52] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.

In very rare cases of strep throat, diseases like rheumatic fever^[53] or glomerulonephritis^[54] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.^[55]^[56] Tonsillitis associated with strep throat, if untreated, is hypothesized to lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).^[57]

References

^ Del Mar CB, Glasziou PP, Spinks AB (2006 Oct). Del Mar, Chris B. ed. "Antibiotics for sore throat". Cochrane Database Syst Rev 18;(4) (4): CD000023. doi:10.1002/14651858.CD000023.pub3. PMID 17054126.
^ ^a ^b ^c ^d ^e ^f ^g Tonsillopharyngitis at Merck Manual of Diagnosis and Therapy Professional Edition
^ ^a ^b ^c ^d ^e ^f ^g Wetmore RF. (2007). "Tonsils and adenoids". In Bonita F. Stanton; Kliegman, Robert; Nelson, Waldo E.; Behrman, Richard E.; Jenson, Hal B.. Nelson textbook of pediatrics. Philadelphia: Saunders. ISBN 1-4160-2450-6.
^ ^a ^b ^c ^d ^e ^f ^g Thuma P. (2001). "Pharyngitis and tonsillitis". In Hoekelman, Robert A.. Primary pediatric care. St. Louis: Mosby. ISBN 0-323-00831-3.
^ ^a ^b ^c ^d ^e ^f ^g Simon HB (2005). "Bacterial infections of the upper respiratory tract". In Dale, David. ACP Medicine, 2006 Edition (Two Volume Set) (Webmd Acp Medicine). WebMD Professional Publishing. ISBN 0-9748327-6-6.
^ Tonsillitis and Adenoid Infection MedicineNet. Retrieved on 2010-01-25
^ S. G. Nour; Mafee, Mahmood F.; Valvassori, Galdino E.; Galdino E. Valbasson; Minerva Becker (2005). Imaging of the head and neck. Stuttgart: Thieme. pp. 716. ISBN 1-58890-009-6.
^ Brook, I.; Foote, P. A. (2006). "Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children". Int J Pediatr Otorhinolaryngol 70 (12): 2099–2102. doi:10.1016/j.ijporl.2006.08.004. PMID 16962178.
^ Brook, I.; Gober, A. E. (2008). "Concurrent influenza A and group A beta-hemolytic streptococcal pharyngotonsillitis". Ann Otol Rhinol Laryngol 117 (4): 310–312. PMID 18478842.
^ Brook, I. (2005). "The role of anaerobic bacteria in tonsillitis". Int J Pediatr Otorhinolaryngol 69 (1): 9–19. doi:10.1016/j.ijporl.2004.08.007. PMID 15627441.
^ ^a ^b van Kempen MJ, Rijkers GT, Van Cauwenberge PB (May 2000). "The immune response in adenoids and tonsils". Int. Arch. Allergy Immunol. 122 (1): 8–19. doi:10.1159/000024354. PMID 10859465.
^ ^a ^b Perry M, Whyte A (September 1998). "Immunology of the tonsils". Immunology Today 19 (9): 414–21. doi:10.1016/S0167-5699(98)01307-3. PMID 9745205.
^ Ezzeddini, Rana; Darabi, Masoud; Ghasemi, Babollah; Jabbari, Yalda; Abdollahi, Shahin; Rashtchizadeh, Nadereh; Gharahdaghi, Abasaad; Darabi, Maryam et al. (2012). "Circulating phospholipase-A2 activity in obstructive sleep apnea". International Journal of Pediatric Otorhinolaryngology 76 (4): 471–4. doi:10.1016/j.ijporl.2011.12.026. PMID 22297210.
^ ^a ^b ^c MedlinePlus Encyclopedia Tonsillitis
^ Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]" (in Dutch; Flemish). Acta Otorhinolaryngol Belg 30 (3): 334–45. PMID 1015288. — fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta
^ Leung AK, Newman R, Kumar A, Davies HD (2006). "Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis". Expert Rev Mol Diagn 6 (5): 761–6. doi:10.1586/14737159.6.5.761. PMID 17009909.
^ ^a ^b Brook I (2007). "Overcoming penicillin failures in the treatment of Group A streptococcal pharyngo-tonsillitis". Int J Pediatr Otorhinolaryngol 71 (10): 1501–8. doi:10.1016/j.ijporl.2007.06.006. PMID 17644191.
^ Shulman ST, Stollerman G, Beall B, Dale JB, Tanz RR (2006 Feb 15). "Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States". Clin Infect Dis 42 (4): 441-7. doi:10.1086/499812. PMID 16421785.
^ Boureau, F. et al. (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation 17: 1–8. doi:10.2165/00044011-199917010-00001.
^ Praskash, T. et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic 98: 124–7.
^ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.
^ Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children". Pediatrics 113 (4): 866–882. doi:10.1542/peds.113.4.866. PMID 15060239.
^ Brook I (2009). "The role of beta-lactamase-producing-bacteria in mixed infections". BMC Infect Dis 9: 202. doi:10.1186/1471-2334-9-202. PMC 2804585. PMID 20003454. http://www.biomedcentral.com/1471-2334/9/202.
^ Brook I (2007). "Microbiology and principles of antimicrobial therapy for head and neck infections". Infect Dis Clin North Am 21 (2): 355–91. doi:10.1016/j.idc.2007.03.014. PMID 17561074. http://linkinghub.elsevier.com/retrieve/pii/S0891-5520(07)00026-8.
^ Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642.
^ Pichichero ME, Casey JR. The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis. Diagn Microbiol Infect Dis. 2007;57(Supplement):S39-S45.
^ ^a ^b Kaplan EL, Chatwal GS, Rohde M (2006). "Reduced ability of penicillin to eradicate ingested Group A streptococci from epithelial cells: clinical and pathogenetic implications". Clin Infect Dis 43 (11): 1398–406. doi:10.1086/508773. PMID 17083011. http://cid.oxfordjournals.org/content/43/11/1398.full.pdf+html.
^ Brook I (1984). "Role of beta-lactamase–producing bacteria in the persistence of streptococcal tonsillar infection". Rev Infect Dis 6 (5): 601–607. doi:10.1093/clinids/6.5.601. PMID 6390637.
^ Brook I, Calhoun L, Yocum PA (1980). "Beta-lactamase-producing isolates of Bacteroides species from children" (PDF). Antimicrob Agents Chemother 18 (1): 164–6. doi:10.1128/AAC.18.1.164. PMC 283957. PMID 6968177. //www.ncbi.nlm.nih.gov/pmc/articles/PMC283957/.
^ Brook I, Foote PA. Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children. Int J Pediatr Otorhinolaryngol. 2006 ;70:2099-102.
^ ^a ^b Brook I, Gober AE (2006). "Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis". J Med Microbiol 55 (8): 989–92. doi:10.1099/jmm.0.46325-0. http://jmm.sgmjournals.org/content/55/8/989.full.pdf+html.
^ ^a ^b Grahn E, Holm SE (1983). "Bacterial interference in the throat flora during a streptococcal tonsillitis outbreak in an apartment house area". Zbl Bakl Hyg A. 256: 72–79.
^ ^a ^b Brook I, Gober AE (1995). "Role of bacterial interference and beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococcal pharyngotonsillitis". Arch Otolaryngol Head Neck Surg. 121 (12): 1405–9. doi:10.1001/archotol.1995.01890120061012. PMID 7488371.
^ Brook I, Gober AE (1999). "Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis". Arch Otolaryngol Head Neck Surg. 125 (5): 552–4. doi:10.1001/archotol.125.5.552. PMID 10326813. http://archotol.ama-assn.org/cgi/reprint/125/5/552.
^ ^a ^b Brook I, Gober AE (1998). "Persistence of group A beta-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis". Arch Otolaryngol Head Neck Surg 124 (9): 993–5. doi:10.1001/archotol.124.9.993. PMID 9738808. http://archotol.ama-assn.org/cgi/reprint/124/9/993.
^ Brook I (1984). "Role of beta-lactamase–producing bacteria in the persistence of streptococcal tonsillar infection". Rev Infect Dis. 6 (5): 601–607. doi:10.1093/clinids/6.5.601. PMID 6390637.
^ Brook I, Gober AE (2006). "Recovery of interfering and beta-lactamase-producing bacteria from group A beta-haemolytic streptococci carriers and non-carriers". J Med Microbiol 55 (12): 1741–4. doi:10.1099/jmm.0.46796-0. http://jmm.sgmjournals.org/content/55/12/1741.full.pdf+html.
^ Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH (2002). "Practice guidelines for the diagnosis and management of Group A streptococcal pharyngitis". Clin Infect Dis 35 (2): 113–125. doi:10.1086/340949. PMID 12087516.
^ ^a ^b Brook I, Hirokawa R (1985). "Treatment of patients with a history of recurrent tonsillitis due to Group A beta-hemolytic streptococci. A prospective randomized study comparing penicillin, erythromycin and clindamycin". Clin Pediatr 24 (6): 331–336. doi:10.1177/000992288502400606.
