Microbiological Findings in Children with Adeno-Tonsillar Hypertrophy


Authors: J. Kraus 1;  M. Glasnák 2;  E. Nártová 3;  E. Pavlík 4;  J. Astl 5
Authors‘ workplace: ORL oddělení Nemocnice Rudolfa a Stefanie Benešov, a. s., primář MUDr. J. Kraus, Ph. D., MBA 1;  Oddělení klinické mikrobiologie Nemocnice Rudolfa a Stefanie Benešov, a. s., primář MUDr. M. Glasnák 2;  ORL klinika 3. LF UK a FN Královské Vinohrady, Praha, přednosta MUDr. M. Chovanec, Ph. D. 3;  Ústav imunologie a mikrobiologie 1. LF UK a VFN, Praha, přednosta prof. MUDr. I. Šterzl, CSc. 4;  ORL klinika 3. LF UK a ÚVN, Praha, přednosta prof. MUDr. J. Astl, CSc. 5
Published in: Otorinolaryng. a Foniat. /Prague/, 65, 2016, No. 1, pp. 18-23.
Category: Original Papers

Overview

Introduction:
The exact cause of adenotonsillar hypertrophy is not clear, but association with chronic or recurrent infection and thus with microbiologic findings in the pharynx is accounted. Pharyngeal flora contains a wide range of bacteria, including commensals and also potential pathogens. The aim of the study was to determine the microbiological profile of the upper respiratory and digestive tract in children with sleep related disorders caused by adenotonsillar hypertrophy and the potential relevance of bacterial colonization for the development of the disease. The research included commonly occurring flora, obligate and potential pathogens. Susceptibility to antibiotics was tested in positive cases.

Material and methods:
A group of 37 children with adenotonsillar hypertrophy indicated for surgery were followed in a prospective study. At the beginning of each surgical procedure the sample of tissue was taken. A total of 49 samples was collected, 32 from adenoids and 17 from tonsils. All samples were examined for the presence of common pharyngeal pathogens.

Results:
The most common microbiological finding was normal bacterial flora that means normal bacterial colonization of the mucous membranes. But nearly two-thirds of the samples contained a potential pathogen. The most frequently present bacteria were Streptococcus pyogenes group A, beta-hemolytic Streptococci group C and Staphylococcus aureus. All strains of beta-hemolytic Streptococci have been well sensitive to penicillin. The resistance to erythromycin has been detected in twenty percent. The strains of Staphylococcus aureus have revealed good susceptibility to cefoxitin and co-trimoxazol.

Conclusion:
Microbiological profile of common bacteria in the pharynx with adenotonsillar hypertrophy is not different from the findings in healthy subjects. Limited effect of antibiotics and good efficacy of surgery may be explained by the forming of biofilms on the mucous surface. The territorial status of antibiotic resistance is still favorable.

Keywords:
adenoidectomy, tonsillectomy, children, adenotonsillar hypertrophy, bacterial flora, pharynx


Sources

1. Al-Mazrou, K. A., Al-Khattaf, A. S.: Adherent biofilms in adenotonsillar diseases in children. Arch. Otolaryngol. Head Neck Surg., 134, 2008, 1, s. 20-23.

2. Bednář, M., Fraňková, V., Schindler, J. et al.: Lékařská mikrobiologie. Praha, Marvil, 1996.

3. Brook, I.: Effects of antimicrobial therapy on the microbial flora of the adenoids. J. Antimicrob. Chemother., 51, 2003, 6, s. 1331-1337.

4. Brook, I., Shah, K.: Effect of amoxycillin with or without clavulanate on adenoid bacterial flora. J. Antimicrob. Chemother., 48, 2001, 2, s. 269-273.

5. DeDio, R. M., Tom, L. W. C., McGowan, K. L. et al.: Microbiology of the tonsils and adenoids in a pediatric population. Arch. Otolaryngol. Head Neck Surg., 114, 1988, 7, s. 763-765.

6. Don, D. M., Goldstein, N. A., Crockett, D. M. et al.: Antimicrobial therapy for children with adenotonsillar hypertrophy and obstructive sleep apnea: A prospective randomized trial comparing azithromycin vs placebo. Otolaryngol. Head Neck Surg., 133, 2005, 4, s. 562-568.

7. Galli, J., Calo, L., Ardito, F. et al.: Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis. Acta Otorhinolaryngol. Ital., 27, 2007, 3, s. 134-138.

8. Garcia-Rodriguez, J. A., Martinez, M. J. F.: Dynamics of nasopharyngeal colonization by potential respiratory pathogens. J. Antimicrob. Chemother, 50, 2002, Suppl. S2, s. 59-73.

9. Glasnák, M.: Laboratorní příručka pro odběr primárních vzorků. Laboratorní příručky Nemocnice Rudolfa a Stefanie Benešov. Dostupné z URL: http://www.hospital-bn.cz/data/articles/down_1480.pdf.

10. Kraus, J., Nártová, E., Pavlík, E. et al.: Prevalence of Helicobacter pylori in adenotonsillar hypertrophy in children. Acta Otolaryngol., 134, 2014, 1, s. 88-92.

11. Křížová, P., Lebedová, V., Beneš, Č.: Vliv rutinní vakcinace v České republice na výskyt invazivních onemocnění způsobených Haemophilus influenzae b. Klin. Mikrobiol. Inf Lék, 10, 2004, 3, s. 118-123.

12. Mobbs, K. J., van Saene, H. K. F., Sunderland, D. et al.: Oropharyngeal gram-negative bacillary carriage - A survey of 120 healthy individuals. Chest, 115, 1999, 6, s. 1570-1575.

13. Niedzielski, A., Korona-Glowniak, I., Malm, A.: High prevalence of Streptococcus pneumoniae in adenoids and nasopharynx in preschool children with recurrent upper respiratory tract infections in Poland – distribution of serotypes and drug resistance patterns. Med. Sci. Monit, 19, 2013, s. 54-60.

14. Nistico, L., Kreft, R., Gieseke, A. et al.: Adenoid reservoir for pathogenic biofilm bacteria. J. Clin. Microbiol., 49, 2011, 4, s. 1411-1420.

15. Rajeshwary, A., Rai, S., Somayaji, G. et al.: Bacteriology of symptomatic adenoids in children. N. Am. J. Med. Sci., 5, 2013, 2, s. 113-118.

16. Sulikowska, A., Grzesiowski, P., Sadowy, E. et al.: Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolated from the nasopharynges of asymptomatic children and molecular analysis of S. pneumoniae and H. influenzae strain replacement in the nasopharynx. J. Clin. Microbiol., 42, 2004, 9, s. 3942-3949.

17. Zemlickova, H., Urbaskova, P., Adamkova, V. et al.: Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus isolated from the nasopharynx of healthy children attending day-care centres in the Czech Republic. Epidemiol. Infect., 134, 2006, 6, s. 1179-1187.

18. Žemličková, H.: Penicilinová ATB – chyby a mýty v jejich podávání. Medical tribune, 8, 2012, 19, C1-C2

Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account