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Darod HH, Melese A, Kibret M, Mulu W. Throat Swab Culture Positivity and Antibiotic Resistance Profiles in Children 2-5 Years of Age Suspected of Bacterial Tonsillitis at Hargeisa Group of Hospitals, Somaliland: A Cross-Sectional Study. Int J Microbiol 2023; 2023:6474952. [PMID: 37065723 PMCID: PMC10098414 DOI: 10.1155/2023/6474952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/11/2022] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Tonsillitis is the third most frequently diagnosed infection in the pediatric age and is associated with significant morbidity and loss of school attendance. Throat swab cultures are useful for the confirmation of children with a clinically suspected tonsillitis. However, Somaliland is one of the underdeveloped countries with a low standard of sanitation and poor health seeking culture. Treatment of tonsillitis with antibiotics is irrational and not empirical. This study determined the bacterial throat swab culture positivity and antibiotic resistance profiles of the bacterial isolates among children 2-5 years of age with suspicion of tonsillitis at Hargeisa Group of Hospital, Somaliland. Materials and Methods A cross-sectional study was conducted from March to July 2020. A total of 374 children from 2 to 5 years of age suspicion of tonsillitis was included using a convenient sampling method. Throat swabs were collected, and bacterial isolation and identification were done using standard bacteriological procedures. Antimicrobial susceptibility testing was done using the disk diffusion method. Data on demographic variables and clinical profiles were collected using structured questionnaires. Logistic regression analysis was computed to identify factors associated with bacterial tonsillitis. Results Overall, 120 (32.1%) (95% CI 27.4-36.8%) of children were positive for bacterial throat cultures. Of these, 23 (19.2%) were mixed bacterial isolates. The most frequent bacterial isolates were beta-hemolytic streptococci 78 (55%), Staphylococcus aureus 42 (29%), and Streptococcus pneumoniae 10 (7%). Isolates revealed 83.3-100% rate of resistance to ampicillin. Beta-hemolytic streptococci isolates were 94.9% resistant to ampicillin. S. aureus was resistant to clarithromycin (38%) while S. pneumoniae isolates were 100% resistant to ampicillin. History of tonsillitis (AOR = 0.12; 95% CI = 0.06-0.21), difficulty in swallowing (AOR = 6.99; 95% CI = 3.56-13.73), and attending schools (AOR = 2.98; 95% CI = 1.64-5.42) were found to be associated with positive throat culture. Conclusions Resistance to ampicillin and MDR among beta-hemolytic streptococci and other isolates of throat colonizers in children with clinically suspected of bacterial tonsillitis are major concerns in Hargeisa, Somaliland. Therefore, treatments of cases are recommended to be guided by regular culture and antimicrobial susceptibility testing to prevent complications of tonsillitis and associated antibiotic resistance.
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Affiliation(s)
- Hamda Hussein Darod
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Melese
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulugeta Kibret
- Department of Biology, Science College, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biochemistry and Microbiology, Laboratory of Microbiology, Faculty of Science, Ghent University, Ghent, Belgium
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Current bacteriological profile of tonsillar surface versus core tissue in patients undergoing tonsillectomy. Indian J Med Microbiol 2022; 42:77-81. [PMID: 36464533 DOI: 10.1016/j.ijmmb.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The current study explored the bacteriological profile in the tonsillar core in patients undergoing tonsillectomy and compared it with tonsillar surface organisms. The antibiotic sensitivity and resistance patterns were also studied. MATERIALS AND METHODS This prospective and observational study was conducted in the Department of Otorhinolaryngology, Head and Neck surgery in a tertiary care institute, on a total of sixty-one patients clinically diagnosed as chronic tonsillitis and undergoing tonsillectomy. Tonsillar surface culture swabs and core tissue specimen were sent in separate vials. The culture isolates and their antibiotic sensitivity were analysed and compared. RESULTS Bacterial growth was detected in 61% of the cases, in cultures from the surface or the core tissue or both. 50.8% specimens of core tissue versus 31.1% of tonsillar surface samples revealed bacterial growth. Of the 13 cases in which surface and core both had bacterial culture growth, the same pathogens were identified in 8 cases. Pseudomonas aeruginosa was the most commonly reported organism in both tonsillar core as well as surface swab cultures. CONCLUSION Our study shows that surface swab culture is not always a reliable indicator of organisms present in core of tonsils in cases of chronic infection. The surface swabs did not always match the pathogens in the core. The higher prevalence and the variability of pathogenic organisms in the core tissue as compared to the surface suggests that a targeted antibiotic treatment based on surface culture swabs is unlikely to eradicate them.
