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Efficacy of early dental and ENT therapy in preventing nephropathy in pediatric Henoch-Schönlein purpura.
- Source :
-
Clinical rheumatology [Clin Rheumatol] 2008 Dec; Vol. 27 (12), pp. 1489-96. Date of Electronic Publication: 2008 Jul 24. - Publication Year :
- 2008
-
Abstract
- In a previous study, we demonstrated the benefit of tonsillectomy for early recovery from Henoch-Schönlein purpura (HSP) nephritis (HSPN), suggesting the pathological role of tonsils in HSP (Inoue et al., Clin Nephrol 67:298-305, 2007). In this study, we evaluated the efficacy of extensive eradication of infectious foci directly connected to the tonsils, including those involved in oral as well as ear, nose, and throat (ENT) diseases, in reducing the nephropathy in HSP. For this purpose, we examined the focal points of infection in 40 newly diagnosed HSP patients. After these focal points of infection had been identified, they were extensively eradicated; when the clinical course was intractable, we also considered tonsillectomy. After administering such therapy to HSP patients, we prospectively followed them up for 0.6 to 8 years. The identified focal infections included dental caries in 28 (70%), apical periodontitis in 21 (53%), rhinosinusitis in 19 (48%), tonsillitis in five (13%), and otitis media in four (10%) of the 40 patients. Seventeen patients (43%) had more than two simultaneous infectious foci, whereas, in five (13%), no infectious focus was found. In 32 patients, antimicrobial treatment with concurrent dental and/or ENT therapy resulted in a complete cure without development of HSPN or recurrent attacks. In eight patients, we performed tonsillectomy-adenotonsillectomy to treat their clinical symptoms, including aggravated purpura and recurrent attacks of HSP or HSPN. All patients were completely cured. The overall incidence of HSPN was only three out of the 40 patients (8%). Oral and ENT diseases were found with high percentages in HSP patients. Early and extensive treatment for these lesions and tonsillectomy-adenotonsillectomy for intractable cases may prevent the complication of HSPN, contributing to the early curing of HSP.
- Subjects :
- Adolescent
Child
Child, Preschool
Dental Caries complications
Dental Caries drug therapy
Female
Follow-Up Studies
Humans
IgA Vasculitis complications
Male
Nephritis etiology
Periapical Periodontitis complications
Periapical Periodontitis drug therapy
Rhinitis complications
Rhinitis drug therapy
Sinusitis complications
Sinusitis drug therapy
Anti-Bacterial Agents therapeutic use
IgA Vasculitis drug therapy
IgA Vasculitis surgery
Nephritis prevention & control
Tonsillectomy
Subjects
Details
- Language :
- English
- ISSN :
- 1434-9949
- Volume :
- 27
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Clinical rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 18651102
- Full Text :
- https://doi.org/10.1007/s10067-008-0954-5