Bacterial smears of mucopurulent material aspirated1 from diseased tonsils frequently show considerable numbers of fusospirochetal organisms, while smears made from swabs of the same tonsils reveal only insignificant numbers of these organisms. What constitutes a significant number of these organisms is somewhat uncertain. The usual textbook picture of Vincent's angina calls for the presence of the organisms in predominant numbers in smears of material from tonsils presenting ulceration and membrane formation. I believe these diagnostic criteria are too exclusive, as I have encountered a great number of cases of follicular tonsillitis in which fusospirochetal organisms seemed to be the most important etiologic agent. Field,2 likewise, observed that "milder [fusospirochetal] infections than those manifested by ulceration and membrane may occur." This author also commented that "grades of [fusospirochetal] infection in the throat and lungs, less severe than the usual textbook picture, are relatively frequent, and they are commonly not correctly diagnosed."
LEWIS JF. FUSOSPIROCHETAL ORGANISMS AND TONSILLITIS: BISMUTH THERAPY OF TONSILLITIS. Arch Otolaryngol. 1942;35(4):587–594. doi:10.1001/archotol.1942.00670010592006
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