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Garcia-Romo GS, Gonzalez-Ibarra M, Donis-Hernandez FR, Zendejas-Buitron VM, Pedroza-Gonzalez A. Immunization with heat-inactivated Staphylococcus aureus induced an antibody response mediated by IgG1 and IgG2 in patients with recurrent tonsillitis. Microbiol Immunol 2016; 59:193-201. [PMID: 25648612 DOI: 10.1111/1348-0421.12241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 12/22/2022]
Abstract
Currently Staphylococcus aureus is the predominant pathogen isolated from the respiratory tract of patients with recurrent tonsillitis. Because of an increase in multi-drug resistant strains of S. aureus, there is a pressing need for effective treatments and preventive approaches to reduce the risk of invasive and life-threatening infections. A preventive vaccine against S. aureus would have a tremendous clinical impact. However, multiple clinical trials have failed to identify an agent that can induce protective responses. Most trials have been based on subunit vaccines using one or a few purified antigens, which may not be enough to confer protection. Here, the impact of a whole-cell vaccine comprised of heat-inactivated S. aureus was investigated in patients with RT. The vaccine was well tolerated and had no significant local or systemic reactions. Immunization with heat-inactivated S. aureus elicited a significant antibody response characterized by production of IgG1 and IgG2 antibodies and, to a lesser extent, of IgA antibodies. Notably, this response was associated with an important decrease in the incidence of tonsillitis and bacterial colonization of the oropharyngeal mucosa. Our results show that whole-cell inactivated S. aureus is safe and capable of evoking specific antibody responses in patients with recurrent tonsillitis.
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Affiliation(s)
- Gina Stella Garcia-Romo
- Department of Immunology and Medical Mycology, Research Division, Hospital Juarez of Mexico, Mexico City, 07760, Mexico; Faculty of Higher Studies Cuautitlan, National Autonomous University of Mexico, Mexico City, 54740, Mexico; Department of Nephrology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
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Bacteriological evaluation of tonsillar microbial flora according to age and tonsillar size in recurrent tonsillitis. Eur Arch Otorhinolaryngol 2014; 271:1661-5. [PMID: 24487459 DOI: 10.1007/s00405-014-2898-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
Although numerous studies based on the bacteriology of the tonsil have been carried out, none of them analyzed the variation of tonsillar flora with respect to both age and tonsillar size. The purpose of this study was to isolate the facultative and obligate anaerobes both from the surface and the core of tonsils in recurrent tonsillitis as well as to analyze the variation of isolated bacterial strains according to age and tonsillar size. A prospective study was performed on 111 patients who underwent tonsillectomy. We analyzed the differences between the bacterial pathogens in recurrent tonsillitis and semi-growth estimates with regard to age and tonsillar grade. Among 111 cases, 604 bacterial strains of 21 different from the tonsil superficial and core were isolated. The most common facultative anaerobic species isolated from the surface and core were Coagulase-negative staphylococci, Alpha-hemolytic streptococci and Diphtheroid bacilli in all subgroups except patients below 8 years old. The most commonly obligate anaerobic species isolated from the core were Propionibacterium acnes, Prevotella melaninogenica and Peptostreptococcus anaerobius. We found no significant difference in the cultured bacteria with respect to age and tonsillar size. The study subgroups did not differ in the occurrence of semiquantitative growth estimates of 3-4+. Our study demonstrates that there is polymicrobial aerobic and anaerobic flora in tonsils with regardless of patient's age and tonsillar size. This polymicrobial spectrum of bacteria may contribute to recurrence and to the failure of conservative treatment of these cases and therefore leads to surgical therapy.