^ ^a ^b Brook I (1989). "Treatment of patients with acute recurrent tonsillitis due to Group A beta‑haemolytic streptococci: a prospective randomized study comparing penicillin and amoxicillin/clavulanate potassium". J Antimicrob Chemother 24 (2): 227–233. doi:10.1093/jac/24.2.227. PMID 2676941.
^ ^a ^b Kaplan EL, Johnson DR (1988). "Eradication of Group A streptococci from the upper respiratory tract by amoxicillin with clavulanate after oral penicillin V treatment failure". J Pediatr 113 (2): 400–403. doi:10.1016/S0022-3476(88)80291-9. PMID 3135377.
^ Holm S, Henning C, Grahn E, Lomberg H, Staley H (1995). "Is penicillin the appropriate treatment for recurrent tonsillopharyngitis? Results from a comparative randomized blind study of cefuroxime axetil and phenoxymethylpenicillin in children. The Swedish Study Group". Scand J Infect Dis. 27 (3): 221–228. doi:10.3109/00365549509019013. PMID 8539545.
^ Holm SE, Roos K, Stromberg A (1991). "A randomized study of treatment of streptococcal pharyngotonsillitis with cefadroxil or phenoxymethylpenicillin (penicillin V)". Pediatr Infect Dis J 10 (10 Suppl): S68–71. doi:10.1097/00006454-199110001-00015. PMID 1945601.
^ Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Clin Infect Dis. 38 (11): 1526–1534. doi:10.1086/392496. PMID 15156437.
^ Pichichero ME (1993). "Cephalosporins are superior to penicillin for treatment of streptococcal-tonsillopharyngitis: is the difference worth it?". Pediatr Infect Dis J. 12 (4): 268–274. doi:10.1097/00006454-199304000-00002. PMID 8483619.
^ ^a ^b Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Clin Infect Dis 38 (11): 1526–1534. doi:10.1086/392496. PMID 15156437.
^ Pichichero ME (1993). "Cephalosporins are superior to penicillin for treatment of streptococcal tonsillopharyngitis: is the difference worth it?". Pediatr Infect Dis J 12 (4): 268–274. doi:10.1097/00006454-199304000-00002. PMID 8483619.
^ Brook I. Antibacterial therapy for acute group a streptococcal pharyngotonsillitis: short-course versus traditional 10-day oral regimens.Paediatr Drugs.2002;4:747-54.
^ Casey JR, Pichichero ME (2005). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Pediatr Infect Dis J. 24 (10): 909–917. doi:10.1097/01.inf.0000180573.21718.36. PMID 16220091.
^ Scottish Intercollegiate Guidelines Network. (January 1999). "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. ISBN 1-899893-66-0. http://www.sign.ac.uk/guidelines/fulltext/34/section6.html. — notes though that these criteria "have been arrived at arbitrarily" from:
Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642.
^ Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941. — this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"
^ Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]" (in German). Ther Umsch 61 (5): 325–8. doi:10.1024/0040-5930.61.5.325. PMID 15195718. — review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"
^ Del Mar CB, Glasziou PP, Spinks AB (2004). Del Mar, Chris. ed. "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html. — Meta-analysis of published research
^ Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]" (in Polish). Wiad. Lek. 54 (1–2): 56–63. PMID 11344703.
^ Ohlsson, A.; Clark, K (September 28 2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ 171 (7): 721–3. doi:10.1503/cmaj.1041275. PMC 517851. PMID 15451830. http://www.cmaj.ca/cgi/content/full/171/7/721. — Canadian Medical Association Journal commentary on Cochrane analysis
^ Danchin, MH; Curtis, N; Nolan, TM; Carapetis, JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA 177 (9): 512–5. PMID 12405896. http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html. — Medical Journal of Australia commentary on Cochrane analysis
^ Pickering, Larry K., ed. (2006). "Group A streptococcal infections". Red Book: 2006 Report of the Committee on Infectious Diseases (Red Book Report of the Committee on Infectious Diseases). Amer Academy of Pediatrics. ISBN 1-58110-194-5.

