{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:37:36Z","timestamp":1786120656441,"version":"build-2736575974"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003252","name":"Lund University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003252","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Prim. Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peritonsillitis, including peritonsillar abscess and cellulitis, is a common deep neck infection often considered a complication of pharyngotonsillitis. However, population-based data on patient characteristics, clinical presentation, and care pathways are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population-based registry study in Region Kronoberg, Sweden (2012\u20132016), including all episodes of peritonsillitis and pharyngotonsillitis diagnosed in primary health care (PHC) and hospitals. New episodes were defined as diagnoses separated by \u2265\u200930 days. Patient characteristics, recent pharyngotonsillitis, and referral pathways between PHC and specialist care were described. Incidence rates and temporal trends were estimated to provide population context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 607 peritonsillitis episodes were identified in 555 patients. Incidence peaked in late adolescence and young adulthood, remained low in children and older adults, and showed no sex differences within age groups. Only 23% of episodes were preceded by pharyngotonsillitis within 30 days (median interval: 2 days), increasing to 29% when restricting the analysis to cases confirmed in the ear, nose, and throat (ENT) department. Most patients (74%) were first diagnosed in PHC, and 71% of these were subsequently managed in the ENT department. Overall, 85% of all episodes involved initial PHC management. Incidence of peritonsillitis declined over time in parallel with pharyngotonsillitis at the population level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Peritonsillitis predominantly affects adolescents and young adults and commonly presents without a recent documented sore throat. PHC plays a central role in initial assessment and referral, with most patients subsequently managed in specialist care. These findings provide population-level insights into patient characteristics and care pathways, with implications for early recognition and management in PHC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03486-0","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T23:11:56Z","timestamp":1786057916000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peritonsillitis in primary care: patient characteristics and care pathways \u2013 a population-based registry study"],"prefix":"10.1186","volume":"27","author":[{"given":"Jon","family":"Pallon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Hedin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"3486_CR1","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1007\/s10096-014-2052-8","volume":"33","author":"TE Klug","year":"2014","unstructured":"Klug TE. Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis. 2014;33:1163\u20137.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"3486_CR2","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1080\/00365540802195226","volume":"40","author":"S Risberg","year":"2008","unstructured":"Risberg S, Engfeldt P, Hugosson S. Incidence of peritonsillar abscess and relationship to age and gender: retrospective study. Scand J Infect Dis. 2008;40:792\u20136.","journal-title":"Scand J Infect Dis"},{"key":"3486_CR3","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1080\/00365540802040562","volume":"40","author":"O Sunnergren","year":"2008","unstructured":"Sunnergren O, Swanberg J, Molstad S. Incidence, microbiology and clinical history of peritonsillar abscesses. Scand J Infect Dis. 2008;40:752\u20135.","journal-title":"Scand J Infect Dis"},{"key":"3486_CR4","doi-asserted-by":"publisher","unstructured":"Klug TE, Sorensen TL, Caulley L, Hillerup S. Post-Pandemic shifts in peritonsillar abscess: incidence and microbiological trends following the cessation of COVID-19-related nonpharmaceutical interventions. Infect Dis (Lond). 2025;57(12):1166\u201374. https:\/\/doi.org\/10.1080\/23744235.2025.2539285.","DOI":"10.1080\/23744235.2025.2539285"},{"key":"3486_CR5","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1093\/jac\/dkt128","volume":"68","author":"EL Powell","year":"2013","unstructured":"Powell EL, Powell J, Samuel JR, Wilson JA. A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother. 