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Alasil SM, Omar R, Ismail S, Yusof MY, Dhabaan GN, Abdulla MA. Evidence of Bacterial Biofilms among Infected and Hypertrophied Tonsils in Correlation with the Microbiology, Histopathology, and Clinical Symptoms of Tonsillar Diseases. Int J Otolaryngol 2013; 2013:408238. [PMID: 24454384 PMCID: PMC3886491 DOI: 10.1155/2013/408238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022] Open
Abstract
Diseases of the tonsils are becoming more resistant to antibiotics due to the persistence of bacteria through the formation of biofilms. Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. We have isolated the microorganisms, evaluated their antimicrobial susceptibility, and detected the presence of bacterial biofilms in tonsillar specimens in correlation with the clinical manifestations of tonsillar diseases. Therefore, a total of 140 palatine tonsils were collected from 70 patients undergoing tonsillectomy at University Malaya Medical Centre. The most recovered isolate was Staphylococcus aureus (39.65%) followed by Haemophilus influenzae (18.53%). There was high susceptibility against all selected antibiotics except for cotrimoxazole. Bacterial biofilms were detected in 60% of patients and a significant percentage of patients demonstrated infection manifestation rather than obstruction. In addition, an association between clinical symptoms like snore, apnea, nasal obstruction, and tonsillar hypertrophy was found to be related to the microbiology of tonsils particularly to the presence of biofilms. In conclusion, evidence of biofilms in tonsils in correlation with the demonstrated clinical symptoms explains the recalcitrant nature of tonsillar diseases and highlights the importance of biofilm's early detection and prevention towards better therapeutic management of biofilm-related infections.
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Affiliation(s)
- Saad Musbah Alasil
- Department of Microbiology, Faculty of Medicine, MAHSA University, 59100 Kuala Lumpur, Malaysia
| | - Rahmat Omar
- Pantai Hospital Cheras, 56100 Kuala Lumpur, Malaysia
| | - Salmah Ismail
- Institute of Biological Science, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohd Yasim Yusof
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ghulam N. Dhabaan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mahmood Ameen Abdulla
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Zagólski O, Kulisiewicz J. Perioperative antibiotic in adenoidectomy with partial tonsillectomy: a randomized trial. ORL J Otorhinolaryngol Relat Spec 2012; 74:86-92. [PMID: 22378321 DOI: 10.1159/000336744] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine potential benefits of perioperative antibiotic therapy in children undergoing adenotonsillotomy. METHODS Adenoidectomy with tonsillotomy was performed in 124 children with obstructive symptoms, aged 5-7 years. Of these, 120 completed the study. Intraoperative intravenous and postoperative oral clindamycin, or placebo for 7 days, were administered. RESULTS There were significant differences between the groups regarding pain intensity (p < 0.001) and duration (p < 0.05), day of return to normal physical activity (p < 0.05), occurrence and duration of oral malodor (p < 0.001), number of doses of additional analgesic (p < 0.001), healing grading (p < 0.05) and parents'/caregivers' satisfaction scores on the 4th postoperative day. There were indications for antibiotic in 2 individuals in the placebo group. CONCLUSIONS There are significant differences in the course of convalescence related to perioperative antibiotic in children after adenotonsillotomy, but strict indications for antibiotics in these patients are rare.
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Affiliation(s)
- Olaf Zagólski
- ENT Department, St. John Grande's Hospital, Kraków, Poland.
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Pereira LMP, Juman S, Bekele I, Seepersadsingh N, Adesiyun AA. Selected bacterial recovery in Trinidadian children with chronic tonsillar disease. Braz J Otorhinolaryngol 2009; 74:903-911. [PMID: 19582348 PMCID: PMC9448947 DOI: 10.1016/s1808-8694(15)30152-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 06/11/2007] [Indexed: 12/04/2022] Open
Abstract
Pharyngotonsillitis in children is widely treated with antibiotics. Aim: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. Methods: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. Results: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3%), Staphylococcus spp. (42.3%) and Gram-negative genera (6.4%). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than ß-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were not concordant for streptococci (p<0.0004) and α-haemolytic Streptococcus (p<0.007). Surface and core ß-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs 70%) and (50.0% vs 25.0%) in older and younger children respectively. Klebsiella spp. (6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively.
