Submitted by Dr LAU Chun Wing Arthur, ICU, PYNEH, Hong Kong, on 28 May 2009
Figure. Peritonsillar abscess.
Which of the following is incorrect about the above condition shown on this CT neck?
A. Culture of peritonsillar abscess usually shows a mixture of aerobic and anaerobic organisms, commonly Group A beta haemolytic Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae. Anaerobic organisms including Prevotella, Porphyromonas, Fusobacterium and Peptostreptococcus spp.
B. This condition was first described by Dr Quinsy (昆西醫生) in the early 19th century.
C. Quinsy means "dog strangulation", and because persons suffering from quinsy throw open the mouth like dogs, especially mad dogs, hence the name for this condition.
D. Streptococcus anginosus is a common commensal of the oral cavity and pharyngeal area, and it is also a possible cause of quinsy.
Answer: B
Peritonsillar abscess (扁桃體周膿腫) is a complication of acute tonsillitis. Tonsillitis is inflammation of the pharyngeal tonsils. In peritonsillar abscess, there is pus trapped between the tonsillar capsule and the lateral pharyngeal wall.
Both the clinical discovery and the etymology of "quinsy" can be traced back to the 14th century. From the Webster’s Online Dictionary (1), "The Latin word is cynanchia, and the Greek word kunanché, from kuon anche, dog strangulation, because persons suffering from quinsy throw open the mouth like dogs, especially mad dogs. From kunanche comes kuanchy, kuansy, quinsy." Other sources also give similar information (2,3).
Streptococcus anginosus can be a cause of peritonsillar abscess. To adequately culture the S. milleri group, incubation in air containing carbon dioxide or in an anaerobic condition is required, and then the differentiation of the 3 species (S anginosus, S intermedius, S constellatus) requires the biochemical reactivity tests. A considerable number of this group could be missed among alpha-streptococci isolated from the peritonsillar abscess (3).
昆西醫生 was a doctor specialized in forensic medicine in the US TV programme 神勇法醫官. It was said to be probably the first TV program with a theme on forensic medicine in Hong Kong.
References
1. Webster’s Online Dictionary
2. Wordswarm
3. Merriam-Webster online dictionary
4. Fujiyoshi T, Inaba T, Udaka T, Tanabe T, Yoshida M, Makishima K.[Clinical significance of the Streptococcus milleri group in peritonsillar
abscesses [Article in Japanese]. Nippon Jibiinkoka Gakkai Kaiho. 2001 Sep;104(9):866-71.
5. Otolaryngology Houston: Clinical photos available