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1. 小児および思春期における急性感染性咽頭炎の診断へのアプローチ approach to diagnosis of acute infectious pharyngitis in children and adolescents
2. 連鎖球菌扁桃咽頭炎の治療および予防 treatment and prevention of streptococcal tonsillopharyngitis
3. 成人における扁桃摘出：適応 tonsillectomy in adults indications
4. 成人における急性咽頭炎の対症療法 symptomatic treatment of acute pharyngitis in adults
5. 小児における扁桃摘出およびアデノイド切除 tonsillectomy and adenoidectomy in children

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Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study.

O'Brien K1, Bellis TW2, Kelson M3, Hood K3, Butler CC4, Edwards A5.
The British journal of general practice : the journal of the Royal College of General Practitioners.Br J Gen Pract.2015 Sep;65(638):e585-92. doi: 10.3399/bjgp15X686497.
BACKGROUND: Antibiotic overuse and inappropriate prescribing drive antibiotic resistance. Children account for a high proportion of antibiotics prescribed in primary care.AIM: To determine the predictors of antibiotic prescription in young children presenting to UK general practices with acute illne
PMID 26324495

Analysis of the intensity of immune cell infiltration and immunoreactivity of RCAS1 in diffuse large B-cell lymphoma of the palatine tonsil and its microenvironment.

Kazmierczak W1, Lazar A, Tomaszewska R, Popiela TJ, Koper K, Wicherek L, Dutsch-Wicherek M.
Cell and tissue research.Cell Tissue Res.2015 Sep;361(3):823-31. doi: 10.1007/s00441-015-2157-0. Epub 2015 Mar 17.
Non-Hodgkin lymphoma of Waldeyer's ring constitutes a small percentage of cases of palatine tonsil malignancies and its precise etiology remains unknown. RCAS1 (receptor cancer-binding antigen expressed on SiSo cells) has been demonstrated to be associated with poor prognosis, the development of lym
PMID 25773455

Japanese Journal

Immunization with heat-inactivated Staphylococcus aureus induced an antibody response mediated by IgG1 and IgG2 in patients with recurrent tonsillitis

Garcia-Romo Gina Stella,Gonzalez-Ibarra Misael,Donis-Hernandez Felipe Raul [他]
Microbiology and immunology 59(4), 193-201, 2015-04
NAID 40020440529

Application of an enzyme-labeled antigen method for visualizing plasma cells producing antibodies against Strep A, a carbohydrate antigen of Streptococcus pyogenes, in recurrent tonsillitis

Onouchi Takanori,Mizutani Yasuyoshi,Shiogama Kazuya [他]
Microbiology and immunology 59(1), 13-27, 2015-01
NAID 40020351689

