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"documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Acta Otorrinolaringol Esp. 2011;62:385-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2616 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 1861 "PDF" => 715 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Vestibular Examination of Children With Alterations in Balance (II): Results by Pathologies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "391" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exploración vestibular de niños con alteraciones del equilibrio (II): resultados por enfermedades" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz González del Pino, Paola Femia, Nicolás Pérez-Fernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "González del Pino" ] 1 => array:2 [ "nombre" => "Paola" "apellidos" => "Femia" ] 2 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Pérez-Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651911000112" "doi" => "10.1016/j.otorri.2011.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651911000112?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000536?idApp=UINPBA00004N" "url" => "/21735735/0000006200000005/v1_201304231502/S2173573511000536/v1_201304231502/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173573511000706" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2011.05.001" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "aid" => "299" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2011;62:375-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3208 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 2460 "PDF" => 693 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Temporal Paragangliomas. A 12-Year Experience" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "375" "paginaFinal" => "380" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paragangliomas temporales. Experiencia de 12 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 710 "Ancho" => 950 "Tamanyo" => 209841 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">During an infratemporal approach in a patient with Fisch type C2 right jugulotympanic paraganglioma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ángel Ramos Macías, Jorge Bueno Yanes, Pilar Bolaños Hernández, Isidoro Lisner Contreras, Ángel Osorio Acosta, Mario Vicente Barrero, María Luisa Zaballos González" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Ángel" "apellidos" => "Ramos Macías" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Bueno Yanes" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "Bolaños Hernández" ] 3 => array:2 [ "nombre" => "Isidoro" "apellidos" => "Lisner Contreras" ] 4 => array:2 [ "nombre" => "Ángel" "apellidos" => "Osorio Acosta" ] 5 => array:2 [ "nombre" => "Mario" "apellidos" => "Vicente Barrero" ] 6 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Zaballos González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000165191100121X" "doi" => "10.1016/j.otorri.2011.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000165191100121X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000706?idApp=UINPBA00004N" "url" => "/21735735/0000006200000005/v1_201304231502/S2173573511000706/v1_201304231502/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief communication</span>" "titulo" => "<span class="elsevierStyleItalic">Yersinia enterocolitica</span> Tonsillitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "384" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Javier García-Callejo, Paula Minguell-González, Veronique Benavent-Corai, Nuria Santonja-López, Noelia Muñoz-Fernández, Jaime Marco-Algarra" "autores" => array:6 [ 0 => array:4 [ "nombre" => "F. Javier" "apellidos" => "García-Callejo" "email" => array:1 [ 0 => "jgarciacall@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Minguell-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Veronique" "apellidos" => "Benavent-Corai" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Nuria" "apellidos" => "Santonja-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Noelia" "apellidos" => "Muñoz-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Jaime" "apellidos" => "Marco-Algarra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Familiar y Comunitaria, Área de de Salud 5, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Amigdalitis por <span class="elsevierStyleItalic">Yersinia enterocolitica</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tonsillitis and its local complications are common in human beings because the tonsils represent the first barrier against entry of antimicrobial agents through the upper respiratory tract and their histological structure allows direct contact between lymphocyte tissue and antigen. The result is an inflammatory process with oedema, hyperaemia, congestion, suppuration and chemotaxis, almost independently of the invading microorganism.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Under the clinical suspicion of bacterial infection, an empirical antibiotic treatment is usually effective in treating symptoms. However, the characteristics of some agents make them particularly resistant to this therapeutic approach.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present a series of 5 cases with common clinical and epidemiological circumstances that led to the clinical suspicion of tonsillar infection by <span class="elsevierStyleItalic">Yersinia enterocolitica</span>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">Since 1999, we have treated 5 patients for acute tonsillitis in an unusual context. All attended the Emergency Service under conventional antibiotic treatment, with significant illness and fever syndrome resistant to antipyretic measures. All presented dysphagia with odynophagia, pharyngolalic voice, drooling without trismus (except for one case), dry irritant cough and bilateral cervical lymphadenitis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patients were admitted and subjected to analytical batteries in peripheral blood, pharyngeal exudate sampling and intravenous antibiotic treatment. In 2 cases, histopathological tonsil samples were obtained under local anaesthesia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of our patients. All subjects were middle-aged, and all were in almost continuous contact with animals, particularly pigs.