Tonsillar surface micro flora: does it truly represent pathological tonsillar flora?

Objective: To determine the best method of identifying core tonsillar flora

Study Design: Quasi-experimental study

Place and Duration of Study: ENT Department, Combined Military Hospital, Lahore, from September 2013 to October 2015

Methodology: Eighty-seven patients of recurrent tonsillitis undergoing tonsillectomy were included. All the patients, after being anaesthetised, had surface swabs taken from the tonsillar surface followed by tonsillar aspiration with a 5cc syringe. Following tonsillectomy, the tonsils were sent for culture of core flora. All three specimens from each patient were cultured according to established criteria

Results: The patient population had 33 [37%] female and 54 [62%] male patients. Flora of 12 [13.8%] surface swabs and 68 [78.2%] tonsillar aspirates matched the flora cultured from core of the tonsils. Chi-square test showed this difference to be significant [p-value <0.001]

Conclusion: Tonsillar aspiration gave a much more realistic picture of the tonsillar core flora as compared to surface swabs

Prevalence of the Helicobacter pylori in the tonsils and adenoids / Prevalência do Helicobacter pylori em amígdalas e adenoides

INTRODUCTION: There is an ongoing debate about the existence and effects of Helicobacter pylori (Hp) in adenotonsillar tissue. OBJECTIVE: A clinical study was conducted to assess the existence of Hp in the adenoid and/or adenotonsillar tissues, which were surgically excised due to chronic adenotonsillitis. METHODS: Phosphoglucosamine mutase gene for the detection of Hp and cytotoxin-associated gene as virulence gene were examined in 84 adenotonsillar tissues obtained from 64 patients and patients' serum by using polymerase chain reaction. RESULTS: Hp IgG was detected in 57 (89%) patients' serum. A total of seven tissue samples from 64 patients (10.9%) were found positive for Hp DNA, of which five were adenoids and two were tonsil tissues. All polymerase chain reaction positive samples were also positive for the cytotoxin-associated gene, which is a virulence determinant for the organism. CONCLUSION: This study suggests that children are exposed to Hp at an early age of their life in this province. Hp may have a role in the pathogenesis of chronic adenotonsillitis, especially in endemic areas. .

INTRODUÇÃO: Há um debate atual sobre os efeitos da Helicobacter pylori (HpHp) no tecido adenotonsilar. OBJETIVO: Conduzimos um estudo clinico para avaliar a existência de Hp nos tecidos adenoideano e/ou adenotonsilar, os quais foram removidos cirurgicamente em decorrência de adenotonsilite crônica. MÉTODO: No total, 84 amostras de tecido obtidos de 64 pacientes foram analisadas para o gen fosfoglucosamina mutase para a detecção de Hp. Os casos positivos foram a seguir examinados para o gen associado à citotoxina, relacionado à virulência, usando-se o método de Reação de Polimerase em Cadeia (PCR). RESULTADOS: A IgG de Hp foi detectado em 57 (89%) soros de pacientes. Sete amostras de tecido de sessenta e quatro pacientes (10.9%) resultou positivo para o DNA de Hp, das quais cinco eram adenóides e duas eram tecido tonsilar. No PCR todas as amostras foram também positivas para o gen associado à citotoxina, o qual é um determinante de virulência. CONCLUSÃO: Esse estudo sugere que as crianças são expostas ao Hp nos primeiros anos de vida nessa província e que o Hp pode ter um papel na patogênese da adenotonsilite crônica, principalmente em áreas endêmicas. .