気管切開を要した舌扁桃炎および多発喉頭蓋嚢胞化膿症例

鈴木亜季,岩田昇,中田誠一 [他]
日本耳鼻咽喉科感染症・エアロゾル学会会誌 = The journal of Japan Society for Infection and Aerosol in Otorhinolaryngology 3(1), 39-42, 2015
NAID 40020446886

Related Pictures

★リンクテーブル★

リンク元	「扁桃炎」「口蓋扁桃炎」

「扁桃炎」

Tonsilitis
	Classification and external resources
	; A culture positive case of Streptococcal pharyngitis with typical tonsillar exudate
ICD-10	J03, J35.0
ICD-9	463
DiseasesDB	13165
MedlinePlus	001043
eMedicine	article/871977
MeSH	D014069

　　[★]

英: tonsillitis
同: 扁桃腺炎
関: 扁桃

「口蓋扁桃炎」

　　[★]

英: tonsillitis
関: 口蓋扁桃、扁桃炎

[0] Del Mar CB, Glasziou PP, Spinks AB (2006 Oct). Del Mar, Chris B. ed. "Antibiotics for sore throat". Cochrane Database Syst Rev 18;(4) (4): CD000023. doi:10.1002/14651858.CD000023.pub3. PMID 17054126.

[merck-1] ^ ^a ^b ^c ^d ^e ^f ^g Tonsillopharyngitis at Merck Manual of Diagnosis and Therapy Professional Edition

[wetmore-2] ^ ^a ^b ^c ^d ^e ^f ^g Wetmore RF. (2007). "Tonsils and adenoids". In Bonita F. Stanton; Kliegman, Robert; Nelson, Waldo E.; Behrman, Richard E.; Jenson, Hal B.. Nelson textbook of pediatrics. Philadelphia: Saunders. ISBN 1-4160-2450-6.

[thuma-3] ^ ^a ^b ^c ^d ^e ^f ^g Thuma P. (2001). "Pharyngitis and tonsillitis". In Hoekelman, Robert A.. Primary pediatric care. St. Louis: Mosby. ISBN 0-323-00831-3.

[simon-4] ^ ^a ^b ^c ^d ^e ^f ^g Simon HB (2005). "Bacterial infections of the upper respiratory tract". In Dale, David. ACP Medicine, 2006 Edition (Two Volume Set) (Webmd Acp Medicine). WebMD Professional Publishing. ISBN 0-9748327-6-6.

[5] Tonsillitis and Adenoid Infection MedicineNet. Retrieved on 2010-01-25

[6] S. G. Nour; Mafee, Mahmood F.; Valvassori, Galdino E.; Galdino E. Valbasson; Minerva Becker (2005). Imaging of the head and neck. Stuttgart: Thieme. pp. 716. ISBN 1-58890-009-6.

[7] Brook, I.; Foote, P. A. (2006). "Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children". Int J Pediatr Otorhinolaryngol 70 (12): 2099–2102. doi:10.1016/j.ijporl.2006.08.004. PMID 16962178.

[8] Brook, I.; Gober, A. E. (2008). "Concurrent influenza A and group A beta-hemolytic streptococcal pharyngotonsillitis". Ann Otol Rhinol Laryngol 117 (4): 310–312. PMID 18478842.

[9] Brook, I. (2005). "The role of anaerobic bacteria in tonsillitis". Int J Pediatr Otorhinolaryngol 69 (1): 9–19. doi:10.1016/j.ijporl.2004.08.007. PMID 15627441.

[Kempen-10] van Kempen MJ, Rijkers GT, Van Cauwenberge PB (May 2000). "The immune response in adenoids and tonsils". Int. Arch. Allergy Immunol. 122 (1): 8–19. doi:10.1159/000024354. PMID 10859465.

[Perry-11] Perry M, Whyte A (September 1998). "Immunology of the tonsils". Immunology Today 19 (9): 414–21. doi:10.1016/S0167-5699(98)01307-3. PMID 9745205.