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Two patients presented bilateral pultaceous palatine tonsillitis and 1 of them presented spontaneous emission of blood through a tonsil for 48<span class="elsevierStyleHsp" style=""></span>h. A third patient attended the service with a properly drained peritonsillar abscess. The remaining 2 were unilateral, non-ulcerating-necrotising episodes. Cervical palpation detected bilateral reactive lymphadenopathies of up to 25<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The tonsils were hyperplastic and hyperaemic in all cases, with no surrounding oedema even in the case of abscesses.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The antibiograms of the pharyngeal exudate and pus were ineffective. We used mainly penicillins, cephalosporins and metronidazole.The chest X-ray studies and Mantoux tests were negative.The biopsy of tonsillar tissue obtained under local anaesthesia in one case resulted definitive.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Peripheral blood contained leukocytosis of up to 22<span class="elsevierStyleHsp" style=""></span>000/mm<span class="elsevierStyleSup">3</span> with neutrophilia between 77% and 91%. There was a sharp rise in acute phase reactants, negative for heterophile antibodies.The lack of response to treatment led to tonsillectomy in 5 cases. There was relative clinical improvement, with samples being referred to Pathological Anatomy. Reports were obtained in 4 cases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The report of the specimens was hyperplastic lymphoid tissue, containing multiple clusters of granulomatous nodules, consisting of histiocytic cells, giant cells and numerous neutrophils in central location. From the histopathological point of view, we carried out a differential diagnosis of yersiniosis, cat scratch disease and sequelae of venereal lymphogranuloma. Samples of tonsillar nucleus tissue sent to the Microbiology Service confirmed the growth of <span class="elsevierStyleItalic">Y. enterocolitica</span>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Signs and symptoms disappeared between 5 and 10<span class="elsevierStyleHsp" style=""></span>days after tonsillectomy in all cases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Y. enterocolitica</span> is a Gram negative coccoid member of the <span class="elsevierStyleItalic">Enterobacteriacea</span> family, which is immobile at 37<span class="elsevierStyleHsp" style=""></span>°C but mobile at 25<span class="elsevierStyleHsp" style=""></span>°C by peritrich flagella. It is an asporogenous agent that grows well in ordinary media.</p><p id="par0090" class="elsevierStylePara elsevierViewall">It is a facultative anaerobe, oxidase negative and catalase positive, which ferments glucose and sucrose with acid production. It produces a thermostable enterotoxin, similar to that of <span class="elsevierStyleItalic">E. coli</span>, within the intestinal epithelial cells. A total of 34 O antigens and 20 H antigens are known for it, which determine the various serotypes and may cause some cross-reactions with <span class="elsevierStyleItalic">Brucella</span> and <span class="elsevierStyleItalic">Salmonella</span>. The most abundant serotypes in Europe are O3 and O9.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In children, it causes an acute adenitis similar to appendicitis and terminal ileitis with diarrhoea. In adults, it may precede episodes of arthritis, septicaemia, and erythema nodosum. Although urinary tract infections and conjunctivitis have been described, the most common manifestation is enterocolitis with fever and abdominal pain, which can last up to 3<span class="elsevierStyleHsp" style=""></span>weeks.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The infection is acquired through the mouth and the bacterium multiplies in Peyer's patches, from where it can spread to the rest of the intestine. It is resistant to β-lactam antibiotics and, to a lesser extent, to tetracyclines, chloramphenicol and aminoglycosides, although enterocolitis is generally treated only symptomatically.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Access through foodstuffs is not exceptional and in the UK, in 1989, it exceeded food poisoning cases by <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Bacillus</span> spp. However, almost all food isolates are due to environmental strains. <span class="elsevierStyleItalic">Y. enterocolitica</span> can be isolated in soil, water, milk, poultry, fish, the intestines of small animals and especially in pork meat.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Documentation is sparse with regard to pharyngotonsillar involvement. Outbreaks of yersiniosis appear more related to faecal-oral transmission than to direct person-to-person contact. Its pathogenesis is determined by adhesins and invasins, proteins encoded by plasmids. Cherchi describes a case of tonsillitis from <span class="elsevierStyleItalic">Y. enterocolitica</span> in a thalassemic child and in another healthy patient within a group of 100 control subjects.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">It is recognised that pigs are the reservoir of <span class="elsevierStyleItalic">Y. enterocolitica</span>.