Microbiology of peritonsillar abscess in the South Estonian population

Abstract

ObjectiveThe first aim of this study was to compare the microbiota of different locations (pus, tonsillar fossa, blood) in peritonsillar abscess (PTA) patients in order to optimize the sampling scheme. The second aim was to estimate the occurrence of tonsillitis episodes and macroscopic oropharyngeal signs characteristic of recurrent tonsillitis in PTA patients.MethodsThe study group consisted of 22 consecutive patients with PTA undergoing bilateral tonsillectomy. The PTA was punctured; pus and tonsillar fossa biopsy samples and the peripheral blood cultures were collected. The index of tonsillitis was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. Macroscopic oropharyngeal signs were evaluated and they were as follows: tonsillar sclerosis, obstruction of the tonsillar crypts, scar tissue on tonsils, cryptic debris, and lymphatic tissue aggregates.ResultsThe cultures of the pus were positive in 16 out of 22 patients and the cultures of the tonsillar fossa samples were positive in all cases. In total, 62 different organisms were found from tonsillar fossa, pus, and blood samples, which belonged to 5 different phyla and 18 different families.In the tonsillar fossa, the most frequent bacteria found were Streptococcus spp. In pus samples, the most frequently found bacteria were Streptococcus spp. and bacteria from the Streptococcus milleri group.ConclusionPTA patients had mixed anaerobic and aerobic microbiota both in the tissue of the tonsillar fossa and the pus of the peritonsillar space. We demonstrated that the tonsillar fossa specimen is a better material for microbiological analyses, because it reveals more bacteria per culture. PTA patients usually have a low number of tonsillitis episodes in their previous history, but a relatively high number of macroscopic oropharyngeal signs, indicating the sclerotic process in palatal tonsils.

Peritonsillar abscess: an 8-year retrospective, culture based evaluation of 208 cases

“…The role of Actinomyces spp. in the oropharyngeal region is also suggested by some recent studies such as in tonsillitis and lymphoid hyperplasia, but was isolated from PTA samples as well [10, 32, 36–38]. In the present study A.…”

“…The role of Actinomyces spp. in the oropharyngeal region is also suggested by some recent studies such as in tonsillitis and lymphoid hyperplasia, but was isolated from PTA samples as well [10,32,[36][37][38]. In the present study A. odontolyticus or other Actinomyces species (such as A. gravenitzii, A. meyeri, A. naeslundii and some others which were not identified by the MALDI-TOF MS) were isolated in 55 of 125 (44 %) polymicrobial PTA cases, however only two cases were found where A. odontolyticus was the only pathogen.…”

“…pyogenes and F. necrophorum in PTA seen in different age groups, several authors reported the presence of other anaerobic species with a possible important role in the process [2, 8, 10, 24, 31, 32]. They agree that it is difficult to pinpoint the pathogenic role of frequently isolated species (mostly anaerobic bacteria) in the process, knowing the very complex composition of the oral microbiome [33, 34].…”

Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis

“…Several studies analyzed the influence of lymphocytes and the adaptive immune system on acute and recurrent tonsillitis and the triggering pathogens [ 2 , 5 , 11 ]. To our knowledge, this is the first report of a correlation between elevated expression of S100A8/A9 and AT, PC, and PTA suggesting an important role of the innate immune response in disease development.…”

“…The most common severe head and neck infection is the peritonsillar abscess (PTA) which is a very frequent reason for nonelective otolaryngological hospital admission [ 4 ]. Extension of an acute tonsillitis or an infection of Weber's salivary glands in the supratonsillar fossa was discussed to be the associated pathomechanisms of PTA which is characterized by an accumulation of pus between the fibrous capsule of the palatine tonsil and the pharyngeal constrictor muscle [ 5 , 6 ]. Due to the level of the uvula tip, peritonsillar abscesses can be divided into superior and inferior types.…”