[12] Ezzeddini, Rana; Darabi, Masoud; Ghasemi, Babollah; Jabbari, Yalda; Abdollahi, Shahin; Rashtchizadeh, Nadereh; Gharahdaghi, Abasaad; Darabi, Maryam et al. (2012). "Circulating phospholipase-A2 activity in obstructive sleep apnea". International Journal of Pediatric Otorhinolaryngology 76 (4): 471–4. doi:10.1016/j.ijporl.2011.12.026. PMID 22297210.

[medline-13] MedlinePlus Encyclopedia Tonsillitis

[pmid1015288-14] Van Cauwenberge P (1976). "[Significance of the fusospirillum complex (Plaut-Vincent angina)]" (in Dutch; Flemish). Acta Otorhinolaryngol Belg 30 (3): 334–45. PMID 1015288. — fusospirillum complex (Plaut-Vincent angina) Van Cauwenberge studied the tonsils of 126 patients using direct microscope observation. The results showed that 40% of acute tonsillitis was caused by Vincent's angina and 27% of chronic tonsillitis was caused by Spirochaeta

[15] Leung AK, Newman R, Kumar A, Davies HD (2006). "Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis". Expert Rev Mol Diagn 6 (5): 761–6. doi:10.1586/14737159.6.5.761. PMID 17009909.

[BrookOvercoming-16] Brook I (2007). "Overcoming penicillin failures in the treatment of Group A streptococcal pharyngo-tonsillitis". Int J Pediatr Otorhinolaryngol 71 (10): 1501–8. doi:10.1016/j.ijporl.2007.06.006. PMID 17644191.

[17] Shulman ST, Stollerman G, Beall B, Dale JB, Tanz RR (2006 Feb 15). "Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States". Clin Infect Dis 42 (4): 441-7. doi:10.1086/499812. PMID 16421785.

[Boureau-18] Boureau, F. et al. (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation 17: 1–8. doi:10.2165/00044011-199917010-00001.

[19] Praskash, T. et al. (2001). "Koflet lozenges in the Treatment of Sore Throat". The Antiseptic 98: 124–7.

[pmid1459378-20] Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.

[21] Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children". Pediatrics 113 (4): 866–882. doi:10.1542/peds.113.4.866. PMID 15060239.

[22] Brook I (2009). "The role of beta-lactamase-producing-bacteria in mixed infections". BMC Infect Dis 9: 202. doi:10.1186/1471-2334-9-202. PMC 2804585. PMID 20003454. http://www.biomedcentral.com/1471-2334/9/202.

[23] Brook I (2007). "Microbiology and principles of antimicrobial therapy for head and neck infections". Infect Dis Clin North Am 21 (2): 355–91. doi:10.1016/j.idc.2007.03.014. PMID 17561074. http://linkinghub.elsevier.com/retrieve/pii/S0891-5520(07)00026-8.

[pmid6700642-24] Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642.

[25] Pichichero ME, Casey JR. The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis. Diagn Microbiol Infect Dis. 2007;57(Supplement):S39-S45.

[cid.oxfordjournals.org-26] Kaplan EL, Chatwal GS, Rohde M (2006). "Reduced ability of penicillin to eradicate ingested Group A streptococci from epithelial cells: clinical and pathogenetic implications". Clin Infect Dis 43 (11): 1398–406. doi:10.1086/508773. PMID 17083011. http://cid.oxfordjournals.org/content/43/11/1398.full.pdf+html.

[27] Brook I (1984). "Role of beta-lactamase–producing bacteria in the persistence of streptococcal tonsillar infection". Rev Infect Dis 6 (5): 601–607. doi:10.1093/clinids/6.5.601. PMID 6390637.

[28] Brook I, Calhoun L, Yocum PA (1980). "Beta-lactamase-producing isolates of Bacteroides species from children" (PDF). Antimicrob Agents Chemother 18 (1): 164–6. doi:10.1128/AAC.18.1.164. PMC 283957. PMID 6968177. //www.ncbi.nlm.nih.gov/pmc/articles/PMC283957/.

[29] Brook I, Foote PA. Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children. Int J Pediatr Otorhinolaryngol. 2006 ;70:2099-102.

