Adenoiditis

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

Adenoid is a lymphoid tissue that forms the Waldeyer ring. Adenoiditis is the inflammation of adenoid tissue. Adenoid infection is mostly due to viral infections. Some bacterial pathogens including H. influenzae, group A β-hemolytic streptococcus, and S. aureus can cause the disease as well. Adenoids can cause recurrent sinusitis and chronic persistent or recurrent otitis if left untreated and can lead to chronic adenoiditis. Medications (antibiotics or steroids) or surgical approach may be required for the management of adenoiditis, depending on the causative agent.

Adenoid was thought to be a part of tonsils and responsible for the symptoms of nasal congestion and obstruction. As a result adenotonsilectomy was performed for at least 2000 years. In the early beginning of 19th century, adenoid and tonsil tissue were known as remnants of an unknown infectious disease, and so they were removed with adenotonsilectomy. Willhelm Meyer of Copenhagen, Denmark in 1800 firstly describe adenoiditis due to adenoid vegetations responsible for nasal symptoms and impaired hearing. He probably was the first one who performed an adenoidectomy separately.

Adenoiditis can be classified into the following types including acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.^[1]

Adenoids are involved in the production of mostly secretory IgA. IgA is transported to the surface providing local immune protection. Studies suggest that a reduction in IgA will occur after an adenoidectomy.^[2] bacteria in the normal flora of the oral cavity, are found in adenoid tissue as well. These include alpha-hemolytic streptococci, enterococci, Corynebacterium species, Coagulase-negative staphylococci, Neisseria species, haemophilus species, micrococcus species, stomatococcus species. Adenoiditis can occur as a result of infection. They can harbor pathogenic bacteria, which may lead to the development of disease of the ears, nose, and sinuses. Adenoiditis can progress to chronic disease if it remains untreated for a long period of time.

Acute adenoiditis is mainly due to viral infection but bacterial infections can cause the disease as well. Bacterial infections have a more important role in recurrent and chronic adenoiditis. The most important viral causes of adenoiditis include EBV, CMV and RSV. The most important bacterial causes adenoiditis include Haemophilus influenzae, group A β-hemolytic streptococcus, and staphylococcus aureus.^[3]

Diagnosis of adenoiditis can be challenging as majority of upper respiratory tract infections present in the same pattern. The most important differential diagnosis of adenoiditis includes tonsilitis, viral upper respiratory tract infection, sinusitis and pharyngitis.

The prevalence of adenoiditis is not completely known. Research indicates that 15-30% of sore throats in children and 5-10% sore throats in adults are due to bacterial adenotonsillitis. The prevalence of adenoiditis decreases with age. Adenoid tissue undergoes atrophy after 10 years of age, so adenoiditis is rarely seen after 15 years.^{[4][5][6][7][8]}

The most potent risk factor in the development of adenoiditis is being a young child. Other risk factors include immunodeficiencies, living in an urban environment with more exposure to viruses or bacteria and usage of immunosuppressant drugs.

There is insufficient evidence to recommend routine screening for adenoiditis.

Acute adenoiditis will usually present with erythema and edema of the adenoids. This occurs rapidly upon infiltration of the adenoids by the pathogen.^[9] Symptoms including fever and sore throat will usually manifest within 24 hours of infection. Adenoiditis is usually combined with tonsillitis due to close anatomical location.

Complications of adenoiditis are caused by persistence and/or spread of the responsible pathogen – usually bacterial. The complications of adenoiditis include speech abnormalities, otitis media, acute sinusitis, pneumonia, adenoid hyperplasia, peritonsillar abscess, and sleep apnea.

The prognosis for acute adenoiditis without treatment is usually good. Adenoiditis is usually a self-limiting disease and resolves by itself within 3-4 days.^[10]

There is no criteria for the diagnosis of adenoiditis. However, seeing inflamed and hypertrophied adenoid tissue with flexible or rigid nasopharyngoscopy can be used as a criteria for adenoidectomy in patients suspected of chronic adenoiditis.

