I have just had a peritonsillar abscess drained. The pus was sent to the lab for a diagnosis. The doctor feels that the cause may be staph bacteria. How could this bacteria have gotten into my throat? I work in a residential treatment facility for juvenile delinquents and wonder if this environment could have led to the infection.

L.

Most folks do not know what a peritonsillar abscess is. Having experienced one, I suspect you wish you did not know either! Here's a word of explanation for those who are blessedly ignorant of the condition.

The space between the tonsil and the muscular wall of the throat is known as the peritonsillar space. If there is a bacterial infection of the tonsils, this infection can spread to the peritonsillar space and create an abscess (a collection of pus). The symptoms of peritonsillar abscess are severe sore throat, inability to open the jaws due to pain, pain with swallowing (indeed, the patient may be unable to swallow his or her saliva), and a "hot-potato voice" caused by trying to avoid moving the tongue when speaking. If a doctor looks into your throat, he or she will see a tonsil that has been pushed to the center of the oral cavity because of the swelling behind the tonsil.

Treatment of peritonsillar abscess is a little controversial. You probably had the classic "incision and drainage," in which the doctor lances the abscess in order to drain the pus. This is painful but, in trained hands, it is reasonably safe and provides rapid relief. I prefer to treat peritonsillar abscesses in this manner. Some doctors aspirate the abscess (push a needle into the abscess to draw out pus), and there are probably a few brave souls who treat these abscesses only with antibiotics. At the other end of the aggressiveness spectrum, some doctors perform a tonsillectomy in order to drain the abscess. Regardless of the treatment, it is important that the patient gets antibiotics, pain medication, and fluids, since dehydration is common.

I cannot say whether you acquired the infection at work or not. Some species of staph bacteria are normal inhabitants of the oral cavity, and some are not. However, we are all exposed to countless disease-causing microorganisms on a daily basis. We touch them, drink them, eat them and bathe in them. Usually these so-called "pathogens" are unable to get a foothold. When such bacteria manage to establish themselves well enough to multiply and inflame or destroy tissues, we recognize this as an infection.

So the question, really, is not "How did this bacteria get into my throat," but "Why did I get this infection at this time?" The answer to this question involves the topic of host defenses. "Host" means you. "Defenses" include your body's immune system, but there are other critically important defenses. For example, your skin and mucus membranes are, arguably, far more important than your immune system for preventing infection!

Something impaired your host defenses so that this staph was able to have a little "kegger" behind your tonsil. Perhaps your peritonsillar abscess was preceded by a viral respiratory tract infection. The common cold occasionally segues into more serious illnesses, presumably by lowering host defenses; perhaps the immune system is a bit worn out by its previous battle, or perhaps the cold virus injures the mucus membranes, damaging their ability to act as a barrier to infection.

In addition to infection, all sorts of things may alter host defenses. Trauma (for example, a burn or cut) damages the physical barriers to infection. Other factors that are thought to impair host defenses are malnutrition, vitamin deficiency, cigarette smoke (direct or secondhand), alcohol, noxious fumes (even smog) and emotional and physical stress.