Quinsy (Peritonsillar Abscess)
Quinsy, also known as a peritonsillar abscess, is the most common type of deep neck infection, characterised by a collection of pus in the peritonsillar space and is usually a suppurative complication of acute tonsillitis.
This updated UKMLA guide to quinsy is based on ENT UK and NHS Scotland, which covers causes, symptoms, complications, diagnosis, and management.
Causes
Quinsy usually develops as a suppurative complication of acute tonsillitis [Ref]
- Acute tonsillitis → peritonsillar cellulitis → peritonsillar abscess
Causative agent: [Ref]
- Quinsy is caused by a polymicrobial mixture of aerobic and anaerobic bacteria
- Most common aerobes: Group A streptococcus and Streptococci viridans
- Most common anaerobes: Fusobacterium necrophorum
Clinical Features
| Symptoms | Signs |
|---|---|
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Complications
Acute complications include: [Ref]
- Airway obstruction
- Abscess rupture → aspiration pneumonitis or lung abscess
- Extension of infection into the deep tissues of the neck or superior mediastinum
- Erosion or septic necrosis into the carotid sheath → life-threatening haemorrhage
Investigation and Diagnosis
Quinsy is primarily a clinical diagnosis.
Imaging (CT / MRI) is necessary if there is suspected spread beyond the peritonsillar space or the presence of complications involving the lateral neck space
Management
Quinsy should be managed in the hospital:
- Discuss with ENT on-call
- Supportive care (analgesia, IV fluids)
- IV antibiotics
- 1st line: IV benzylpenicillin
- Penicillin allergy: IV clarithromycin
- Abscess drainage
- Needle aspiration, or incision and drainage
- Only cases with small abscesses (<1cm) without muffled voice, drooling or trismus may not require drainage