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Affiliation(s)
| | | | - Isaac Bekele
- Dr (Senior Lecturer, Biometrics and Head, Department of Food Production)
| | | | - Abiodun A Adesiyun
- Dr (Professor of Veterinary Public Health and Director, School of Veterinary Medicine)
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The relationship between chronic otitis media with effusion and surface and deep flora of hypertrophic adenoids. Int J Pediatr Otorhinolaryngol 2009; 73:1438-40. [PMID: 19692130 DOI: 10.1016/j.ijporl.2009.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The relationship between bacterial flora of the adenoids and middle ear problems is unclear. In this study, superficial and deep aerobic and anaerobic bacterial flora of adenoid tissues were compared in children with and without chronic otitis media with effusion (cOME). PATIENTS AND METHODS Between 2004 and 2007, family members of children (ages 1-14 years) who were scheduled to undergo adenoidectomy were approached for participation in the study. Of the 180 patients who gave consent, 107 (59%) did not have cOME (Group I), whereas 73 (41%) had had a tympanostomy tube previously due to cOME (Group II). Prior to adenoidectomy, swabs were taken from the surface of the adenoids, and samples of deep tissue for culture were obtained from curetted tissue. All samples were cultured aerobically and anaerobically. Growth of 10 of the bacteria most commonly cultured were evaluated: 5 classified as normal flora (coagulase-negative staphylococci, α-hemolytic streptococci, Neisseria spp., Prevotella spp. ve Peptostreptococci) and 5 potential pathogens (S. aureus, S. pyogenes, S. pneumoniae, H. influenzae ve Moraxella spp.). RESULTS Isolation rates of potential pathogens including S. pneumoniae,H. influenzae and Moraxella spp. from surface and deep cultures of adenoids were between 5 and 15% (no significant differences between those with and without cOME). While S. aureus was the most frequently isolated bacteria (26%) in children with cOME (Group II), the incidence of S. pyogenes as a potential pathogen was only 1% (p<0.05) in Group II and the anaerobic Prevotella spp. were significantly less common (p<0.05) in children with cOME (Group II). CONCLUSION Potential pathogens of middle ear colonized in adenoid tissue may not be significant factor for the etiopathogenesis of cOME. Bacterial interference mechanisms may play an important role in pathogenesis of cOME because of Prevotella spp. showed statistically significant decrease children with cOME.
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Jabbari Moghaddam Y, Rafeey M, Radfar R. Comparative assessment of Helicobacter pylori colonization in children tonsillar tissues. Int J Pediatr Otorhinolaryngol 2009; 73:1199-201. [PMID: 19523691 DOI: 10.1016/j.ijporl.2009.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective was to survey the results of RUT (rapid urease test) in children tonsillar tissues. METHODS In a prospective clinical study 285 children (4-14 years) tonsillar tissue tested with RUT (rapid urease test) and histopathologic biopsy and simultaneously serum IgG Helicobacter pylori level was measured for all patients. RESULTS One hundred and thirteen patients (39.6%) were positive to H. pylori in histopathologic examination. Forty patients (14%) had positive RUT and 15 patients had positive serum IgG anti-H. pylori level. In 40 patients the results in both histopathology and RUT were positive (P=0.000) although in 172 patients the results in both histopatologhic and RUT were negative (P=0.000). CONCLUSIONS This study showed that H. pylori was present in tonsillar tissue and RUT is not sensitive enough for diagnosis of H. pylori in tonsillar tissue. Indicating that H. pylori has a possible role in reservoir of H. pylori in children.
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Khademi B, Niknejad N, Gandomi B, Yeganeh F. Comparison of Helicobacter Pylori Colonization on the Tonsillar Surface versus Tonsillar Core Tissue as determined by the CLO test. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708600817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter- like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H pylori colonization in tonsillar core tissue.
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Affiliation(s)
- Bijan Khademi
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nika Niknejad
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrooz Gandomi
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firoozeh Yeganeh
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
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Jelavic B, Bevanda M, Ostojic M, Leventic M, Vasilj M, Knezevic E. Tonsillar colonization is unlikely to play important role in Helicobacter pylori infection in children. Int J Pediatr Otorhinolaryngol 2007; 71:585-90. [PMID: 17239446 DOI: 10.1016/j.ijporl.2006.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 09/18/2006] [Accepted: 12/09/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine (i) seroprevalence of Helicobacter pylori (HP) infection in children undergoing tonsillectomy, (ii) possible HP colonization on tonsils of children and its importance in HP transmission, and (iii) if four examined socio-economic factors are the risk factors for HP transmission and HP colonization on tonsils in children. METHODS Rapid urease test (RUT) of tonsils, and serologic blood tests for HP were performed in 77 children (aged 4-14 years) in Bosnia and Herzegovina (B-H), undergoing tonsillectomy. RUT positive tonsils were cultured for HP. RUT positive children were tested using (13)Carbon-urea breath test ((13)C-UBT). Information about socio-economic potential risk factors was obtained from the parents. RESULTS Out of 139 pharyngeal and palatine tonsils, 17 palatine tonsils in 14 children were RUT positive and had negative HP culture. Eight children had positive both RUT and (13)C-UBT. There was no significant difference between children with hypertrophy and those with recurrent tonsillitis comparing their serologic tests results. There was no significant difference between seronegative (n=61) and seropositive (n=16) children comparing their age, sex, parental education level, owning a family courtyard, attending a children's collective, and owning a pet cat. CONCLUSIONS The results in this prospective study do not support the notion that tonsils are an important reservoir for HP transmission in children in B-H. The examined socio-economic factors did not enhance HP seropositivity rate in children.
