Vincent's angina: Difference between revisions
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==Background== | ==Background== | ||
*Fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis"<ref>Taylor, FE; McKinstry, WH (1917). "The Relation of Peri-dental Gingivitis to Vincent's Angina." Proceedings of the Royal Society of Medicine. 10 (Laryngol Sect): 43–8. </ref> | *Fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous [[pharyngitis]] and tonsillitis"<ref>Taylor, FE; McKinstry, WH (1917). "The Relation of Peri-dental Gingivitis to Vincent's Angina." Proceedings of the Royal Society of Medicine. 10 (Laryngol Sect): 43–8. </ref> | ||
*Same pathogenic organisms as [[acute necrotizing ulcerative gingivitis]] | *Same pathogenic organisms as [[acute necrotizing ulcerative gingivitis]] | ||
*Vincent's angina is sometimes confused with ANUG, but the former is tonsillitis and pharyngitis, and the latter involves the gums | *Vincent's angina is sometimes confused with ANUG, but the former is tonsillitis and pharyngitis, and the latter involves the gums | ||
==Clinical Features<ref>Marx, J. A., Hockberger, R. S., Walls, R. M., & Adams, J. (2002). Rosen's emergency medicine: Concepts and clinical practice. St. Louis: Mosby.</ref>== | ==Clinical Features<ref>Marx, J. A., Hockberger, R. S., Walls, R. M., & Adams, J. (2002). Rosen's emergency medicine: Concepts and clinical practice. St. Louis: Mosby.</ref>== | ||
*Superficial ulceration and necrosis of the tonsils and pharynx that often | *Superficial ulceration and necrosis of the tonsils and pharynx that often results in formation of a pseudomembrane | ||
*Foul smelling breath | *Foul smelling breath | ||
*Odynophagia | *Odynophagia | ||
*Submandibular lymphadenopathy | *Submandibular [[lymphadenopathy]] | ||
*Exudate | *Exudate | ||
*Patietns typically have poor oral hygiene | *Patietns typically have poor oral hygiene | ||
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==Management== | ==Management== | ||
*Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema | *Organisms involved are polymycrobial but often include [[Fusobacterium necrophorum]], [[Treponema|Treponema pallidum]], Selenomonas, and Prevotella | ||
===Uncomplicated Disease=== | ===Uncomplicated Disease=== | ||
Revision as of 21:06, 11 August 2017
Background
- Fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis"[1]
- Same pathogenic organisms as acute necrotizing ulcerative gingivitis
- Vincent's angina is sometimes confused with ANUG, but the former is tonsillitis and pharyngitis, and the latter involves the gums
Clinical Features[2]
- Superficial ulceration and necrosis of the tonsils and pharynx that often results in formation of a pseudomembrane
- Foul smelling breath
- Odynophagia
- Submandibular lymphadenopathy
- Exudate
- Patietns typically have poor oral hygiene
Differential Diagnosis
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [3]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
Evaluation
- Diagnosis based on clinical findings and gram stain
Management
- Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema pallidum, Selenomonas, and Prevotella
Uncomplicated Disease
- Amoxicillin 250mg 3 x daily for 7 days AND/OR
- Metronidazole 250mg 3 x daily for 7 days[4]
Complicated Disease
- Penicillin V 500mg PO q6 hours PLUS metronidazole 500mg PO q8 hours x 10 days OR
- Amoxicillin 500mg PO TID PLUS metronidazole 250mg PO TID for 10d OR
- Amoxicillin-clavulanate 500mg/125mg PO TID or 875mg/125mg PO BID for 10d OR
- Clindamycin 150-300mg PO TID for 10d OR
- Doxycycline 100mg PO BID for 10d[5]
Disposition
See Also
External Links
References
- ↑ Taylor, FE; McKinstry, WH (1917). "The Relation of Peri-dental Gingivitis to Vincent's Angina." Proceedings of the Royal Society of Medicine. 10 (Laryngol Sect): 43–8.
- ↑ Marx, J. A., Hockberger, R. S., Walls, R. M., & Adams, J. (2002). Rosen's emergency medicine: Concepts and clinical practice. St. Louis: Mosby.
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
- ↑ Atout R. N. et al. Managing Patients with Necrotizing Ulcerative Gingivitis. J Can Dent Assoc 2013;79:d46. http://www.jcda.ca/article/d46. Accessed April 2015
- ↑ Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015