Relation of Actinomyces with Tonsillar Hypertrophy and Antibiotic Use

The Clinical Significance of Tonsillar Actinomyces in Histopathological Samples after Tonsillectomy

BACKGROUND

Actinomyces is a genus of Gram-positive anaerobic or microaerophilic bacteria with a branched filamentous shape. Their presence in tonsil tissue is usually determined by histopathological examination. In the crypts of removed tonsils, they have a prevalence ranging from 0.8% to 61.6%. The role of Actinomyces in diseases of the palatine tonsils is not clearly defined. The aim of the study was to determine the importance of Actinomyces in the pathology of palatine tonsils and to assess the impact of these bacteria on the clinical data.

METHODS

the retrospective analysis of the histopathological findings of patients undergoing tonsillectomy in our hospital from January 2017 to the end of December 2019 was performed in terms of the occurrence of Actinomyces. The data were collected based on the medical history. The study included 481 patients aged 3-82 years. From the study group, 100 adult patients were randomly selected, and a telephone survey was conducted. The questions included the co-occurrence of bronchial asthma, halitosis, tonsilloliths, and cigarette smoking. The questions were related to the complications following tonsillectomy and the severity of postoperative pain. Existence of a relationship was investigated between occurrence of tonsillar Actinomyces and age, sex, body mass index, and medical condition (obstructive sleep apnea, chronic palatine tonsillitis), respectively. The size of the removed tonsils was assessed and compared depending on the presence of the bacteria.

RESULTS

patients aged 18 years and older had a higher probability of presenting Actinomyces. The estimated odds ratio for the presence of the bacteria per year of age was 1.023 [1.007, 1.041]. No statistically significant results were found for the other variables. The co-occurrence of the bacteria and halitosis was close to statistical significance (p = 0.064).

CONCLUSIONS

multivariate analysis of the role of Actinomyces in tonsillar pathology showed that these microorganisms should be considered saprophytes of the oropharyngeal microflora that had no significant relationship with the pathology of palatine tonsils. Further studies on their influence on halitosis are warranted.

[Cervicofacial actinomycosis]

Actinomycosis is an infectious disease caused by gram-positive, facultative anaerobic bacteria, which in most cases manifests itself in the cervicofacial area and often has a dentogenic focus. The clinical presentation ranges from acute abscess to chronically fistulating soft tissue processes. Early diagnosis and an appropriate therapeutic approach including a combination of extensive antibiotic treatment and, if necessary, surgical intervention are critical. This article presents five cases of actinomycete infections, which are intended to illustrate the variety of clinical presentations, the problems on the way to the correct diagnosis and possible therapeutic courses.

Microbiological Profile of Chronic Tonsillitis in the Pediatric Age Group

Introduction

Tonsillitis is a very common disease in children. Understanding the microbiology and pathology of chronic tonsillitis is an important step in its management. The aim of the study was to describe the microbiological profile of core tonsillar tissue in chronic tonsillitis in children.

Materials and methods

Children under 16 years of age with chronic tonsillitis were recruited in the descriptive study. Children with recurrent tonsillitis and recurrent tonsillitis with obstructive symptoms were included. Children who underwent tonsillectomy for obstructive symptoms alone and those who received antibiotics for at least one month prior to surgery were excluded from the study. Dissection and the snare method of tonsillectomy were done on all children. The operated specimen was cut into two halves in a sterile container. The core of the tonsillar tissue was swabbed with two sterile cotton-tipped swabs and sent for the microbiological evaluation of aerobes and anaerobes. The tonsillar tissue was sent for a histopathological examination.

Results

A total of 106 children were operated for chronic tonsillitis in one year. The mean age of children included in this study was 9.4 years. The duration of symptoms due to tonsillar disease ranged from four weeks to 28 months. There were 48 males and 58 females. Recurrent tonsillitis was the most common indication for tonsillectomy in all children. A total of 301 aerobes and 171 anaerobic microorganisms were isolated from 106 children with chronic tonsillitis. The aerobic bacterial species most often isolated was Streptococcus viridans, which was present in 83 children followed by Group A, β-hemolytic Streptococci in 67 children. The anaerobic bacterial most often isolated was Peptococcus species in 49 children. Polymicrobial aerobic and anaerobic flora were present in all tonsillar specimens, yielding an average of 4.1 isolates per specimen. The histopathological examination revealed chronic tonsillitis with reactive follicular hyperplasia in all (100%) children. Actinomycosis was associated with non-specific reactive follicular hyperplasia in four specimens.

Conclusion

Polymicrobial aerobic and anaerobic flora are identified in deep tonsillar tissue in children with tonsillitis. The identification of bacterial isolates from the core tissue in recurrent tonsillitis could dictate the management of chronic tonsillitis. The histopathological examination of the core tissues of the tonsils helps in an accurate identification of organisms that are difficult to culture.