Doctoral defence: Risto Vaikjärv “Etiopathogenetic aspects of peritonsillar abscess“

On 28 January at 13:00 Risto Vaikjärv will defend his doctoral thesis “Etiopathogenetic aspects of peritonsillar abscess”. 

Supervisors:
Professor Reet Mändar, University of Tartu
Associate Professor Priit Kasenõmm, University of Tartu
Research Fellow Siiri Kõljalg, University of Tartu
Research Fellow Jelena Štšepetova, University of Tartu

Opponent:
Professor Anne Pitkäranta, University of Helsinki (Finland) 

Summary
Peritonsillar abcess (PTA) is characterized by accumulation of a purulent secretion between the fibrous capsule of the palatine tonsil and the pharyngeal superior constrictor muscle. Treatment for PTA usually consists of opening of abscess and adequate antibacterial therapy. PTA has traditionally been regarded as the complication of acute tonsillitis, but some studies have shown that PTA can develop also from small salivary gland (Webber glands) infection.

The main aim of the present thesis was to evaluate the etiopathogenetic factors, aspects of clinical picture and possible novel ways to treat and prevent peritonsillar abscess. 

A total of 114 patients were studied in two different phases. Risk factors for the development of PTA are scaring and fibrosis of within tonsils and peritonsillar tissue due to previous recurrent inflammations. Smoking and not receiving antibacterial treatment before hospitalization is associated with more acute clinical picture of PTA. Although half of PTA patients fulfill clinical criteria for sepsis, it does not worsen or extend clinical course of PTA. 

We found that tonsillar fossa sample is the best specimen for microbiological analysis using culture method since it has significantly higher yield of pathogenic bacteria than culture of free pus. In case of molecular diagnostics, both pus samples and biopsy samples are suitable. Most common causative agents of PTA tend to be Streptococcus pyogenes, fusobacteria and Streptococcus milleri group. Penicillin alone proves to be the most optimal initial choice for PTA treatment.

PTA is most associated with Streptococcus pyogenes that is also most common causative agent for acute tonsillitis. The polyols like erythritol and xylitol have inhibitory effect against most Streptococcus pyogenes strains and may therefore have potential in preventing PTA and relieving Streptococcus pyogenes throat infection.

The defence will be held in Teams.