Quantitative real-time polymerase chain reaction for detecting Mycoplasma hyosynoviae and Mycoplasma hyorhinis in pen-based oral, tonsillar, and nasal fluids

Mycoplasma (M.) hyorhinis and M. hyosynoviae are pathogens known to cause disease in pigs post-weaning. Due to their fastidious nature, there is increased need for culture-independent diagnostic platforms to detect these microorganisms. Therefore, this study was performed to develop and optimize quantitative real-time PCR (qPCR) assays to rapidly detect M. hyorhinis and M. hyosynoviae in pen-based oral fluids as well as nasal and tonsillar fluids as proxies for samples used in swine herd surveillance. Two methods of genomic DNA extraction, automated versus manual, were used to compare diagnostic test performance. A wean-to-finish longitudinal study was also carried out to demonstrate the reproducibility of using pen-based oral fluids. Overall, pen-based oral and tonsillar fluids were more likely to be positive for both types of bacteria whereas only M. hyorhinis was detected in nasal fluids. DNA extraction protocols were shown to significantly influence test result. Although the initial detection time somewhat differed, both organisms were repeatedly detected in the longitudinal study. Overall, this study evaluated two qPCR methods for rapid and specific detection of either mycoplasma. Results from the present investigation can serve as a foundation for future studies to determine the prevalence of the two microorganisms, environmental load, and effectiveness of veterinary interventions for infection control.

[Study in vitro study of the efficacy of some antibiotic in preventing the adherence of some aerobic bacteria isolated from tonsil's core]

It was proven that biofilm formation had an important role in relapse infections and bacterial resistance against antibiotics in recurrent bacterial infections. Bacterial biofilm formation in crypts of tonsil's Core is considered as a major factor in the chronicity and treatment failure in patients with recurrent tonsillitis. According to that, we aimed in our study to evaluate the efficacy of some antibiotics recommended in recurrent tonsillitis in preventing the biofilm formation by some bacteria isolated from tonsil's core. We had worked on five aerobic species, isolated from tonsil's core of children suffering from recurrent tonsillitis and undergoing tonsillectomy, three were Gram Positive Cocci [Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes], and two were Gram Negative bacilli [Klebsiella pneumonia, Escherichia coli]. We evaluated efficacy of five different antibiotics, Amoxicillin clavulanic acid, Azithromycin, Lincomycin, Cefuroxime, and Ceftriaxone. Bacterial identification and Disk diffusion test were carried out through standard procedures. Evaluation of the anti adherence efficacy of the antibiotics were carried out by using "The microtiter plate assay". Our study shows that Azithromyin has the best efficacy on the Gram Positive Cocci adherence, followed by Cephalosporin, and Augmentin, while Lincomycin increased the adherence's rate. Ceftriaxone has the best efficacy on the Gram Negative Bacilli adherence, while Lincomycin and Cefuroxime increased the adherence's rate, and Augmentin and Azithromycin have no effect on the adherence

Achado de bactérias selecionadas em crianças de Trinidad com doença amigdaliana crônica / Selected bacterial recovery in Trinidadian children with chronic tonsillar disease

Faringoamigdalite na população pediátrica é largamente tratada com antibióticos. OBJETIVO: Estudar a microflora presente na superfície e no núcleo de amígdalas após adenoamigdalectomia eletiva em crianças. MÉTODO: Amígdalas de 102 crianças de Trinidad foram prospectivamente estudadas por meio de culturas e identificações bacteriológicas feitas a partir de amostras das superfícies e núcleos de suas amígdalas entre 2005-2006. RESULTADOS: A partir de 360 amígdalas, foram isolados Streptococcus spp. (51,3 por cento), Staphylococcus spp. (42,3 por cento) e Gram-Negativos (6,4 por cento). A identificação de estafilococos e estreptococos tanto na superfície quanto no núcleo foi semelhante (p>0,05). Encontramos mais (p<0,001) Streptococcus spp. nas superfícies (82,2 por cento) do que nos núcleos (63,3 por cento); a prevalência de estreptococos alfa-hemolíticos foi maior (p<0,001) do que aquela de estreptococos beta-hemolíticos nas superfícies (74,4 por cento vs. 18,6 por cento) do que nos núcleos (58,9 por cento vs. 13,7 por cento). Não houve concordância entre superfícies e núcleos com relação a estreptococos (p<0,0004) e estreptococos alfa-hemolíticos (p<0,007). Estreptococos beta-hemolíticos foram mais identificados (p<0,05) em crianças dentre 6-16 anos do que naquelas entre 1-5 anos de idade (31 por cento e 23,8 por cento vs 12,5 por cento e 8 por cento). A prevalência de S. pyogenes na superfície e no núcleo foi de (84,6 por cento vs 70 por cento) e (50,0 por cento vs 25,0 por cento) em crianças de maior faixa etária e crianças mais novas, respectivamente. Klebsiella spp. (6,6 por cento, 2,2 por cento), Proteus (4,4 por cento, 4,4 por cento) e Pseudomonas (4,4 por cento, 1,1 por cento) cresceram nas superfícies e núcleos, respectivamente. CONCLUSÃO: As superfícies amigdalianas tinham mais estreptococos e estreptococos hemolíticos do que seus núcleos. Crianças mais velhas tiveram mais estreptococos beta-hemolíticos, e são altamente colonizadoras...