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Although the original source is identified, transmission control is impractical since it requires the systematic evisceration of the animals. However, a significant decrease in the transmission of yersiniosis has been demonstrated through the removal of the tongue and tonsils.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus, bacterial risk varies with food preferences.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The affinity of <span class="elsevierStyleItalic">Y. enterocolitica</span> for lymphatic tissue is extraordinary and its adherence to intestinal Peyer's patches is very high. At the top of the latter, there are M cells that transport macromolecules and microorganisms from the intestinal lumen into the patches by pinocytosis, with the antigen accessing the lymphoid tissue. In childhood, these patches show a predominance of T cells in 80%. M cells partially inactivate the bacteria. Neighbouring macrophages process their antigens and present them to T cells to produce cytokines, which promote the mechanisms of intestinal inflammation.</p><p id="par0120" class="elsevierStylePara elsevierViewall">This action is carried out due to the synthesis of plasmid invasins, especially Ail (attachment invasion locus) and Yada (<span class="elsevierStyleItalic">Yersinia</span> adhesion).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The intestinal epithelium possesses integrins, which are β1 chain receptors for these invasins. Generally, intestinal integrins are of β4 chains and are not adhesive, but at 37<span class="elsevierStyleHsp" style=""></span>°C and with a pH less than 7, the integrins become strong recruiters of <span class="elsevierStyleItalic">Y. enterocolitica</span>.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This acidification of focal pH enhances highly reactive Peyer's patches in individuals younger than 14<span class="elsevierStyleHsp" style=""></span>years.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The bacterial plasmid also produces <span class="elsevierStyleItalic">Yersinia</span> outer proteins (Yops). These are highly virulent proteins if they access lymphatic tissue adhered to <span class="elsevierStyleItalic">Yersinia</span>, although they do not generate any effect whatsoever when exogenously injected into cell cultures. Yops have protein kinase activity, transducing signals from the host cell and altering their ability to attract antigen-presenting cells and phagocytes.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> This culminates in aggressive oxidative stress of their lysosomal content, with complete consumption of antioxidant titres, enhancing tonsillar damage.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Furthermore, Yops inhibit platelet aggregability and cytokine release from this source, so the defence mechanisms of the tonsil are overridden. The focal clinical expression is a hyperplastic palatine tonsil, hyperaemic, suppurative and without oedematous reactions in its vicinity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Additionally, YadA invasin shows a strong resistance to the bactericidal reaction of serum, inducible at 37<span class="elsevierStyleHsp" style=""></span>°C, degrading the C3b complement factor and cancelling its cascade.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Lastly, there is evidence that iron in the host enhances the virulence of <span class="elsevierStyleItalic">Y. enterocolitica</span> through its accessibility. This is done by generating a siderophore known as yersiniabactin, a protein of 482 D capable of sustaining a weak but consistent binding with iron of ferritin, transferrin and lactoferrin in the subject.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">These powers of adhesion, interference to phagocytosis and resistance to the bactericidal action of serum are enhanced by <span class="elsevierStyleItalic">Y. enterocolitica</span> in Peyer's patches based on proximity to M cells. Tonsillar yersiniosis seems to be more related to sustained contact of the agent with a surrounding environment of the patient's aerodigestive tract, because the bacteria present mucoid fimbriae−Myf (mucoid <span class="elsevierStyleItalic">Yersinia</span> factor) and PsaA (pH 6 antigen adhesin)−which predispose them towards the formation of tonsillar phagosomes in situations of pH 5–6.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Changes in the pH of the tonsillar area are not generally sudden unless there is a previous infectious trigger or a repetition of bacterial contact with the subject. It seems evident that an environment contaminated by <span class="elsevierStyleItalic">Y. enterocolitica</span> predisposes the tonsils towards its incubation. These environments are relatively rare and are restricted to stocks of pigs. An anamnesis directed in this regard and the finding of unusual tonsillitis−inflammatory asymmetries, unilateral tonsillitis, abscesses−with torpid response to conventional antibiotic therapy, should lead diagnostic suspicion towards this agent.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Serological diagnosis is difficult due to the variability of serotypes, but enterobacteria are easy to isolate in simple culture media, such as MacConkey or peptone water with 5% salt, unless an antibiotic protocol has been previously initiated. This is common and delays filiation of the case. Capacity for serum autoagglutination at 37<span class="elsevierStyleHsp" style=""></span>°C and for Congo red stain uptake of infected histological samples should guide the process. However, the limitation in bacterial isolates and the fact that antibiotic sensitivity requires unusual chemotherapeutic agents, such as aminoglycosides or chloramphenicol, make tonsillectomy advisable in the previously discussed epidemiological circumstances.