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Paratonsillar abscess (paratonsillitis): causes and pathogenesis
Last reviewed: 23.04.2024
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Causes of paratonzillitis
The disease occurs as a result of penetration into the paratonsillar space of a virulent infection in the presence of favorable conditions for spread and development. Streptococcus group A (Streptococcus pyogenes) is most often the causative agent, with the participation of non-pathogenic and opportunistic strains. Similarly, Staphylococcus aureus (Staphylococcus aureus), and, more rarely, Escherichia colli, Haemophilus Influenzae, Klebsiella, yeast fungi of the genus Candida, are often the causative agents of the infection. In recent years, an important role in the development of paratonsillitis of anaerobic infection has been shown, especially in the group of patients who had pathogens with anaerobic properties: Prévotella, Porphyro, Fusobacterium, Peptostreptococcus spp. - the most severe clinical course of the disease was noted. The microorganisms most frequently sown from the abscess cavity (Streptococcus viridans and Klebsiella pneumoniae) were found in a third of cases. In patients whose disease was complicated by diabetes, Klebsiella pneumoniae was detected in more than half of the cases. At the present stage, in two-thirds of all cases of abscesses, strains of beta-lactamase-producing microorganisms were detected.
Pathogenesis of paratonzillitis
In most cases, paratonzillitis develops as a complication of angina, somewhat less often as a regular exacerbation of chronic tonsillitis. The most frequent place of infection from the amygdala into the paratonsillar space is the upper pole of the amygdala. This is due to the fact that the mucous glands of Weber are located outside the capsule of the amygdala in the region of the upper pole, which are involved in inflammation in chronic tonsillitis. Hence the infection can spread directly into the paratonsillar region, which in the upper pole region contains loose fiber more than in other departments. Sometimes in the paratonzillar space in the thickness of the soft palate is located an additional lobe; if it is left with tonsillectomies, then it turns out to be a stained scars, which creates conditions for the development of abscesses here.
There is also a possible odontogenic pathway for the development of paratonsillitis, associated with the carious process of mainly the posterior teeth of the lower jaw (second molars, cubes of wisdom), 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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