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Antibody response to Arcanobacterium haemolyticum infection in humans.

Arcanobacterium haemolyticum causes pharyngitis, exanthema, and other infections. The evidence of the pathogenicity of A. haemolyticum depends on clinical descriptions of culture-positive patients and a comparison of carrier rates of patients with pharyngitis and healthy, matched controls. In this investigation, the antibody response of the host was studied for the first time, using SDS-PAGE and Western blot analyses. Paired acute and convalescent sera showed development of antibodies to A. haemolyticum in 7 of 8 patients. The antibodies reacted primarily with four distinct cell wall-associated proteins with estimated molecular masses of 80, 60, 50, and 30 kDa. Moreover, the reactivity of convalescent sera from 19 patients was compared with that of sera from 19 controls. Antibodies to A. haemolyticum were found in sera from 16 patients and 6 controls (P < .005); the antibody response of the patients was strong compared with that of the controls. These results indicate that A. haemolyticum infection induces an antibody response in the host.

Acute Disease↗

The hazards of oral sex.

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AIDS-Related Opportunistic Infections↗

The management of peritonsillar sepsis by needle aspiration.

172 consecutive patients admitted with suspected unilateral peritonsillar sepsis were studied. Needle aspiration of the peritonsillar space was performed, and they were all then treated with intravenous antibiotics (usually benzylpenicillin). Any pus obtained was cultured. The aspiration was repeated if the patient was not improving after 24 h. A quantity of pus was aspirated at the first attempt from 91 patients (53%); 82 of these required no further aspiration but 7 required a further single aspiration and 2 required a further 2 aspirations before resolution of the sepsis. 71 of the 81 patients (88%) from whom pus had not been aspirated, and who were therefore initially considered to have peritonsillar cellulitis, required no further aspirations. However, 6 subsequently drained pus spontaneously and 4 produced a positive aspirate on a second occasion. Four patients required a change in their antibiotic therapy. We have found the combination of needle aspiration and parenteral antibiotics to be an effective treatment of peritonsillar sepsis. All patients were spared the unpleasant and painful experience of an incision and drainage procedure.

Adolescent↗

Is a single quinsy an indication for tonsillectomy?

There has recently been some discussion on whether a single quinsy is an indication for tonsillectomy. This paper presents a retrospective study of 36 patients who presented with a quinsy over the past 37 years but did not have interval tonsillectomy. Prolonged follow-up shows that the rate of recurrence of a quinsy can double compared to the recurrence rate under 5 years. Despite this it remains relatively low and an uncomplicated quinsy does not warrant tonsillectomy.

Adolescent↗

Penicillin for acute sore throat in children: randomised, double blind trial.

OBJECTIVE: To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: 43 family practices in the Netherlands. PARTICIPANTS: 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate). Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days. MAIN OUTCOME MEASURES: Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months. RESULTS: Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela. CONCLUSION: Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.

Acute Disease↗

Descending necrotising mediastinitis.

Descending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to this high mortality, but awareness of such a complication and early diagnosis using computed tomographic scanning leads to prompt surgical drainage, proper antibiotic therapy, and survival.

Adult↗

Alkaline phosphatase activity in the human tonsils and its relation to tonsillar diseases.

Alkaline phosphatase activity was examined in the human tonsils in fetal life and after repeated attacks of acute tonsillitis and in quinsy. Gomori's metal precipitate technique was used to demonstrate the phosphatase activity using four different substrates: sodium beta-glycerophosphate and adenosine triphosphate at pH 9, riboflavin 5-phosphate at pH 9.2 and 5-monophosphoric acid at pH 8.3. (2) The phosphatase activity differs somewhat according to the phosphate ester used as a substrate illustrating an example of 'substrate specificity'. (3) Alkaline phosphatase activity was increased in the case of both acute and chronic inflammation. This increase has been discussed in relation to such phenomena as transformation of lymphocytes into macrophages and antibody formation.

Acute Disease↗