2013;68:1941\u201350.","journal-title":"J Antimicrob Chemother"},{"key":"3486_CR6","doi-asserted-by":"publisher","unstructured":"Slouka D, Hanakova J, Kostlivy T, Skopek P, Kubec V, Babuska V et al. Epidemiological and microbiological aspects of the peritonsillar abscess. Int J Environ Res Public Health. 2020;17(11):4020. https:\/\/doi.org\/10.3390\/ijerph17114020.","DOI":"10.3390\/ijerph17114020"},{"key":"3486_CR7","doi-asserted-by":"publisher","first-page":"w20404","DOI":"10.4414\/smw.2021.20404","volume":"151","author":"L Helfenberger","year":"2021","unstructured":"Helfenberger L, Fischer R, Giezendanner S, Zeller A. Risk factors for peritonsillar abscess in streptococcus a-negative tonsillitis: a case control study. Swiss Med Wkly. 2021;151:w20404.","journal-title":"Swiss Med Wkly"},{"key":"3486_CR8","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12941-023-00649-0","volume":"22","author":"M Saar","year":"2023","unstructured":"Saar M, Vaikjarv R, Parm U, Kasenomm P, Koljalg S, Sepp E, et al. Unveiling the etiology of peritonsillar abscess using next generation sequencing. Ann Clin Microbiol Antimicrob. 2023;22:98.","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"3486_CR9","doi-asserted-by":"publisher","unstructured":"Bella Z, Erdelyi E, Szalenko-Tokes A, Kiricsi A, Gaal V, Benedek P et al. Peritonsillar abscess: an 8-year retrospective, culture based evaluation of 208 cases. J Med Microbiol. 2022;71(9). https:\/\/doi.org\/10.1099\/jmm.0.001576.","DOI":"10.1099\/jmm.0.001576"},{"key":"3486_CR10","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1007\/s10096-025-05156-y","volume":"44","author":"E Lindberg","year":"2025","unstructured":"Lindberg E, Hermansson A, Nygren D, Gisselsson-Solen M. Association between clinical outcome and microbiological findings in peritonsillar abscess - an observational study. Eur J Clin Microbiol Infect Dis. 2025;44:1925\u201333.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"3486_CR11","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1007\/s10096-012-1573-2","volume":"31","author":"M Rusan","year":"2012","unstructured":"Rusan M, Klug TE, Henriksen JJ, Ellermann-Eriksen S, Fuursted K, Ovesen T. The role of viruses in the pathogenesis of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. 2012;31:2335\u201343.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"3486_CR12","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1177\/0194599816639551","volume":"155","author":"TE Klug","year":"2016","unstructured":"Klug TE, Rusan M, Fuursted K, Ovesen T. Peritonsillar abscess: complication of acute tonsillitis or Weber\u2019s glands infection? Otolaryngol Head Neck Surg. 2016;155:199\u2013207.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"3486_CR13","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.amjoto.2008.12.003","volume":"31","author":"T Marom","year":"2010","unstructured":"Marom T, Cinamon U, Itskoviz D, Roth Y. Changing trends of peritonsillar abscess. Am J Otolaryngol. 2010;31:162\u20137.","journal-title":"Am J Otolaryngol"},{"key":"3486_CR14","first-page":"45","volume":"57","author":"N Dunn","year":"2007","unstructured":"Dunn N, Lane D, Everitt H, Little P. Use of antibiotics for sore throat and incidence of quinsy. Br J Gen Pract. 2007;57:45\u20139.","journal-title":"Br J Gen Pract"},{"issue":"Suppl 1","key":"3486_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1469-0691.2012.03766.x","volume":"18","author":"C Pelucchi","year":"2012","unstructured":"Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18(Suppl 1):1\u201328.","journal-title":"Clin Microbiol Infect"},{"key":"3486_CR16","first-page":"CD000023","volume":"12","author":"A Spinks","year":"2021","unstructured":"Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12:CD000023.","journal-title":"Cochrane Database Syst Rev"},{"key":"3486_CR17","doi-asserted-by":"publisher","first-page":"e016221","DOI":"10.1136\/bmjopen-2017-016221","volume":"7","author":"T Cars","year":"2017","unstructured":"Cars T, Eriksson I, Granath A, Wettermark B, Hellman J, Norman C, et al. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. BMJ Open. 2017;7:e016221.","journal-title":"BMJ Open"},{"key":"3486_CR18","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1177\/0194599811415802","volume":"145","author":"S Kordeluk","year":"2011","unstructured":"Kordeluk S, Novack L, Puterman M, Kraus M, Joshua BZ. Relation between peritonsillar infection and acute tonsillitis: myth or reality? Otolaryngol Head Neck Surg. 2011;145:940\u20135.