A positive history of fever, nasal obstruction, and snoring is suggestive of adenoiditis. The most common symptoms of adenoiditis include purulent nasal discharge, mouth breathing, nasal pain and sore throat.^[11][12][13]

Patients with adenoiditis are usually well-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharge.^[14][15][16]

Laboratory findings consistent with the diagnosis of adenoiditis include neutrophilia, positive culture for organism from throat exam sampling, and positive blood culture for the organism in severe cases.^[17]

On lateral neck x-ray, adenoiditis is characterized by enlargement of adenoids and narrowing of airways. Adenoiditis diagnosis can be confirmed if during flexible or rigid nasopharyngoscopy inflamed adenoid tissue is seen. Flexible or rigid nasopharyngoscopy can provide a direct visualization of nasopharynx and Waldeyer ring so that the inflamed adenoid tissue can be seen too.^[18]

The mainstay of therapy for adenoiditis is symptomatic therapy. Medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include amoxicillin – clavulanic acid or cephalosporin.

Surgery is not the first-line treatment option for patients with adenoiditis. Adenoidectomy is usually reserved for patients with chronic persistent adenoiditis who developed adenoid hypertrophy. Adenoidectomy has shown to be effective independent of the size of the adenoids.^[19]

Primary prevention strategies to prevent adenoiditis include hygienic practices.

Secondary prevention involves usage of antibiotics to prevent recurrence of adenoiditis. It can be helpful in certain circumstances like history of rheumatic fever, to prevent pharyngitis cause by group A beta-hemolytic streptococci.^[20]

• Tonsilitis

adenoids can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection.adenoids can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection.

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

Adenoiditis was first discovered by Willhelm Meyer in 1800. Adenoids were thought to be a part of tonsills and adenotonsillectomy has been performed for at least 2000 years.

• Cornelius Caesus in A.D 30. explained that tonsils are covered by a membrane and require to be separated and extracted by a process called tonsillectomy. This encyclopedia was recovered in 1478 in Papal library, after being lost for 1400 years.^[1]
• Adenoids were thought to be a part of tonsills and responsible for the symptoms of nasal congestion and obstruction. As a result adenotonsillectomy has been performed for at least 2000 years.^[1]
• In the sixth and seventh centuries Aetius and Paul described surgical treatment of adenotonsillitis, as one of the most ancient surgical procedures.
• In the early beginning of 19th century, adenoid and tonsill tissue were known as remnants of an unknown infectious disease, and so they were removed with adenotonsillectomy.^[1]
• Willhelm Meyer of Copenhagen, Denmark in 1800 first described adenoiditis due to adenoid vegetations responsible for nasal symptoms and impaired hearing. It is believed that Meyer was the first one who performed an adenoidectomy separately.^[2]
  

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

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.^[1] 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 may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.^[1] 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.

Subtypes	Duration of symptoms
Acute adenoiditis	Acute onset of symptoms[2]
Recurrent acute adenoiditis	At least 4 or more episodes of acute adenoiditis within a 6 months period[3]
Chronic/persistent adenoiditis	Persistent adenoiditis for more than 6 months Presence of complications

		Pathogen	Clinical features (other than adenoiditis)	Treatment
Viral adenoiditis[4][5][6]		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, Sore throat, white patches on the tonsils and back of the throat, Muscle weakness, fatigue, tender lymphadenopathy, involvement of posterior cervical lymph nodes	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-and-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, and pneumonia in children under 1 year of age Recurrent wheezing and asthma	Treating symptoms and complications of the infection Ribavirin
		Cytomegalovirus	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 Ganciclovir Foscarnet Cidofovir
		Herpes virus	Watery blisters in the skin or mucous membranes (such as the mouth or lips) or on the genitals[1]	Acyclovir Valacyclovir Famcyclovir
Bacterial adenoiditis	Acute [7][8][9][10]	Haemophilus influenzae	Bacteremia, and acute bacterial meningitis, epiglottitis, Otitis media,conjunctivitis, Sinusitis, Pneumonia	Beta lactamase inhibitor antibiotics
		Group A β-hemolytic streptococcus	Strep throat, acute rheumatic fever, scarlet fever, acute glomerulonephritis and necrotizing fasciitis
		Staphylococcus aureus	Toxic shock syndrome
		Moraxella catarrhalis	Otitis media, sinusitis, tracheobronchitis, pneumonia
		Streptococcus pneumoniae	Pneumonia, sinusitis, otitis media, endocarditis
	Recurrent[4][9]	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 [11][9]
Parasitic adenoiditis		Toxoplasma gondii	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[4][11][5]		Allergies	Allergic sinusitis Redness and itching of the conjunctiva (allergic conjunctivitis) Sneezing, coughing, broncho-constriction, 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, dysphagia, vomiting, effortless spitting up, coughing, and other respiratory problems	Lifestyle Modifications Proton pump inhibitors Antacids Alginic acid(Gaviscon)

