Abscesso peritonsilar: aspectos clínicos e diagnósticos em crianças

Abstract

Introduction: Peritonsillar abscess, a deep infection in the neck, is a collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles. Peritonsillar abscess (PTA) is the most common deep neck infection in children and adolescents, accounting for at least 50% of cases. It occurs most frequently in teenagers and young adults, but also in younger children. Peritonsillar abscesses are often polymicrobial. The predominant bacterial species are: Streptococcus pyogenes (group A streptococcus [GAS]); Streptococcus anginosa; Staphylococcus aureus(including methicillin-resistant S. aureus [MRSA]) and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Objectives: to discuss clinical aspects of peritonsillar abscesses in children. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “peritonsillar abscesses” and “children”. Articles from 2019-2024 (total 71) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Rapid assessment of the degree of upper airway obstruction is the initial step in the evaluation of the patient with a potential peritonsillar abscess (PTA). Patients who are anxious and impatient (leaning forward with their head) and have difficulty breathing should have their airways cleared before evaluation. The typical clinical presentation of PTA is a severe (usually unilateral) sore throat, fever, and hoarseness. Clustering of saliva or drooling may be present. Trismus, related to irritation and reflex spasm of the internal pterygoid muscle, occurs in almost two-thirds of patients; helps distinguish PTA from severe pharyngitis or tonsillitis. Historical characteristics are important in guiding management. Important aspects of the history include frequency and severity of recurrent episodes of infectious pharyngitis, previous episodes of PTA, and snoring or other symptoms of obstructive sleep apnea. The presence of trismus may limit the ability to perform an adequate examination. If drooling is present, suggesting the possibility of epiglottitis, care should be taken not to be aggressive during examination of the oral cavity. If there is doubt about whether the patient has a PTA, epiglottitis, or other infection in the deep neck space, imaging or testing may be necessary in the operating room. Examination in the operating room allows for controlled placement of an artificial airway. Examination findings consistent with PTA include an enlarged and fluctuating amygdala with deviation of the uvula to the opposite side. Alternatively, there may be fullness or protuberance of the posterior soft palate near the tonsil with fluctuation on palpation. Clinical findings are sufficient to establish the diagnosis of PTA in many patients. However, clinical features cannot always distinguish PTA from peritonsillar cellulitis. For patients with a clinical diagnosis of PTA, we strongly prefer ultrasound by an experienced clinician, whenever available, to confirm the presence of an abscess and help guide management decisions. Conclusion: All patients with suspected peritonsillar infection require empirical antibiotic therapy. The choice of medication and treatment route depends on the degree of the disease and local patterns of antibiotic resistance.