Tonsillitis

Tonsillitis is a common disease of childhood. It is extremely infectious in that it spreads easily by droplets. The incubation period is two to four days. The diagnosis of tonsillitis generally requires the consideration of group A beta-hemolytic Streptococcus (GABHS) infection. However, numerous other bacteria alone or in combinations (including Staphylococcus aureus and Haemophilus influenzae), viruses, and other infectious and noninfectious causes should be considered. Recognition of the cause and choice of appropriate therapy are of utmost importance in assuring rapid recovery and preventing complications.

The role of anaerobic bacteria in this infection is hard to elucidate because anaerobes are normally prevalent on the surface of the tonsils and pharynx, so that cultures taken directly from these areas are difficult to interpret. The anaerobic species that have been implicated in tonsillitis are Actinomyces, Fusobacterium, and pigmented Prevotella and Porphyromonas spp.

Anaerobes have been isolated from the cores of tonsils of children with recurrent GABHS (1) and non-GABHS (2,3) tonsillitis and peritonsillar abscesses (4). Beta-lactamase-producing strains of Bacteroides fragilis, Fusobacterium spp., H. influenzae, and S. aureus were isolated from the tonsils of 73% to 80% of children with GABHS recurrent tonsillitis (RT) (1,5,6) and from 40% of children of non-GABHS tonsillitis (2).

The failure to make a microbiological diagnosis for a known aerobic bacteria or viral pathogen in many cases of acute and RT argues for the possible role of anaerobes in this infection. A possible explanation is that the bacteria sampled by the surface swabbing technique are not an accurate reflection of the flora of the tonsillar tissue.(7-9)

It is known that deep tonsillar cultures yielded more GABHS and S. aureus (7-10). Comparison of surface and core cultures in a study of 23 chronically inflamed tonsils (9) showed discrepancies between the surface and core cultures in 30% of the aerobic isolates and in 43% of the anaerobic isolates. Although it is impractical to culture the core of the tonsil in patients, these findings indicate that the routine cultures obtained from the surface of the tonsils do not always represent the nature of the bacterial flora of the core of the tonsil, where potential pathogens such as GABHS or anaerobic bacteria may persist. Several investigators have suggested that hitherto unrecognized penicillin-sensitive bacteria may be responsible for many cases of non-streptococcal tonsillitis. The etiologic role of anaerobic bacteria, however, has received little attention until recently.

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