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

The pathogenesis of adenoiditis is characterized by its inflammation. This process is primarily due to an elevated rate of trafficking of lymphocytes into adenoid from the blood, exceeding the rate of outflow from the adenoid.^[1] Adenoids are involved in the production of mostly secretory IgA, which is transported to the surface where it provides local immune protection. Adenoids can be infected by either bacterial and viral pathogens leading to adenoiditis.^[2]

• Adenoids are on the posterior nasopharynx, posterior to the nasal cavity. They are a component of the Waldeyer’s ring of lymphoid tissue, which is a ring of lymphoid tissue and includes adenoids and tonsils.

• Adenoids are developed from lymphocytes infiltration in subendothelium of nasopharynx during the 16th week of gestation.

• After the birth adenoids begin to enlarge.
• By the time children are aged 6 months, lactobacilli, anaerobic streptococci, actinomycosis, Fusobacterium species, and Nocardia species are present in the mucosal flora.
• Normal flora found in the mature adenoid tissue consists:
  • Alpha-hemolytic streptococci
  • Enterococci
  • Corynebacterium species
  • Coagulase-negative staphylococci
  • Neisseria species
  • Haemophilus species
  • Micrococcus species
  • Stomatococcus species
• It is normal to find symptomatic adenoids in children aged 18-24 months.
• They continue their grow until individuals are aged 5-7 years.

• Adenoids start to shrink by the age 6-7.
• By the time children reach 10-12, the adenoids are usually small enough for the child to become asymptomatic.

• Adenoids are involved in the production of mostly secretory IgA, which is transported to the surface providing local immune protection. Studies suggest that a reduction in IgA will happen postoperative of adenoidectomy.^[2]

• Adenoiditis can happen as a result of infection and harbor pathogenic bacterial activity, which may lead to the development of disease of the ears, nose, and sinuses. Adenoiditis can progress to chronic disease if remain untreated for a long term.

• Parental history of tonsillectomy and atopy hold significant predictive power in pediatric adenoiditis.^[3][4]
• The pathogenesis of adenoiditis is characterized by its inflammation. This process is primarily due to an elevated rate of trafficking of lymphocytes into adenoid from the blood, exceeding the rate of outflow from the adenoid.^[1]
• The persistence of tonsillitis beyond 3 months is known as chronic tonsillitis. In case of chronic bacterial tonsillitis the bacteria persist in the tonsils and lead to chronic inflammation. This persistent infection and inflammation leads to chronic tonsillitis. Manifestations appear whenever the patient has decline in immunity.
• The immune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the adeoid especially in paracortex area which lead to excess enlargement of the adenoids.
• Bacterial adenoiditis is primarily caused by group A β-hemolytic streptococcus (GABHS) Streptococcus pyogenes infection.^[5]
  • S. pyogenes and taxonomically-similar bacteria infiltrate the adenoidal epithelium, successfully penetrating the protective mucosal films in the oral and nasal cavity.^[6][7]
    • Colonization begins when the bacteria adheres to the adenoid surface proteins through lipoteichoic acid (LTA), depositing fibronectin molecules that bind to the adenoidal epithelium.^[6][8]
• Adenoid paracortex may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).

• On gross pathology, characteristic findings of adenoiditis, include:

• Enlarged adenoids
• Soft greasy yellow areas within capsule

• On microscopic histopathological analysis, characteristic findings of adenoiditis
• Recurrent bacterial tonsillitis is caused primarily by Staphylococcus aureus.^[9]
  • S. aureus invades the adenoids through microbial surface components recognizing adhesive matrix molecules (MSCRAMMs)^[9]
  • Following invasion, S. aureus is internalized by non-phagocytic cells through fibronectin-binding protein and beta-integrins.^[10]
  • Invasion of non-eukaryotic cells results in the up-regulation of cytokines, resulting in adenoiditis

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

Acute adenoiditis is mainly due to viral infection but bacterial infections can cause the disease as well. Bacterial infections have a more important role in recurrent and chronic adenoiditis. The most important viral causes include EBV, CMV and RSV. The most important bacterial causes include Haemophilus influenzae, group A β-hemolytic streptococcus, and staphylococcus aureus.^[1]

