Tonsillar colonisation of Fusobacterium necrophorum in patients subjected to tonsillectomy

Abstract

BackgroundFusobacterium necrophorum is a well-known cause of Lemirre’s disease and accumulating evidence support its pathogenic role in peritonsillar abscess while its role in recurrent and chronic tonsillitis is uncertain. The objective of this study was to assess the prevalence of oropharyngeal colonisation with F. necrophorum and Beta-haemolytic streptococci in a cohort of patients scheduled for tonsillectomy due to recurrent or persistent throat pain, and to evaluate the dynamics of colonisation with repeated sampling during a follow-up time of 6 to 8 months.MethodsFifty-seven (57) patients aged 15–52 years scheduled for tonsillectomy due to chronic/recurrent tonsillitis or recurrent peritonsillar abscess were included. Throat swabs for the detection of F. necrophorum and Beta-haemolytic streptococci and clinical data was collected at inclusion, at the time of surgery and 6 to 8 months after surgery. Statistical analysis was performed using the Chi-square, Fisher’s exact and Mc Nemar tests.ResultsFusobacterium necrophorum was found in 28, 30 and 16 % of the patients at inclusion, surgery and follow up respectively. The corresponding results for beta-haemolytic streptococci were 5, 9 and 5 %. Patients colonised with F. necrophorum at follow-up, after tonsillectomy, were equally relieved from their previous throat pain as non-colonised patients. Looking at individual patients, the culture results for F. necrophorum varied over time, indicating a transient colonisation.ConclusionFusobacterium necrophorum was frequently found in throat cultures in this cohort of patients with recurrent or chronic throat pain leading to tonsillectomy. Colonisation was equally frequent in the asymptomatic cohort post-tonsillectomy, indicating that F. necrophorum is not alone causative of the symptoms. In an individual perspective, colonisation with F. necrophorum was transient over time.

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

“…Infections of the middle ear or sinuses may rarely be complicated by intracranial abscess 15. Lemierre’s syndrome,16 from thrombophlebitis of the internal jugular vein associated with Fusobacterium necrophorum infection, is a rare complication of sore throat,16 but F necrophorum might be frequently detectable in patients with symptoms of sore throat 1718 The annual number of cases of Lemierre’s syndrome in England was reported to have increased from 19 in 1997 to 34 in 1999, prompting a reminder from the chief medical officer that some symptoms of sore throat may require antibiotic treatment 19.…”

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis

“…The majority of studies investigated primarily the prevalence of F. necrophorum pharyngitis in adolescents and young adults, ranging between 15 and 45 years old, since this is the age group reported to have the highest rates of peritonsillar abscesses and Lemierre's syndrome (15,16). The prevalence of F. necrophorum among this population is 10% to 48% (7,9,11,12,17). In contrast, the incidence of Lemierre's syndrome is low in younger children (18,19).…”

Implication of Fusobacterium necrophorum in recurrence of peritonsillar abscess

“…The implication of FN as a pathogenic driver for recurrent peritonsillar infections and abscesses fits within the continuum of our increasing awareness of FN presence with pharyngotonsillar infections and well‐established knowledge of FN generation of Lemierre syndrome . It is thus theorized that FN acts to colonize the oropharynx and result in recurrent infections/abscesses .…”