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 percent), Staphylococcus spp. (42.3 percent) and Gram-negative genera (6.4 percent). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2 percent) than cores (63.3 percent) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than ß-haemolytic Streptococcus on surfaces (74.4 percent vs. 18.6 percent) than cores (58.9 percent vs. 13.7 percent). 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 percent and 23.8 percent vs 12.5 percent and 8 percent). S. pyogenes surface and core prevalence was (84.6 percent vs 70 percent) and (50.0 percent vs 25.0 percent) in older and younger children respectively. Klebsiella spp. (6.6 percent, 2.2 percent), Proteus (4.4 percent, 4.4 percent) and Pseudomonas (4.4 percent, 1.1 percent) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for α haemolytic streptococci. Older children grow more β-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested.

Tonsillar microbial flora: a comparison of infected and non-infected tonsils.

OBJECTIVE: The main objective of this study was to find out the most common organism affecting the tonsils in recurrent tonsillitis. METHODOLOGY: This was a prospective study consisting of total number of 50 patients, conducted in the ENT department of Dhulikhel Hospital, KUTH, Dhulikhel, Nepal. The study period was one year and three months (March 2004 to April 2005). RESULTS: Total numbers of 50 patients were selected, of which 32 were of acute tonsillitis and 18 were taken as control. Among these males were 32 and females were 18. The age group was from 3 years to 64 years. Throat swabs of patients were taken by aseptic method and were sent to the laboratory immediately. Among the infected tonsils the most common organism was Streptococcus viridans followed by Streptococcus pneumoniae and Moraxella catarrhalis. The third most common was Beta haemolytic streptococci whereas Micrococcus was not isolated in any of the infected samples. Likewise in non-infected tonsils, the most common organism isolated was again Streptococcus viridans followed by Micrococcus and Diptheroids. In these specimen no Beta haemolytic streptococci was isolated from the control group. CONCLUSION: Thus, the study is able to put forward the fact that most common organism affecting the tonsils in infected as well as non- infected state is Streptococcus viridans. Where as Beta haemolytic streptococci was not found in non-infected tonsils, likewise Micrococcus was not found in infected tonsils.

The correlation of micro-organisms between tonsillar crypt culture and tonsillar core culture in chronic tonsillitis.

OBJECTIVES: This study was undertaken to seek the correlation between tonsillar core and tonsillar crypt cultures and study the incidence of beta- lactamase producing bacteria (BLPB) in chronic tonsillitis patients. MATERIAL AND METHOD: The study was carried out in Department of Otolaryngology from Feb 2000 to Dec 2001. Patients with chronic tonsillitis who underwent tonsillectomy were enrolled, and culture results from tonsillar crypts were compared with tonsillar core. RESULTS: The tonsil were removed from 61 patients. Age ranging from 2-14 years (n=21) and 15-50 years (N= 40); H. influenza (25.2%), S. aureus (23.4%), and S. viridian (11.3%) were isolated from tonsillar core, while 25.9% and 24% of organisms isolated from tonsillar crypt were H. influenza and S. aurieus, respectively. Correlations between tonsillar core and tonsillar crypt culture were 100% specificity for Group A beta hemolytic streptococcocus (GABHS), 86.2% for H. influenza and 81.5% for S. aureus. Regarding beta-lactamase production, 29.2% of H. influenza were beta lactamase producing bacteria (BLPB), while 88.9% of S. aureus were BLPB. CONCLUSION: The present study demonstrates a high correlation in cultures obtained from tonsillar crypt and tonsillar core. The difference in isolated technique may account for the higher correlation when compared to previous studies. The incidence of beta- lactamase producing bacteria in chronic tonsillitis was high.