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres94824" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec81977" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94825" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec81976" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-14" "fechaAceptado" => "2011-01-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec81977" "palabras" => array:3 [ 0 => "Tonsillitis" 1 => "<span class="elsevierStyleItalic">Yersinia</span>" 2 => "Infection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec81976" "palabras" => array:3 [ 0 => "Amigdalitis" 1 => "<span class="elsevierStyleItalic">Yersinia</span>" 2 => "Infección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present five cases of tonsillitis secondary to <span class="elsevierStyleItalic">Yersinia enterocolitica</span>. No response to commonly used antibiotics and continuous professional contact with pigs were common. The definitive diagnosis was established by bacteriological isolation on tonsil tissue samples.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos los casos de cinco pacientes con infección amigdalar debida a <span class="elsevierStyleItalic">Yersinia enterocolitica</span>. Fue común la ausencia de respuesta a antibióticos de empleo habitual y el contacto habitual con suidos. El diagnóstico definitivo se estableció por aislamientos microbiológicos de muestras histológicas amigdalares.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: García-Callejo FJ, et al. Amigdalitis por <span class="elsevierStyleItalic">Yersinia enterocolitica</span>. Acta Otorrinolaringol Esp. 2011;62:381–4.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; Fbg: fibrinogen; YE: <span class="elsevierStyleItalic">Yersinia enterocolitica</span>.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender/age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Relationship \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Farmer-shepherd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shepherd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abattoir worker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Veterinary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Veterinary \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute hemorrhagic tonsillitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peritonsillar abscess (chocolate-like pus) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral pultaceous tonsillitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute mebrano-pultaceous tonsillitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral membranous tonsillitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evolution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25<span class="elsevierStyleHsp" style=""></span>days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18<span class="elsevierStyleHsp" style=""></span>days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35<span class="elsevierStyleHsp" style=""></span>days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15<span class="elsevierStyleHsp" style=""></span>days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tonsillitis history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–3/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exudate study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus</span> spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus viridans</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AmoxicillinPenicillin VClarithromycinCefuroxime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AmoxicillinCo-amoxiclavErythromycinClindamycinMetronidazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Co-amoxiclavMetronidazoleCeftriaxoneLevofloxacinVancomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Co-amoxiclavCefuroximeClindamycinVancomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Co-amoxiclavClindamycinMetronidazoleCeftriaxoneCiprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute phase reactants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 87<span class="elsevierStyleHsp" style=""></span>mmFbg 6.32<span class="elsevierStyleHsp" style=""></span>g/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 55<span class="elsevierStyleHsp" style=""></span>mmFbg 6.9<span class="elsevierStyleHsp" style=""></span>g/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 62<span class="elsevierStyleHsp" style=""></span>mmCRP 73<span class="elsevierStyleHsp" style=""></span>mg/lFbg 8.1<span class="elsevierStyleHsp" style=""></span>g/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 87<span class="elsevierStyleHsp" style=""></span>mmCRP 188<span class="elsevierStyleHsp" style=""></span>mg/lFbg 7.4<span class="elsevierStyleHsp" style=""></span>g/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 111<span class="elsevierStyleHsp" style=""></span>mmCRP 265<span class="elsevierStyleHsp" style=""></span>mg/lFbg 8.4<span class="elsevierStyleHsp" style=""></span>g/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoculture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not done \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not done \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive for <span class="elsevierStyleItalic">Yersinia</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolation of YE in biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolation of YE in biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolation of YE in tonsil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolation of YE in tonsil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolation of YE in tonsil \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179647.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiological Characteristics of Patients Attended.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => 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