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Affiliation(s)
- Boris Jelavic
- Department of Otorhinolaryngology, Mostar University Hospital, Mostar, Bosnia and Herzegovina.
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Van Staaij BK, Van Den Akker EH, De Haas Van Dorsser EHM, Fleer A, Hoes AW, Schilder AGM. Does the tonsillar surface flora differ in children with and without tonsillar disease? Acta Otolaryngol 2003; 123:873-8. [PMID: 14575405 DOI: 10.1080/00016480310000395] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate whether the tonsillar flora differ in children with and without adenotonsillar disease. MATERIAL AND METHODS Tonsil surface swabs were taken from 218 children indicated for adenotonsillectomy because of moderate symptoms of recurrent tonsillopharyngitis or adenotonsillar hypertrophy (T+Ads group). Control swabs were taken from 100 children without symptoms of adenotonsillar disease who visited the ophthalmology clinic. Potential respiratory pathogens were identified. RESULTS Potential respiratory pathogens were found in 54% of the T+Ads group, compared to 41% of the control group (p = 0.04). Haemophilus influenzae was the commonest pathogen in both groups, being found in 41% of the T+Ads group and 34% of the control group. Moraxella catarrhalis was found more often in the T+Ads group compared to the control group: 7% vs 0% (p = 0.004). H. influenzae was found in 32% of the children with recurrent tonsillitis, compared to 48% of the children with symptoms of tonsillar hypertrophy (p = 0.03). CONCLUSIONS The prevalence of potential respiratory pathogens on the tonsillar surface of children with moderate symptoms of recurrent tonsillopharyngitis and/or tonsillar hypertrophy differs only slightly from that in children without symptoms of adenotonsillar disease. Variations in the microbial flora do not seem to play an essential role in the predisposition of these children to tonsillar disease.
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Affiliation(s)
- Birgit K Van Staaij
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
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Abstract
The pathogenesis of recurrent tonsillitis has not been fully explored. Most studies in this field have focused on pathogenic bacteria whereas less research has been done concerning the host defense. In earlier studies it was shown that there is an active cellular defense in the tonsillar surface secretion, consisting of phagocytes, and therefore in this study the possibility that this defense is altered in patients with recurrent tonsillitis was explored. Neutrophils were obtained from tonsillar surface secretions in eight patients with recurrent tonsillitis and eight healthy volunteers and the capacity of the neutrophils to respond to chemotactic stimuli was examined in an in vitro system. A significantly higher fraction of the neutrophils obtained from the patients with recurrent tonsillitis responded to chemotactic stimuli compared to those obtained from the healthy volunteers. It is concluded that there is a hyperactive cellular defense in the tonsillar surface secretion in patients with recurrent tonsillitis. This finding and its significance in the pathogenesis of recurrent tonsillitis are discussed.
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Affiliation(s)
- Anders Ebenfelt
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
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Rajasuo A, Leppänen J, Savolainen S, Meurman JH. Pericoronitis and tonsillitis: clinical and darkfield microscopy findings. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:526-32. [PMID: 8734697 DOI: 10.1016/s1079-2104(96)80041-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Upper respiratory tract infections and tonsillitis and pharyngitis in particular increase the risk of lower third molar pericoronitis. The study was made to investigate clinical and microbiologic associations between pericoronitis and tonsillitis. STUDY DESIGN The subjects were 20-year-old Finnish male conscripts. Thirty-eight patients had tonsillitis without and 33 patients had tonsillitis with a symptom-free erupting lower third molar; 27 patients had pericoronitis but healthy tonsils. All subjects were examined clinically. Bacterial samples were taken from healthy and diseased tonsils and from healthy and diseased third molar pericoronal pockets. The microbes were classified morphologically with the use of a darkfield microscope. RESULTS Eighty-two percent of infected tonsils had deep crypts and 52% of them exudated pus compared with 36% (p < 0.001) and 0% (p < 0.001) in healthy tonsils, respectively. Infected lower third molars were less than half erupted and had on average 8.8 mm deep pericoronal pockets compared with pockets 5.5 mm deep recorded in symptom-free cases (p < 0.001). Spirochetes were more common in infected pockets than in symptom-free cases comprising 8.2% versus 3.0% of the total bacterial count (p = 0.044). Rods were more common in infected tonsils than healthy ones (8.9% versus 4.8%, p = 0.041). CONCLUSION There were similarities in morphologic microbiota of pericoronitis and tonsillitis. However, clinical findings of tonsils did not appear to link with the findings of third molars.
