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Paratonsillar abscess (paratonsillitis) - Causes and pathogenesis
Last reviewed: 04.07.2025
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Causes of paratonsillitis
The disease occurs as a result of penetration of a virulent infection into the paratonsillar space in the presence of favorable conditions for spread and development. The causative agent is most often group A streptococci (Streptococcus pyogenes), while non-pathogenic and opportunistic strains may participate. Staphylococcus aureus is approximately as common a causative agent of infection, and somewhat less often Escherichia colli, Haemophilus Influenzae, Klebsiella, and yeast fungi of the genus Candida. In recent years, an important role of anaerobic infection in the development of paratonsillitis has been shown, and it was in the group of patients in whom pathogens with anaerobic properties were isolated: Prеvotella, Porphyro, Fusobacterium, Peptostreptococcus spp. - that the most severe clinical course of the disease was noted. The most frequently isolated microorganisms from the abscess cavity (Streptococcus viridans and Klebsiella pneumoniae) were detected in a third of cases. In patients whose disease was complicated by diabetes mellitus, Klebsiella pneumoniae was detected in more than half of the cases. At the present stage, strains of beta-lactamase-producing microorganisms were detected in two thirds of all abscess cases.
Pathogenesis of paratonsillitis
In most cases, paratonsillitis develops as a complication of angina, and somewhat less often as another exacerbation of chronic tonsillitis. The most common site of infection penetration from the tonsil into the paratonsillar space is the upper pole of the tonsil. This is due to the fact that in the area of the upper pole, outside the capsule of the tonsil, there are Weber's mucous glands, which are involved in inflammation in chronic tonsillitis. From here, the infection can spread directly to the paratonsillar region, which in the area of the upper pole contains more loose tissue than in other areas. Sometimes in the paratonsillar space, in the thickness of the soft palate, there is an additional lobule; if it is left during tonsillectomy, it turns out to be walled up by scars, which creates conditions for the development of abscesses here.
An odontogenic path of development of paratonsillitis is also possible, associated with the carious process mainly of the posterior teeth of the lower jaw (second molars, wisdom cubes), periostitis of the alveolar process. In this case, the infection spreads through the lymphatic vessels directly to the paratonsillar tissue, bypassing the palatine tonsils.
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