Adenoiditis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview:

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis. Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

Classification

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis. Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

Adenoiditis classification based on durtion of symptoms

Subtypes	Duration of symptoms
Acute adenoiditis	Acute onset of symptoms
Recurrent acute adenoiditis	At least 4 or more episodes of acute adenoiditis within a 6 months period
Chronic/persistent adenoiditis	Persistent adenoiditis for more than 6 months Presence of complications

Adenoiditis classification based on the responsible pathogen and coexisting conditions

		Pathogen	Clinical features	Treatment
Viral adenoiditis		Epstein-barr virus (EBV)	Asymptomatic In small children, the course of the disease is frequently asymptomatic. Majority of adults infected with mono also remain asymptomatic with serological evidence of past infection. Initial Prodrome Common symptoms include: low-grade fever without chills is seen in nearly all cases, Sore throat, white patches on the tonsils and back of the throat are often seen, Muscle weakness and sometime extreme fatigue, tender lymphadenopathy, particularly the posterior cervical lymph nodes are involved	Treating symptoms and complications of the infection
		Human adenovirus	Common cold syndrome, Pneumonia, Croup, Bronchitis	Treating symptoms and complications of the infection
		Enterovirus	Mild respiratory illness (common cold), Hand, foot and mouth disease, acute hemorrhagic conjunctivitis, Aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, acute flaccid paralysis.[2]	Treating symptoms and complications of the infection
		Rhinovirus	Sore throat, runny nose, nasal congestion, sneezing and cough; sometimes accompanied by muscle aches, fatigue, malaise, headache, muscle weakness, or loss of appetite.	Interferon-alpha Pleconaril
		Respiratory syncytial virus	Bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under 1 year of age Recurrent wheezing and asthma	Treating symptoms and complications of the infection Ribavirin
		Cytomegalovirus	Common symptoms include: Low-grade fever without chills is seen in nearly all cases, Sore throat: white patches on the tonsils and back of the throat are often seen, Muscle weakness and sometime extreme fatigue, tender lymphadenopathy, particularly the posterior cervical lymph nodes are involved Other symptoms that have been described in patients with EBV infection include: unable to swallow due to enlarged tonsils, dry cough, Loss of appetite, Anorexia, Nausea without vomiting, Abdominal pain- a possible symptom of a potentially fatal rupture of the spleen[1] and diarrhea	Treating symptoms and complications of the infection
		Herpes virus	Watery blisters in the skin or mucous membranes (such as the mouth or lips) or on the genitals.[1]	Acyclovir Valacyclovir Famcyclovir
		Cytomegalovirus (CMV)	Mononucleosis like presentation Retinitispresents with blurred vision and floaters. Colitis presents with abdominal pain and bloody diarrhea, Pneumonitis	Ganciclovir Foscarnet Cidofovir
Bacterial adenoiditis	Acute	Haemophilus influenzae	Bacteremia, and acute bacterial meningitis. Occasionally, it causes cellulitis, osteomyelitis, epiglottitis, and joint infections, Otitis media and conjunctivitis, Sinusitis, Pneumonia	Beta lactamase inhibitor antibiotics
		Group A β-hemolytic streptococcus	Strep throat, acute rheumatic fever, scarlet fever, acute glomerulonephritis and necrotizing fasciitis Rheumatic fever
		Staphylococcus aureus	Atopic dermatitis Toxic shock syndrome
		Moraxella catarrhalis	Otitis media and sinusitis, tracheobronchitis and pneumonia
		Streptococcus pneumoniae	Pneumonia, sinusitis, otitis media, endocarditis
	Recurrent	Usually due to normal flora pathogens: Staphylococcus aureus Group A β-hemolytic streptococcus	Nasal airway obstruction, Snoring, sleep apnea, oral breathing, sore or dry throat from breathing through the mouth, purulent rhinorrhea, nasal obstruction, fever, ear pain, Headache, Sore throat	Antihistamines Cosrticosteroids Decongestants
	Chronic
Parasitic adenoiditis		Toxoplasma gondii	Symptoms are often influenza-like: Cervical lymphadenopathy, sore throat, muscle aches and pains that last for a month or more, fever, malaise, night sweats	Pyrimethamine Sulfadiazine Leucovorin (Folinic acid)
Non-infectious adenoiditis		Allergies	Allergic sinusitis Redness and itching of the conjunctiva (allergic conjunctivitis) Sneezing, coughing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as angioedema	Antihistamines
		Asthma	Cough with or without sputum (phlegm) production, pulling in of the skin between the ribs when breathing (intercostal retractions), Shortness of breath that gets worse with exercise or activity, wheezing	Fast-acting bronchodilators (LABA) Short-acting selective beta2-adrenoceptor agonists Anticholinergic medications
		GERD	Heartburn, esophagitis, strictures, difficulty swallowing (dysphagia), vomiting, effortless spitting up, coughing, and other respiratory problems	Lifestyle Modifications Proton pump inhibitors Antacids Alginic acid (Gaviscon)