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Affiliation(s)
- A Rajasuo
- Valkeala Military Hospital, Finnish Defence Forces, Helsinki, Finland
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Ebenfelt A, Lundberg C. Cellular defence in surface secretion in acute pharyngotonsillitis. Acta Otolaryngol 1996; 116:97-103. [PMID: 8820359 DOI: 10.3109/00016489609137721] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As acute pharyngotonsillitis is contagious the offensive organisms are supposed to enter mostly from the outside of the diseased person into the tonsillar secretion and tissues. To elucidate the function and the pathophysiological importance of the cellular defence system in the surface secretion of the tonsils, the cellular kinetics and spatial relations between the cellular elements in the secretion were followed during the course of acute pharyngotonsillitis in 16 patients using a newly invented imprint technique. The most prominent findings in the secretions at the start of the infections, irrespective of positive or negative bacterial culture for beta-haemolytic streptococci, were huge numbers of bacteria, great numbers of granulocytes, many of which showed signs of exhaustion and death, and extensive intracellular and frustrated phagocytosis, features highly consistent with an infectious process. During healing there were rapid and profound changes in cellular content and spatial relations towards those in secretions of healthy volunteers. However, even in the surface secretions of these subjects, bacteria, granulocytes and in some areas phagocytosis were present, albeit to a significantly lesser extent. It is concluded that a cellular defence system is constantly active in the surface secretions of the tonsils. During disease, this system is strongly activated and stressed. Based on our recent and present results it is speculated that acute pharyngotonsillitis is primarily and often only due to the emergence of an overload on the cellular defence system of the surface secretion.
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Affiliation(s)
- A Ebenfelt
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
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Meurman JH, Rajasuo A, Murtomaa H, Savolainen S. Respiratory tract infections and concomitant pericoronitis of the wisdom teeth. BMJ (CLINICAL RESEARCH ED.) 1995; 310:834-6. [PMID: 7711620 PMCID: PMC2549217 DOI: 10.1136/bmj.310.6983.834] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To discover if there is an association between respiratory tract infections and pericoronitis of erupting third molars in young adults. DESIGN Data from male military conscripts' medical records were collected over five years and the incidence of respiratory tract infection before and after acute pericoronitis (191 cases) and before and after standard (722 cases) and operative (741) extractions compared with that in controls (n = 703) who had no infections in the third molar regions. SUBJECTS 14,500 male military conscripts aged 20. SETTING Garrisons in Valkeala and Kouvola, Finland. RESULTS The incidence of respiratory tract infection was significantly higher during the two weeks before acute pericoronitis was diagnosed compared with that in controls. The highest incidence was observed in the three days before pericoronitis (odds ratio 6.8; 95% confidence interval 3.0 to 15.0). The incidence was also increased in the first week after pericoronitis (odds ratio 3.7; 1.6 to 8.4) and three days before (odds ratio 2.6; 0.9 to 7.5) and during the first week after extraction of third molars (odds ratio 2.6; 1.3 to 5.3). CONCLUSIONS Respiratory tract infection may precipitate and occur concomitantly with acute pericoronitis. Third molar surgery for pericoronitis, on the other hand, may trigger respiratory tract infection.