Surface and core flora in recurrent tonsillitis

Recurrent tonsillitis is managed by ENT surgeons quite frequently. Thirty five such patients underwent tonsillectomty and samples were taken from the surface and core of tonsillar tissue and sent for aerobic and anaerobic culture. Results revealed a marked discrepency between surface and core organisms. It was concluded that superficial throat swab has little role to identify all bacteria responsible. Therapeutic recommendations need to be reconsidered on these grounds

Panorama global da bacteriologia das amígdalas palatinas de crianças / Children palatine tonsils bacteriology: a comprehensive view

A microbiologia das amígdalas continua sendo assunto de muita discussäo. Este trabalho investiga a flora amigdaliana abrangendo-a em praticamente todas as situaçöes patogênicas e também normais. Foram colhidos swabs da superfície de amígdalas de 132 crianças normais (sem AR) em meses quentes (Q> (61 crianças) e frios (F) (71 crianças), de 64 crianças na fase aguda de amigdalite (AA) e de 76 com amigdalite recorrente (com AR, fora da fase aguda). Neste último grupo ainda foi realizado o estudo do core (interior) das amígdalas. Imediatamente após a coleta, o material era introduzido em meio específico e a cultura era realizada no máximo em 8 horas, seguindo padröes da microbiologia clínica. Como resultados, obtivemos uma alta prevalência de Streptococcus viridans nos três grupos. Entre o grupo Q e F foi notado que realmente existem diferenças sazonais, sendo Streptococcus viridans, Neisseria sp e enterobactérias mais freqüentes no grupo F. Comparando-se o grupo com AR e o sem AR vimos que Neisseria sp e enterobactérias säo mais freqüentes no sem AR. No grupo AA, Neisseria sp foi mais freqüente que no grupo normal (sem AR). Este trabalho é importante, pois traz a microbiologia das amígdaIas estudada de forma ampla, melhorando assim a interpretaçäo dos swabs e direcionando a um correto tratamento das afecçöes amigdalianas

Estudo microbiológico das amígdalas / Microbiology stydy on tonsils

Durante muitos anos o S. pyogenes foi considerado como principal bactéria envolvida nas amigdalites agudas e de repetiçäo. Nos estudos realizados fora do Brasil nós podemos verificar que esta incidência tem diminuído. Podemos notar o aumento da incidência do H. influenza, M. catarrhalis, S. aureus e outras. Pesquisamos as bactérias de 52 amígdalas de pacientes que foram submetidos a cirurgia. estes foram divididos em 3 grupos: amigdalites recorrentes, hipertrofia de amigdalas e de adenóides e amigdalites recorrentes com hipertrofia de amígdalas e de adenóides. Cultura de superfície e do interior ("core") foram realizadas nestes diferentes grupos. Comparamos os nossos achados bacteriológicos de superfície e "core" nos três diferentes grupos. Encontramos concordância de superfície e de "core" das seguintes bactérias no total: S.alfa hemolítico 82,6 porcento, H.influenzae 38,5 porcento, S.aureus 34,6 porcento. Todos os demais resultados comparativos säo apresentados e discutidos

Prevalence of throat infections in school children of Islamabad with special reference to streptococcal infections: I

A total number of 310 school children of both sexes under the age of 15 year, were investigated randomly for throat flora. It was revealed that 41.9% had bacterial pathogens isolated, comprising of Streptococcus group A [13%], Streptococcus non group A [14%] and Staphylococcus coagulase positive [13.9%], while Klebsiella pneumonae and Pseudomonas sp. were less than 1%. The rest of the pupils had normal throat flora. There was slight female preponderance to straptococcal infection. The pupils who had streptococcal infection, majority of them had raised anti-streptolysin [ASO] titre, enlarged tonsils and palpable tonsillar lymphnodes. Additional complaints of cold, cough and recurrent sore throat were also present in most of streptococcal group A positive group. There was declining tendency of streptococcal group A infection with increasing age