[jmm.sgmjournals.org-30] Brook I, Gober AE (2006). "Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis". J Med Microbiol 55 (8): 989–92. doi:10.1099/jmm.0.46325-0. http://jmm.sgmjournals.org/content/55/8/989.full.pdf+html.

[ReferenceA-31] Grahn E, Holm SE (1983). "Bacterial interference in the throat flora during a streptococcal tonsillitis outbreak in an apartment house area". Zbl Bakl Hyg A. 256: 72–79.

[ReferenceB-32] Brook I, Gober AE (1995). "Role of bacterial interference and beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococcal pharyngotonsillitis". Arch Otolaryngol Head Neck Surg. 121 (12): 1405–9. doi:10.1001/archotol.1995.01890120061012. PMID 7488371.

[33] Brook I, Gober AE (1999). "Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis". Arch Otolaryngol Head Neck Surg. 125 (5): 552–4. doi:10.1001/archotol.125.5.552. PMID 10326813. http://archotol.ama-assn.org/cgi/reprint/125/5/552.

[archotol-34] Brook I, Gober AE (1998). "Persistence of group A beta-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis". Arch Otolaryngol Head Neck Surg 124 (9): 993–5. doi:10.1001/archotol.124.9.993. PMID 9738808. http://archotol.ama-assn.org/cgi/reprint/124/9/993.

[35] Brook I (1984). "Role of beta-lactamase–producing bacteria in the persistence of streptococcal tonsillar infection". Rev Infect Dis. 6 (5): 601–607. doi:10.1093/clinids/6.5.601. PMID 6390637.

[36] Brook I, Gober AE (2006). "Recovery of interfering and beta-lactamase-producing bacteria from group A beta-haemolytic streptococci carriers and non-carriers". J Med Microbiol 55 (12): 1741–4. doi:10.1099/jmm.0.46796-0. http://jmm.sgmjournals.org/content/55/12/1741.full.pdf+html.

[37] Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH (2002). "Practice guidelines for the diagnosis and management of Group A streptococcal pharyngitis". Clin Infect Dis 35 (2): 113–125. doi:10.1086/340949. PMID 12087516.

[ReferenceC-38] Brook I, Hirokawa R (1985). "Treatment of patients with a history of recurrent tonsillitis due to Group A beta-hemolytic streptococci. A prospective randomized study comparing penicillin, erythromycin and clindamycin". Clin Pediatr 24 (6): 331–336. doi:10.1177/000992288502400606.

[Brook-39] Brook I (1989). "Treatment of patients with acute recurrent tonsillitis due to Group A beta‑haemolytic streptococci: a prospective randomized study comparing penicillin and amoxicillin/clavulanate potassium". J Antimicrob Chemother 24 (2): 227–233. doi:10.1093/jac/24.2.227. PMID 2676941.

[Kaplan-40] Kaplan EL, Johnson DR (1988). "Eradication of Group A streptococci from the upper respiratory tract by amoxicillin with clavulanate after oral penicillin V treatment failure". J Pediatr 113 (2): 400–403. doi:10.1016/S0022-3476(88)80291-9. PMID 3135377.

[41] Holm S, Henning C, Grahn E, Lomberg H, Staley H (1995). "Is penicillin the appropriate treatment for recurrent tonsillopharyngitis? Results from a comparative randomized blind study of cefuroxime axetil and phenoxymethylpenicillin in children. The Swedish Study Group". Scand J Infect Dis. 27 (3): 221–228. doi:10.3109/00365549509019013. PMID 8539545.

[42] Holm SE, Roos K, Stromberg A (1991). "A randomized study of treatment of streptococcal pharyngotonsillitis with cefadroxil or phenoxymethylpenicillin (penicillin V)". Pediatr Infect Dis J 10 (10 Suppl): S68–71. doi:10.1097/00006454-199110001-00015. PMID 1945601.

[43] Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Clin Infect Dis. 38 (11): 1526–1534. doi:10.1086/392496. PMID 15156437.