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Affiliation(s)
- J H Meurman
- Faculty of Dentistry, University of Kuopio, Finland
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Ebenfelt A, Lundberg C. Bacterial invasion of the tonsillar tissues in acute pharyngotonsillitis and in the adenoid: a preliminary study. Clin Otolaryngol 1994; 19:310-3. [PMID: 7994887 DOI: 10.1111/j.1365-2273.1994.tb01237.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to understand the immunological and inflammatory processes in which the tonsils are involved it is necessary to know the spatial relation between bacteria and the tissues. In this study four adenoids and four palatine tonsils obtained at elective surgery and four palatine tonsils obtained during à chaud surgery for quinsy were examined histologically. Acridine orange and fluorescence microscopy were used to identify bacteria in tonsillar tissue. The adenoids were also stained with haematoxillin-eosin. Bacteria were in every case seen on the surfaces and in the crypts of the tonsils and adenoids. In the tissues, however, bacteria were never seen irrespective of whether the tonsils were obtained during an acute infection or not. We conclude that bacterial invasion in tonsillar tissue is neither a prerequisite for a clinically manifest acute bacterial pharyngotonsillitis nor a common feature in tonsils clinically recognized as non-infected.
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Affiliation(s)
- A Ebenfelt
- Department of Otorhinolaryngology, Sahlgrenska Sjukhuset, Göteborg, Sweden
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Mitchelmore IJ, Reilly PG, Hay AJ, Tabaqchali S. Tonsil surface and core cultures in recurrent tonsillitis: prevalence of anaerobes and beta-lactamase producing organisms. Eur J Clin Microbiol Infect Dis 1994; 13:542-8. [PMID: 7805681 DOI: 10.1007/bf01971304] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The bacterial flora of the tonsil surface and core was compared in patients suffering from recurrent tonsillitis. Surface swabs and tonsil core tissues were received as paired samples from 50 patients admitted for elective tonsillectomy. Analysis of paired samples from individual patients revealed differences in the bacterial flora of the tonsil core and the tonsil surface. Of 366 aerobic isolates, 30% grew from the surface alone, 26% from the core only and 44% from both sites. Of 290 anaerobic isolates, 35% grew from the surface alone, 33% from the core only and 31% from both sites. The total number of isolates from surface and core samples was similar (average 9.2 and 8.8, respectively). The range of species isolated was also similar for both surface and core samples, as was the proportion of organisms producing beta-lactamase from each site (10.7% and 9.5%, respectively). Eighty-two percent of patients carried beta-lactamase-producing organisms on either the tonsil surface or in the core tissue. A surface swab does not reliably reflect the types of organisms present in the tonsil core in individual patients. Anaerobes are a major component of tonsil surface and core bacterial flora in patients with recurrent tonsillitis. The high carriage rate of beta-lactamase-producing organisms in the tonsils should be considered when selecting antimicrobial therapy for persistent or recurrent tonsillitis.
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Affiliation(s)
- I J Mitchelmore
- Department of Medical Microbiology, St. Bartholomew's Hospital, West Smithfield, London, UK
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Huminer D, Pitlik S, Levy R, Samra Z. Mycoplasma and Chlamydia in adenoids and tonsils of children undergoing adenoidectomy or tonsillectomy. Ann Otol Rhinol Laryngol 1994; 103:135-8. [PMID: 8311389 DOI: 10.1177/000348949410300209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1% core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.
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Affiliation(s)
- D Huminer
- Department of Internal Medicine, Beilinson Medical Center, Petah Tiqva, Israel
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Stjernquist-Desatnik A, Prellner K, Schalén C. Colonization by Haemophilus influenzae and group A streptococci in recurrent acute tonsillitis and in tonsillar hypertrophy. Acta Otolaryngol 1990; 109:314-9. [PMID: 2180250 DOI: 10.3109/00016489009107448] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One hundred patients subjected to tonsillectomy because of recurrent acute tonsillitis or tonsillar hypertrophy were evaluated bacteriologically both with ordinary throat culturing and cultures from tonsillar cores. In 26% of the patients H. influenzae was isolated and in 20% beta-haemolytic group A streptococci. Growth of B. catarrhalis was obtained in 10% and group C-, group G streptococci or pneumococci in less than 5% each. None of the group A streptococcal strains proved tolerant to penicillin. A much higher isolation rate of H. influenzae was found in cultures obtained from tonsillar core tissue (23%) than from ordinary throat cultures (2%). This was also the fact, though to a lower extent, regarding group A streptococci. H. influenzae and group A streptococci were isolated as often in patients with tonsillar hypertrophy as in patients suffering from recurrent acute tonsillitis, suggesting a role of these bacteria in both conditions.
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