Vincent's angina: Difference between revisions
(Created page with "==Background== *Fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis"<ref>Taylor, FE; McKinstry, WH (1917). "T...") |
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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> | [[File:Gray1014.png|thumb|Anatomy of the posterior pharynx.]] | ||
*Same pathogenic organisms as [[acute necrotizing ulcerative gingivitis]] | *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> | ||
*Vincent's angina is sometimes confused with ANUG, but the former is tonsillitis and pharyngitis, and the latter involves the gums | *Same pathogenic organisms as [[acute necrotizing ulcerative gingivitis]] (ANUG) | ||
*Vincent's angina is sometimes confused with [[ANUG]], but the former is tonsillitis and pharyngitis, and the latter involves the gums | |||
==Clinical Features== | ==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 | [[File:Vincent angina right.jpg|thumb|Pseudomembrane of right tonsil.]] | ||
*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 | ||
* | *Patients typically have poor oral hygiene | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Sore throat DDX}} | {{Sore throat DDX}} | ||
{{Dental Problems DDX}} | |||
{{DDX oral rashes and lesions}} | {{DDX oral rashes and lesions}} | ||
| Line 20: | Line 23: | ||
==Management== | ==Management== | ||
*Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema | *Organisms involved are polymycrobial but often include [[Fusobacterium necrophorum]], [[Treponema pallidum|Treponema]], Selenomonas, and Prevotella | ||
===Uncomplicated Disease=== | ===Uncomplicated Disease=== | ||
*[[Amoxicillin]] 250mg 3 x daily for 7 days '''AND/OR''' | |||
*[[Metronidazole]] 250mg 3 x daily for 7 days<ref>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</ref> | |||
===Complicated Disease=== | ===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<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref> | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
| Line 42: | Line 44: | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Latest revision as of 13:50, 11 December 2021
Background
- Fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis"[1]
- Same pathogenic organisms as acute necrotizing ulcerative gingivitis (ANUG)
- 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
- Patients 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
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
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, 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