Acute adenoiditis is mainly due to viral infection but bacterial infections can cause the disease as well. Bacterial infections have a more important role in recurrent and chronic adenoiditis^[2][3]:

• Epstein-barr virus (EBV)
• Human adenovirus
• Enterovirus
• Rhinovirus
• Respiratory syncytial virus
• Mononucleosis
• Cytomegalovirus (CMV)
• Toxoplasmosis
• Herpes virus

• Haemophilus influenzae
• Group A β-hemolytic streptococcus
• Staphylococcus aureus

• Moraxella catarrhalis
• Streptococcus pneumoniae

• Sensitivity to mold allergens
• GERD
• Asthma

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

Diagnosis of adenoiditis can be challenging as majority of upper respiratory tract infections show the same pattern. The most important differential diagnosis include tonsilitis, viral upper respiratory tract infection, sinusitis and pharyngitis.

Adenoiditis must be differentiated from other diseases that cause fever, nasal airway obstruction and snoring, and sore throat.

The table below outlines the differences between adenoiditis and other respiratory tract infections.

Disease/Variable	Presentation	Causes	Imaging finding	Treatment
Upper respiratory tract infection[1][2][3]	Itchy, watery eyes Nasal discharge Nasal congestion Sneezing Sore throat Cough Headache Fever Malaise Fatigue, weakness Muscle pain	Influenza viruses	_	Symptomatic therapy: Decongestants
Peritonsillar abscess[4][5]	Severe sore throat Otalgia Fever A “hot potato” or muffled voice Drooling Trismus	Aerobic and anaerobic bacteria Streptococcuspyogenes	On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area	Ampicillin-sulbactam Clindamycin Vancomycin Linezolid
Croup[6][7][8]	Cough Stridor but no drooling Hoarseness Difficulty breathing Common cold Runny nose Fever	Parainfluenza virus	Steeple sign on neck X-ray	Dexamethasone Nebulised epinephrine
Epiglottitis[9][10]	Stridor and drooling but no cough Difficulty breathing Fever Chills Difficulty swallowing Hoarseness of voice	H. influenza type b Beta-hemolytic streptococci Staphylococcus aureus Fungi Viruses	Thumbprint sign on neck x-ray	Airway maintenance Parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin Adjuvant therapy includes: corticosteroids racemic Epinephrine
Pharyngitis[11][12]	Sore throat Pain on swallowing Fever Headache Abdominal pain Nausea and vomiting	Group A beta-hemolyticstreptococcus	_	Antimicrobial therapy mainly penicillin-based and analgesics
Tonsilitis [13][14]	Sore throat Pain on swallowing Fever Headache Cough	Viral Adenovirus, Rhinovirus Influenza Coronavirus Respiratory syncytial virus. Bacterial Group A streptococcalbacteria	Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary	Tonsillectomy Antibiotic therapy
Sinusitis[15][16]	Nasal congestion and blockage Facial pain and pressure Ear pressure or fullness Nasal discharge, which may be purulent Decreased or absent sense of smell Headache Cough Fever Fatigue Bad breath Maxillary tooth pain	Viruses Rhinovirus Influenza virus Parainfluenza virus Bacteria Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus pyogenes Staphylococcus aureus: common in chronic sinusitis Pseudomonas aeruginosa	On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen	Supportive therapy is the mainstay of treatment for both cases of acute and chronic rhinosinusitis Antibiotics (macrolides, penicillins, clavulonic acid- amoxicillin) an be added in select cases of acute, as well as chronic rhinosinusitis

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

The prevalence of adenoiditis is not completely known. In 2015, the prevalence and incidence of adenoiditis was estimated to be 12000 cases per 100,000 individuals worldwide.^[1] The prevalence of adenoiditis decreases with age. Adenoid tissue go through atrophy process after 10 years of age so adeoiditis is rarely seen after 15 .^[2]

• The prevalence of adenoiditis is not completely known.

• In 2015, the prevalence of adenoiditis was estimated to be 12000 cases per 100,000 individuals worldwide.^[1]

• The prevalence of adenoiditis is not completely known.

• In 2015, the incidence of adenoiditis was estimated to be 12000 cases per 100,000 individuals worldwide.

• The case fatality rate of tonsillitis is unknown.

• Adenoiditis commonly affects children.
• The prevalence of adenoiditis decreases with age.
• Adenoid tissue undergo atrophy after 10 years of age so adenoiditis is rarely seen after 15.
• Adenoiditis can be seen in adults too, although it is rare in this patient population. However due to improved diagnostic modalities, adenoiditis is usually treated or removed during childhood.

