The Medical Consumer's Advocate

Peritonsillar abscess

 

Q: I have just had a peritonsillar abscess drained. The pus was sent to the lab for a diagnosis. The doctor feels that the cause may be a staph bacteria. How could this bacteria have gotten into my throat?

 

A: Most folks out there do not know what a peritonsillar abscess is; having experienced one, I suspect you wish you did not know what it is! Here’s a word of explanation for those who are blessedly ignorant of the condition.

The space between the tonsil and the muscular wall of the throat is known as the peritonsillar space. If there is a bacterial infection of the tonsils, this infection can spread to the peritonsillar space and create an abscess (a collection of white blood cells and bacteria, living and dead– pus, in other words.) The symptoms of peritonsillar abscess are: severe sore throat, pain with swallowing (indeed, the patient may be unable to swallow his/her own saliva), a "hot potato" voice, and inability to open the jaws due to pain. If a doctor looks into your throat, he/she will see a tonsil that has been pushed to the center of the oral cavity by swelling behind the tonsil.

Treatment of peritonsillar abscess is a little controversial; you probably had the classic "incision and drainage," in which the doctor lances the abscess in order to drain the pus. This is a painful procedure but, in trained hands, it is reasonably safe and provides rapid relief. I prefer to treat peritonsillar abscesses in this manner. Some doctors aspirate the abscess (push a needle into the abscess and suck out some pus), and there are probably a few brave souls who treat these abscesses only with antibiotics. At the other end of the aggressiveness spectrum, some doctors perform a tonsillectomy in order to drain the abscess. Regardless of the treatment employed, it is important to treat the patient with appropriate antibiotics, pain medication, and aggressive rehydration (since most patients have had little to eat or drink in the preceding day or two, and most patients also have fever, dehydration is common.)

On to your question. I cannot say whether you acquired the infection at work or not. Some species of Staph are normal inhabitants of the oral cavity, some are not. Bacteria and other micro-organisms capable of causing disease are known as pathogens. Usually pathogens are unable to get a foothold. When such bacteria manage to establish themselves well enough to multiply and inflame or destroy tissues, we recognize this as an infection.

We are exposed to countless pathogens on a daily basis; we touch them, drink them, eat them and bathe in them. The question, really, is not "how did this bacteria get into my throat," but, "why did I get this infection at this time?" The answer to this question involves the topic of host defenses. "Host" means you (life’s a party, you’re the host, and infection is when a bunch of really obnoxious bacteria crash the party.) "Defenses" include the immune system, but there are other defenses that are critically important. For example, your skin and mucus membranes are, arguably, far more important than your immune system for preventing infection!

Now for the hocus pocus. Continuing the party analogy, something impaired your host defenses so that this Staph was able to have a little kegger behind your tonsil. Perhaps your peritonsillar abscess was preceded by a viral respiratory tract infection (the common cold, in other words.) The common cold occasionally segues into more serious illnesses (such as sinusitis, bronchitis, or even pneumonia), presumably by lowering host defenses. Perhaps the immune system is a bit worn out by its previous battle, or perhaps the cold virus injures the mucus membranes, damaging their ability to act as a barrier to infection.

All sorts of things are thought to alter host defenses. As suggested in the previous paragraph, antecedent infection and chronic infection can lower host defenses. Trauma (e.g., a burn or laceration) damages the physical barriers to infection. Other factors that are thought to impair host defenses are: malnutrition, vitamin deficiency, cigarette smoke (direct or secondhand), alcohol, noxious fumes (even smog), and emotional and physical stress.

 

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