Atypical pharyngitis in suppurative otitis media cases

ABSTRACT

Unexplained persistent or recurrent bacterial pharyngitis in some patients who are suffering from infected middle ear cleft. Bacteriological swabs were obtained from both ears and pharynx of thirty-seven cases with chronic otorrhea and perforation, who are complaining of recurrent or persistent sore throat. isolation and identification of the microorganisms were done. This included examination by direct Gram stained films and cultures. Isolated Gram-negative bacilli were subjected to further identification by biochemical reactions and antimicrobial susceptibility testing using modified Kirby Bauer disk diffusion method. Identical isolates from the same patient [ear and pharyngeal swabs] were subjected to further identification by genotyping using the pulsed field gel electrophoresis technique [PFGE]. Six cases [16%] showed identity in both phenotypes and genotypes for ear and pharyngeal samples from the same patient. Four of the isolates were Pseudomonas aeruginosa, one was Proteus mirabilis, and one was Escherichia coli. None of these three species is known to be among the primary organisms that may cause pharyngitis. Bacterial pharyngitis in patients with chronically infected middle ear cleft may be attributed to the same organism invading the middle ear mucosa. In addition, this study highlights some organisms as pharyngeal invaders although they are not among the previously documented causatives of bacterial pharyngitis. However, the study did not confirm the method of spread of these organisms between the middle ear cleft and the pharynx and did not prove whether the spread was directly via the eustachian tube or not. The study correlates the causative organism of the middle ear infection and that infected the pharyngeal mucosa by using phenotypic and genotypic bacteriological identification and typing methods: