Adenoiditis classification: Difference between revisions

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== Overview: ==
== Overview: ==
Adenoiditis can be classified into acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.<ref name="urlHead & Neck Surgery--otolaryngology - Google Books">{{cite web |url=https://books.google.com/books/about/Head_Neck_Surgery_otolaryngology.html?id=mFlV1-v_eVwC |title=Head & Neck Surgery--otolaryngology - Google Books |format= |work= |accessdate=}}</ref>
Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.<ref name="urlHead & Neck Surgery--otolaryngology - Google Books">{{cite web |url=https://books.google.com/books/about/Head_Neck_Surgery_otolaryngology.html?id=mFlV1-v_eVwC |title=Head & Neck Surgery--otolaryngology - Google Books |format= |work= |accessdate=}}</ref> Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.


== Classification ==
== Classification ==
Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.<ref name="urlHead & Neck Surgery--otolaryngology - Google Books" /> Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.
* {| class="wikitable" ! ! |- |Acute adenoiditis |Acute onset of symptoms<ref name="pmid12117336">{{cite journal |vauthors=Havas T, Lowinger D |title=Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy |journal=Arch. Otolaryngol. Head Neck Surg. |volume=128 |issue=7 |pages=789–91 |year=2002 |pmid=12117336 |doi= |url=}}</ref> |- |Recurrent acute adenoiditis |It is defined by presence of at least 4 or more episodes of acute adenoiditis within a 6 months period<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> |- |Chronic/persistent adenoiditis |
* Persistent adenoiditis for more than 6 months
* Presence of comlications |}
{| class="wikitable"
! colspan="2" |
!Pathogen
!Clinical features
!Treatment
|-
| colspan="2" rowspan="8" |Viral adenoiditis<ref name="pmid21377220">{{cite journal| author=Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H| title=Is there any correlation between allergy and adenotonsillar tissue hypertrophy? | journal=Int J Pediatr Otorhinolaryngol | year= 2011 | volume= 75 | issue= 4 | pages= 589-91 | pmid=21377220 | doi=10.1016/j.ijporl.2011.01.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377220  }}</ref><ref name="pmid22870291">{{cite journal| author=Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L et al.| title=High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42136 | pmid=22870291 | doi=10.1371/journal.pone.0042136 | pmc=3411673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22870291  }}</ref><ref name="pmid11249975">{{cite journal |vauthors=Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE, Vassallo J |title=Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=58 |issue=1 |pages=9–15 |year=2001 |pmid=11249975 |doi= |url=}}</ref>
|[[Epstein Barr virus|Epstein-barr virus]] (EBV)
|
* Asymptomatic
** In small children, the course of the disease is frequently asymptomatic. Majority of adults infected with ''mono'' also remain asymptomatic with serological evidence of past infection.
* Initial Prodrome
** Common symptoms include: low-grade [[fever]] without chills is seen in nearly all cases, [[Sore throat]], white patches on the tonsils and back of the throat are often seen, [[Muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], particularly the posterior [[cervical lymph nodes]] are involved
|Treating symptoms and complications of the infection
|-
|[[Adeno virus|Human adenovirus]]
|
* Common cold syndrome, [[Pneumonia]], [[Croup]], [[Bronchitis]]
|Treating symptoms and complications of the infection
|-
|[[Enterovirus]]
|
* Mild respiratory illness ([[common cold]]), [[Hand, foot and mouth disease]], acute [[hemorrhagic]] [[conjunctivitis]], [[Aseptic meningitis]], [[Myocarditis|myocarditis,]] severe [[neonatal]] [[sepsis]]-like disease, acute [[flaccid paralysis]].<sup>[[Enterovirus|[2]]]</sup>
|Treating symptoms and complications of the infection
|-
|[[Rhinovirus]]
|
* [[Pharyngitis|Sore throat]], [[Rhinitis|runny nose]], [[nasal congestion]], [[Sneeze|sneezing]] and [[cough]]; sometimes accompanied by [[Myalgia|muscle aches]], [[Fatigue (medical)|fatigue]], [[malaise]], [[headache]], [[muscle weakness]], or [[Anorexia (symptom)|loss of appetite]].
|[[Interferon]]-alpha
[[Pleconaril]]
|-
|[[Respiratory syncytial virus]]
|
* [[Bronchiolitis]] (inflammation of the small airways in the lung) and [[pneumonia]] in children under 1 year of age
Recurrent wheezing and [[asthma]]
|Treating symptoms and complications of the infection.
[[Ribavirin]]
|-
|[[Cytomegalovirus]]
|
* Common symptoms include: Low-grade [[fever]] without chills is seen in nearly all cases, [[Sore throat]]: white patches on the tonsils and back of the throat are often seen, [[Muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], particularly the posterior [[cervical lymph nodes]] are involved
* Other symptoms that have been described in patients with [[EBV|EBV infection]] include: unable to swallow due to [[Tonsils|enlarged tonsils]], [[Cough|dry cough]], [[Loss of appetite]], [[Anorexia]], [[Nausea]] without [[vomiting]], [[Abdominal pain]]- a possible symptom of a potentially fatal rupture of the spleen<sup>[[Mononucleosis history and symptoms|[1]]]</sup> and [[diarrhea]]
|Treating symptoms and complications of the infection
|-
|[[Herpes virus]]
|
* Watery [[Blister|blisters]] in the [[skin]] or [[mucous membranes]] (such as the mouth or lips) or on the [[Genital|genitals]].<sup>[[Herpes simplex virus|[1]]]</sup>
|Acyclovir
Valacyclovir
Famcyclovir
|-
|[[Cytomegalovirus|Cytomegalovirus (CMV)]]
|
* [[Mononucleosis]] like presentation
* [[Retinitis]]<nowiki/>presents with [[blurred vision]] and [[floaters]]. [[Colitis]] presents with [[abdominal pain]] and [[bloody diarrhea]]
* [[Pneumonitis]]
|Ganciclovir
[[Foscarnet]]


=== Acute adenoiditis ===
[[Cidofovir]]
<ref name="pmid12117336">{{cite journal |vauthors=Havas T, Lowinger D |title=Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy |journal=Arch. Otolaryngol. Head Neck Surg. |volume=128 |issue=7 |pages=789–91 |year=2002 |pmid=12117336 |doi= |url=}}</ref>
|-
| rowspan="7" |bacterial adenoiditis
| rowspan="5" |Acute <ref name="pmid9804015">{{cite journal |vauthors=Lilja M, Räisänen S, Stenfors LE |title=Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=45 |issue=1 |pages=15–20 |year=1998 |pmid=9804015 |doi= |url=}}</ref><ref name="pmid7991612">{{cite journal |vauthors=Wessels MR, Bronze MS |title=Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=91 |issue=25 |pages=12238–42 |year=1994 |pmid=7991612 |pmc=45412 |doi= |url=}}</ref><ref name="Cunningham2000">{{cite journal|last1=Cunningham|first1=M. W.|title=Pathogenesis of Group A Streptococcal Infections|journal=Clinical Microbiology Reviews|volume=13|issue=3|year=2000|pages=470–511|issn=0893-8512|doi=10.1128/CMR.13.3.470-511.2000}}</ref><ref name="pmid4564883">{{cite journal |vauthors=Ellen RP, Gibbons RJ |title=M protein-associated adherence of Streptococcus pyogenes to epithelial surfaces: prerequisite for virulence |journal=Infect. Immun. |volume=5 |issue=5 |pages=826–30 |year=1972 |pmid=4564883 |pmc=422446 |doi= |url=}}</ref>
|[[Haemophilus influenzae]]
|
* [[Bacteremia]], and acute bacterial [[meningitis]]. Occasionally, it causes [[cellulitis]], [[osteomyelitis]], [[epiglottitis]], and joint infections


=== Recurrent acute adenoiditis ===
* [[Otitis media]] and [[conjunctivitis]]
* It is defined by presence of at least 4 or more episodes of acute adenoiditis within a 6 months period.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>


=== Chronic/persistent adenoiditis ===
* [[Sinusitis]]
* Persistent adenoiditis for more than 6 months
 
* Presence of comlications
* [[Pneumonia]]
| rowspan="5" |Beta lactamase inhibitor antibiotics
|-
|[[Streptococcus|Group A β-hemolytic streptococcus]]
|
* [[Strep throat]], acute [[rheumatic fever]], [[scarlet fever]], acute [[glomerulonephritis]] and [[necrotizing fasciitis]]
* [[Rheumatic fever]]
|-
|[[Staphylococcus aureus]]
|
* [[Atopic dermatitis]]
* [[Toxic shock syndrome]]
|-
|[[Moraxella catarrhalis]]
|
* Otitis media and sinusitis, tracheobronchitis and [[pneumonia]]
|-
|[[Streptococcus pneumoniae]]
|
* Pneumonia, sinusitis, otitis media, endocarditis
|-
|Recurrent<ref name="pmid21377220" /><ref name="Cunningham2000" />
| rowspan="2" |Usually due to normal flora pathogens:
*[[Staphylococcus aureus]]
*[[Streptococcus|Group A β-hemolytic streptococcus]]
| rowspan="2" |
* Nasal [[airway obstruction]], [[Snoring]], [[sleep apnea]], oral breathing, sore or dry throat from breathing through the mouth, [[Rhinorrhea|purulent rhinorrhea]], nasal obstruction, fever, ear pain, [[Headache]], [[Sore throat]]
| rowspan="2" |[[Angioedema|Antihistamines]]
[[Angioedema|Cosrticosteroids]]
 
[[Angioedema|Decongestants]]
|-
|Chronic <ref name="pmid17136878">{{cite journal| author=Akcay A, Tamay Z, Dağdeviren E, Guler N, Ones U, Kara CO et al.| title=Childhood asthma and its relationship with tonsillar tissue. | journal=Asian Pac J Allergy Immunol | year= 2006 | volume= 24 | issue= 2-3 | pages= 129-34 | pmid=17136878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17136878  }}</ref><ref name="Cunningham2000" />
|-
| colspan="2" |[[Parasitic disease|Parasitic adenoiditis]]
|''[[Toxoplasma gondii]]''
|
* Symptoms are often [[influenza]]-like: Cervical lymphadenopathy, sore throat, muscle aches and pains that last for a month or more, fever, malaise, night sweats
|[[Pyrimethamine]]
[[Sulfadiazine]]
 
[[Leucovorin]] ([[Folinic acid]])
|-
| colspan="2" rowspan="3" |Non-infectious adenoiditis<ref name="pmid21377220" /><ref name="pmid17136878" /><ref name="pmid22870291" />
|Allergies
|
* Allergic [[sinusitis]]
* Redness and [[Itch|itching]] of the [[conjunctiva]] (allergic conjunctivitis)
* Sneezing, coughing, [[bronchoconstriction]], [[Wheeze|wheezing]] and [[dyspnea]], sometimes outright attacks of [[asthma]], in severe cases the airway constricts due to swelling known as [[angioedema]]
|
|-
|[[Asthma]]
|
* [[Cough]] with or without [[sputum]] ([[phlegm]]) production, pulling in of the skin between the ribs when breathing (intercostal retractions), [[Shortness of breath]] that gets worse with [[Exercise induced asthma|exercise or activity]], [[wheezing]]
|[[LABA|Fast-acting bronchodilators]] ''([[LABA]])''
[[SABA|Short-acting selective beta<sub>2</sub>-adrenoceptor agonists]]
 
[[Asthma anticholinergic therapy|Anticholinergic medications]]
|-
|[[GERD]]
|
* [[Heartburn]], [[esophagitis]]''',''' [[Stenosis|strictures]], difficulty swallowing ([[dysphagia]]), [[vomiting]], effortless spitting up, [[coughing]], and other respiratory problems
|Lifestyle Modifications
[[Proton pump inhibitor]]s
 
[[Antacid]]s
 
[[Alginic acid]] ([[Gaviscon]])
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 12:30, 15 June 2017

Adenoiditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview:

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.[1] Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

Classification

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.[1] Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

  • {| class="wikitable" ! ! |- |Acute adenoiditis |Acute onset of symptoms[2] |- |Recurrent acute adenoiditis |It is defined by presence of at least 4 or more episodes of acute adenoiditis within a 6 months period[3] |- |Chronic/persistent adenoiditis |
  • Persistent adenoiditis for more than 6 months
  • Presence of comlications |}
Pathogen Clinical features Treatment
Viral adenoiditis[4][5][6] Epstein-barr virus (EBV)
  • Asymptomatic
    • In small children, the course of the disease is frequently asymptomatic. Majority of adults infected with mono also remain asymptomatic with serological evidence of past infection.
Treating symptoms and complications of the infection
Human adenovirus Treating symptoms and complications of the infection
Enterovirus Treating symptoms and complications of the infection
Rhinovirus Interferon-alpha

Pleconaril

Respiratory syncytial virus
  • Bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under 1 year of age

Recurrent wheezing and asthma

Treating symptoms and complications of the infection.

Ribavirin

Cytomegalovirus Treating symptoms and complications of the infection
Herpes virus Acyclovir

Valacyclovir

Famcyclovir

Cytomegalovirus (CMV) Ganciclovir

Foscarnet

Cidofovir

bacterial adenoiditis Acute [7][8][9][10] Haemophilus influenzae Beta lactamase inhibitor antibiotics
Group A β-hemolytic streptococcus
Staphylococcus aureus
Moraxella catarrhalis
  • Otitis media and sinusitis, tracheobronchitis and pneumonia
Streptococcus pneumoniae
  • Pneumonia, sinusitis, otitis media, endocarditis
Recurrent[4][9] Usually due to normal flora pathogens: Antihistamines

Cosrticosteroids

Decongestants

Chronic [11][9]
Parasitic adenoiditis Toxoplasma gondii
  • Symptoms are often influenza-like: Cervical lymphadenopathy, sore throat, muscle aches and pains that last for a month or more, fever, malaise, night sweats
Pyrimethamine

Sulfadiazine

Leucovorin (Folinic acid)

Non-infectious adenoiditis[4][11][5] Allergies
Asthma Fast-acting bronchodilators (LABA)

Short-acting selective beta2-adrenoceptor agonists

Anticholinergic medications

GERD Lifestyle Modifications

Proton pump inhibitors

Antacids

Alginic acid (Gaviscon)

References

  1. 1.0 1.1 "Head & Neck Surgery--otolaryngology - Google Books".
  2. Havas T, Lowinger D (2002). "Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy". Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.
  3. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  4. 4.0 4.1 4.2 Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H (2011). "Is there any correlation between allergy and adenotonsillar tissue hypertrophy?". Int J Pediatr Otorhinolaryngol. 75 (4): 589–91. doi:10.1016/j.ijporl.2011.01.026. PMID 21377220.
  5. 5.0 5.1 Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L; et al. (2012). "High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease". PLoS One. 7 (8): e42136. doi:10.1371/journal.pone.0042136. PMC 3411673. PMID 22870291.
  6. Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE, Vassallo J (2001). "Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis". Int. J. Pediatr. Otorhinolaryngol. 58 (1): 9–15. PMID 11249975.
  7. Lilja M, Räisänen S, Stenfors LE (1998). "Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes". Int. J. Pediatr. Otorhinolaryngol. 45 (1): 15–20. PMID 9804015.
  8. Wessels MR, Bronze MS (1994). "Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice". Proc. Natl. Acad. Sci. U.S.A. 91 (25): 12238–42. PMC 45412. PMID 7991612.
  9. 9.0 9.1 9.2 Cunningham, M. W. (2000). "Pathogenesis of Group A Streptococcal Infections". Clinical Microbiology Reviews. 13 (3): 470–511. doi:10.1128/CMR.13.3.470-511.2000. ISSN 0893-8512.
  10. Ellen RP, Gibbons RJ (1972). "M protein-associated adherence of Streptococcus pyogenes to epithelial surfaces: prerequisite for virulence". Infect. Immun. 5 (5): 826–30. PMC 422446. PMID 4564883.
  11. 11.0 11.1 Akcay A, Tamay Z, Dağdeviren E, Guler N, Ones U, Kara CO; et al. (2006). "Childhood asthma and its relationship with tonsillar tissue". Asian Pac J Allergy Immunol. 24 (2–3): 129–34. PMID 17136878.