Study of the differences in microbiology between children and adults in cases of tonsillitis

This study was carried out on 100 patients, 50 of them were aged 1-5 years [children] and the others 50 were aged 15-40 years [adults]. The study was designed to examine and compare the aerobic bacteria of the surface of the tonsils of children and adults in cases of acute tonsillitis. The commonest organisms isolated from the tonsils of children were: Group A beta-hemolytic streptococci [38%], Staphylococcus aureus [20%], Streptococcus pneumonia [10%], Hemophilus influenza [8%] and diphteroids [8%]. In adults, the commonest organisms were: Staphylococcus aureus [34%], group A beta- hemolytic streptococci [22%], Escherichia coli [10%], Streptococcus pneumonia [4%] and Hemophilus influenza [4%]. This comparison may be of importance for the choice of the appropriate antibiotics for the treatment of tonsillitis in children and adults

Surface versus core aerobic and anaerobic tonsillar flora in recurrent tonsillitis

Routine throat swabs taken from the surface of the tonsils do not always predict the real tonsillar flora since the pathogens are usually located in the core of the tonsil. The tonsil surface and core cultures of 52 tonsillectomy cases were studied under aerobic and anaerobic conditions. Group A beta-hemolytic streptococcus was found to be the most common pathogen isolated in recurrent tonsillitis, and it was isolated more in the core cultures than the surface cultures. Beta-hemolytic streptococcus isolation was found to increase in anaerobic incubation. All of the beta-hemolytic streptococcus strains were sensitive to penicillin. In 58.3% of the isolated Staphylococcus aureus strains beta-lactamare activity was determined

Bacteriología comparativa de las amigdalitis agudas y crónicas en niños / Comparative bacteriology of acute and chronic tonsilitis in children

Se realiza un estudio bacteriológico del frotis amigdaliano de una muestra de 158 niños de 12 años o menos distribuidos en 4 grupos como sigue: Grupo A con 49 niños sanos; Grupo B con 52 niños con patología amigdaliana crónica sin enfermedad en el momento del estudio; Grupo C con 31 niños con patología amigdaliana aguda ocasional con enfermedad en el momento del estudio y Grupo D con 26 niños con patología amigdaliana crónica con enfermedad en el momento del estudio. Los resultados fueron sometidos a análisis estadístico. La presencia de Staphylococus aureus fue significamente mayor en los niños con amigdalitis aguda a repetición, estuvieran o no enfermos en el momento del estudio (grupos B y D) comparados con los niños sanos o con amigdalitis aguda ocasional (grupos A y C). Todos los demás gérmenes potencialmente patógenos encontrados no tenían relevancia estadísticamente significativa en la muestra analizada. Se concluyen los siguiente hexchos destacables: La Branhamella catarrhalis y el Streptococcus viridans son gérmenes presentes en todos los niños estudiados. En una patología amigdaliana aguda o crónica, la cantidad de microorganismos de la flora amigdaliana habitual está substancialmente aumentada en relación a la flora habitual de niños sanos de acuerdo a un recuento semicuantitativo en placa. El tratamiento habitual de una amigdalits con Penicilina, en cualquiera de sus formas, deberá considerar si se trata de una amigdalitis ocasional o bien de una amigdalitis crónica reagudizada, en el segundo caso deberá contemplarse la posibilidad de la existencia de un Staphylococcus aureus y asociar al tratamiento de un antibiótico antiestafilocócico, previo estudio bacteriológico. El hallazgo del Staphylococcus aureus en el cultivo del frotis amigdaliano de un niño con amigdalitis agudas a repetición, deberá ser considerado un eventual elemento de juicio más oara la calificación de cronicidad y ulterior decisión quirúrgica