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"3486_CR19","doi-asserted-by":"publisher","first-page":"3997","DOI":"10.1007\/s00405-017-4738-x","volume":"274","author":"E Kaltiainen","year":"2017","unstructured":"Kaltiainen E, Wiksten J, Aaltonen LM, Ilmarinen T, Hagstrom J, Blomgren K. The presence of minor salivary glands in the peritonsillar space. Eur Arch Otorhinolaryngol. 2017;274:3997\u20134001.","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"3486_CR20","doi-asserted-by":"publisher","first-page":"e0228122","DOI":"10.1371\/journal.pone.0228122","volume":"15","author":"E Sanmark","year":"2020","unstructured":"Sanmark E, Wiksten J, Valimaa H, Aaltonen LM, Ilmarinen T, Blomgren K. Peritonsillar abscess may not always be a complication of acute tonsillitis: a prospective cohort study. PLoS ONE. 2020;15:e0228122.","journal-title":"PLoS ONE"},{"key":"3486_CR21","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1080\/00016489.2022.2026003","volume":"142","author":"N Vanhapiha","year":"2022","unstructured":"Vanhapiha N, Sanmark E, Blomgren K, Wiksten J. Minor salivary gland infection as origin of peritonsillitis - novel theory and preliminary results. Acta Otolaryngol. 2022;142:182\u20136.","journal-title":"Acta Otolaryngol"},{"key":"3486_CR22","first-page":"7443","volume":"26","author":"B Sizer","year":"2022","unstructured":"Sizer B, Deveci E, Demir S, Yorgancilar AE. Weber\u2019s gland immune\/histopathology in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases. Eur Rev Med Pharmacol Sci. 2022;26:7443\u201353.","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"3486_CR23","unstructured":"Statistiska centralbyr\u00e5n (SCB). [Statistics Sweden]. Population statistics [Befolkningsstatistik]. Stockholm: Statistiska centralbyr\u00e5n. 2025. Available from: https:\/\/www.statistikdatabasen.scb.se\/pxweb\/en\/ssd\/START__BE__BE0101__BE0101A\/BefolkningNy\/. Cited 6 Oct 2025."},{"key":"3486_CR24","doi-asserted-by":"crossref","unstructured":"Risberg S, Engfeldt P, Hugosson S, Revonta H, Revol M, Combescure R, Monnier C, Becker Y, Dulguerov M. Peritonsillar abscess and cellulitis and their relation to a positive antigen detection test for streptococcal infection. Scand J Infect Dis N. Diagnosis of peritonsillar abscess-a prospective study comparing clinical with CT findings in 133 consecutive patients. Diagnostics (Basel). 2025;15(2):228.","DOI":"10.3390\/diagnostics15020228"},{"key":"3486_CR25","doi-asserted-by":"publisher","unstructured":"Teppo H, Revonta M. Diagnosis of peritonsillar abscess in primary care. Eur J Gen Pract. 2007;13(3):163-164. https:\/\/doi.org\/10.1080\/13814780701471134.","DOI":"10.1080\/13814780701471134"},{"key":"3486_CR26","doi-asserted-by":"crossref","unstructured":"Voruz F, Revol R, Combescure C, Monnier Y, Becker M, Dulguerov N. Diagnosis of peritonsillar abscess-a prospective study comparing clinical with CT findings in 133 consecutive patients. Diagnostics (Basel). 2025;15(2):228.","DOI":"10.3390\/diagnostics15020228"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-026-03486-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03486-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03486-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:32:19Z","timestamp":1786062739000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12875-026-03486-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3486"],"URL":"https:\/\/doi.org\/10.1186\/s12875-026-03486-0","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"27 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was granted by the Regional Ethics Review Board in Link\u00f6ping, Sweden (2016\/529\u2009\u2212\u200931), and all procedures were performed in accordance with relevant national guidelines and the Declaration of Helsinki. All managers of the participating PHCCs provided their consent for data extraction, which was included in the ethical application. Since the study involved only retrospective and pseudonymized patient data, the Regional Ethics Review Board in Link\u00f6ping waived the requirement for individual informed patient consent. Patient confidentiality was strictly maintained through the use of encrypted identification numbers.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"291"}}