[44] Pichichero ME (1993). "Cephalosporins are superior to penicillin for treatment of streptococcal-tonsillopharyngitis: is the difference worth it?". Pediatr Infect Dis J. 12 (4): 268–274. doi:10.1097/00006454-199304000-00002. PMID 8483619.

[Casey_JR_1534-45] Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Clin Infect Dis 38 (11): 1526–1534. doi:10.1086/392496. PMID 15156437.

[46] Pichichero ME (1993). "Cephalosporins are superior to penicillin for treatment of streptococcal tonsillopharyngitis: is the difference worth it?". Pediatr Infect Dis J 12 (4): 268–274. doi:10.1097/00006454-199304000-00002. PMID 8483619.

[47] Brook I. Antibacterial therapy for acute group a streptococcal pharyngotonsillitis: short-course versus traditional 10-day oral regimens.Paediatr Drugs.2002;4:747-54.

[48] Casey JR, Pichichero ME (2005). "Meta-analysis of cephalosporins versus penicillin for treatment of Group A streptococcal tonsillopharyngitis in adults". Pediatr Infect Dis J. 24 (10): 909–917. doi:10.1097/01.inf.0000180573.21718.36. PMID 16220091.

[49] Scottish Intercollegiate Guidelines Network. (January 1999). "6.3 Referral Criteria for Tonsillectomy". Management of Sore Throat and Indications for Tonsillectomy. Scottish Intercollegiate Guidelines Network. ISBN 1-899893-66-0. http://www.sign.ac.uk/guidelines/fulltext/34/section6.html. — notes though that these criteria "have been arrived at arbitrarily" from:
Paradise JL, Bluestone CD, Bachman RZ, et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642.

[pmid12093941-50] Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M (2002). "Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children". Pediatrics 110 (1 Pt 1): 7–15. doi:10.1542/peds.110.1.7. PMID 12093941. — this later study by the same team looked at less severely affected children and concluded "modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations"

[pmid15195718-51] Wolfensberger M, Mund MT (2004). "[Evidence based indications for tonsillectomy]" (in German). Ther Umsch 61 (5): 325–8. doi:10.1024/0040-5930.61.5.325. PMID 15195718. — review of literature of the past 25 years concludes "No consensus has yet been reached, however, about the number of annual episodes that justify tonsillectomy"

[pharyngitis-cochrane-52] Del Mar CB, Glasziou PP, Spinks AB (2004). Del Mar, Chris. ed. "Antibiotics for sore throat". Cochrane Database Syst Rev (2): CD000023. doi:10.1002/14651858.CD000023.pub2. PMID 15106140. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000023/frame.html. — Meta-analysis of published research

[pmid11344703-53] Zoch-Zwierz W, Wasilewska A, Biernacka A, et al. (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]" (in Polish). Wiad. Lek. 54 (1–2): 56–63. PMID 11344703.

[54] Ohlsson, A.; Clark, K (September 28 2004). "Antibiotics for sore throat to prevent rheumatic fever: Yes or No? How the Cochrane Library can help". CMAJ 171 (7): 721–3. doi:10.1503/cmaj.1041275. PMC 517851. PMID 15451830. http://www.cmaj.ca/cgi/content/full/171/7/721. — Canadian Medical Association Journal commentary on Cochrane analysis

[55] Danchin, MH; Curtis, N; Nolan, TM; Carapetis, JR (2002). "Treatment of sore throat in light of the Cochrane verdict: is the jury still out?". MJA 177 (9): 512–5. PMID 12405896. http://www.mja.com.au/public/issues/177_09_041102/dan10028_fm.html. — Medical Journal of Australia commentary on Cochrane analysis

[56] Pickering, Larry K., ed. (2006). "Group A streptococcal infections". Red Book: 2006 Report of the Committee on Infectious Diseases (Red Book Report of the Committee on Infectious Diseases). Amer Academy of Pediatrics. ISBN 1-58110-194-5.

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案内

tonsillitis