Vincent's angina

Vincent's angina (also termed Plaut-Vincent's angina),[1][2] is pharyngitis (inflammation of the pharynx) and tonsillitis (inflammation of the palatine tonsils), caused by infection with two types of bacteria called fusiform (Fusobacterium species)[3] and spirochaetes (Borrelia species[3] and Spirillum species).[4] This symbiosis of bacteria is sometimes termed a "fusospirochaetal" infection.

Naming and confusion with Vincent's gingivitis

It is named after Jean Hyacinthe Vincent, a French physician who was working at the Paris Pasteur Institute. Vincent described a fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis",[5] which later became known as Vincent's angina. Later in 1904, Vincent described the same pathogenic organisms in "ulceronecrotic gingivitis".

As a result, Vincent's angina is widely confused with necrotizing ulcerative gingivitis (previously also called "Vincent's gingivitis"), however the former is tonsillitis and pharyngitis,[6] and the latter involves the gums, and usually the two conditions occur in isolation from each other. The term "angina" is derived from a Latin word which means "to choke" or " to throttle." However, this condition should not be confused with the modern usage of the term angina ("angina pectoris"), which refers to chest pain caused by insufficient blood supply to the muscles of the heart. Many publications using the term "Vincent's angina" date from the twentieth century, and the term is not so common in modern times.

Symptoms

Symptoms of Vincent's angina were reported as:[7]

  • Normal or increased temperature
  • Headaches
  • Chilly sensations,
  • Generalized malaise (fatigue),
  • Lymphadenopathy (enlargement of submaxillary and cervical lymph glands),
  • Tenderness and severe pain when talking or swallowing (odynophagia),
  • Halitosis (bad breath)

If the gums are also involved, symptoms of necrotizing ulcerative gingivitis, such as painful gums may also be present.

The tonsils show single or multiple greyish-white ulcers, usually on only one of the palatine tonsils. The ulcers appear surrounded by reddened area and they bleed when touched or when the pseudo membrane is removed.[7] Ulceration may extend onto the soft palate.[7]

Diagnosis

Differential diagnosis is with follicular (lacunar) tonsillitis, diphtheria, syphilis and acute leukemia.[7] One of the risk factors for Vincent's angina is immunocompromise.[4]

Alternative definitions

Different types of Vincent's angina were sometimes defined, such as pseudomembraneous,[8] or acute / subacute / chronic / recurrent.[7]

References
  1. Rodríguez-Rodríguez, M; Rodríguez-Rosell, V; Rodríguez-Asensio, J (March 2020). "[Unilateral tonsillitis: Plaut-Vincent angina]". Semergen. 46 (2): e9–e10. doi:10.1016/j.semerg.2019.07.004. PMID 31387816. S2CID 201186466.
  2. Biswas, D; Stafford, N (June 2010). "Borrelia tonsillitis: common symptoms but uncommon organism". European Archives of Oto-Rhino-Laryngology. 267 (6): 989–90. doi:10.1007/s00405-010-1229-8. PMID 20237790. S2CID 11494853.
  3. Díez2007, O; Batista, N; Bordes, A; Lecuona, M; Lara, M (June 2007). "[Microbiological diagnosis of upper respiratory tract infections]". Enfermedades Infecciosas y Microbiologia Clinica. 25 (6): 387–93. doi:10.1157/13106964. PMC 7130232. PMID 17583652.
  4. Ito, A; Watanabe, K (2015). "Vincent's angina". Internal Medicine (Tokyo, Japan). 54 (20): 2707. doi:10.2169/internalmedicine.54.5074. PMID 26466716.
  5. 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. PMC 2017821. PMID 19979715.
  6. DeGowin, EL (1981). Bedside diagnostic examination (4th ed.). New York: Macmillan. ISBN 9780023280306.
  7. Popov, NP (February 1946). "Vincent's Angina-Some Diagnostic Pitfalls". California and Western Medicine. 64 (2): 83. PMC 1473790. PMID 18747222.
  8. Progressive Medicine: A Quarterly Digest of Advances, Discoveries, and Improvements in the Medical and Surgical Sciences. (1927). United States: Lea & Febiger.
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