• Adenoiditis does not show predilection for any gender.

• Adenoiditis does not show predilection for any race.

• There is no geographic predisposition to tonsillitis.

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

The most potent risk factor in the development of adenoiditis is being a young child. Other risk factors include immuno-deficiencies, living in an urban environment with more exposure to viruses or bacteria and usage of immuno-suppressant drugs.

Risk factors for adenoiditis involve increasing the risk of invasion by pathogenic viruses or bacteria.^[1][2][3]

• Living or working in close proximity to children
• Living in an urban environment with more exposure to viruses or bacteria
• Young child or elderly adult
• Immunocompromised
• Living or working in close proximity to airborne pollutants, such as smoke
• Living in colder climates^[4]
• Excessive and prolonged use of corticosteroids
• Obesity or overweight^[5]
• Living with someone who suffers the disease

To go back to the main page, click here

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

• The page name should be “(Disease name) natural history, complications and prognosis”, with only the first letter of the title capitalized.
• Goal: To provide information on the natural progression of the disease without treatment, complications that occur as a result of the disease and its treatment, and the anticipated and actual outcomes of treatment.
• As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
• Remember to create links within Wikidoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you make your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links click here.
• Remember to follow the same format and capitalization of letters as outlined in the template below.
• Remember this is not the section to put the history of the disease in time. This would be detailed in the historical perspective section.
• Remember this is not the section to put the history of the patient. This would be detailed in the diagnosis section, under history.
• You should include the name of the disease in the first sentence of every subsection.

• The overview section should include the disease name in the first sentence.
• The goal is to summarize the entire page in several sentences. This section can be the same as the natural history, complications and prognosis segment on the overview page.
• To see an example, click here.

• First Sentences:

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Common complications of [disease name] include [complication 1], [complication 2], and [complication 3]. Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

OR

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.

• Examples:

Example 1: If left untreated, 20% to 30% of patients with IgA nephropathy may progress to develop ESRD. Common complications of IgA nephropathy include pro-thrombotic states, such as stroke and myocardial infarction. Prognosis is generally good, and the 5-year mortality rate of patients with IgA nephropathy is approximately 5%.

• Additional Sentences:

[Disease/malignancy] is associated with a 5 year survival rate of [#]%.

The presence of metastasis is associated with a particularly poor prognosis among patients with [disease/malignancy]. The 5 year event free survival rate is less than [#]%.

The [Subtype of disease or malignancy] is associated with the most favorable prognosis.

The prognosis varies with the [characteristic] of tumor: [subtype of disease/malignancy] have the most favorable prognosis.

• Examples:

Example 1: Rhabdomyosarcoma is associated with a 5 year survival rate of 72%.

Example 2: The presence of metastasis is associated with a particularly poor prognosis among patients with rhabdomyosarcoma. The 5 year event free survival rate is less than 30%.

Example 3: The embryonal subtype of rhabdomyosarcoma is associated with the most favorable prognosis.

Example 4: The prognosis varies with the location of tumor: orbital and genitourinary tract rhabdomyosarcomas have the most favorable prognosis.

• If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
• Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.

 

• The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.
• The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

• The natural history of disease details how the disease progresses without treatment.
• Here are a few template sentences you can use: “The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. The symptoms of (disease name) typically develop ___ years after exposure to ___. Without treatment, the patient will develop symptoms of ___, which will/ may eventually lead to ___.

• Using lists can be helpful for describing this section.
• You can use these template sentences;
  • “Complications that can develop as a result of (disease name) are ___ (describe in list form)”.
  • “Complications that can develop as a result of the treatment of (disease name) are ___ (describe in list form).
  • Next to each complication, provide a brief one sentence description detailing the complication.
• For an example of the complications section in a natural history, complications and prognosis page, click here.

• This section should detail the prognosis of the disease, both treated and untreated.
• Here are some template sentences; “The prognosis of (disease name) is poor/good with treatment. Without treatment, (disease name) will result in ___. (Disease name) is associated with a 1/5/10 year mortality of __ among patient with ______ (for example high grade lesions). The presence of ___ is associated with a particularly poor prognosis among patients with (disease name).
• For an example of a prognosis section within a natural history, complications and prognosis page, click here.

• References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
• For information on how to add references into your page, click here.

Template:WikiDoc Sources