The role of haemophilus influenzae in the pathogenesis of tonsillar hypertrophy in children

Abstract

Tonsil core specimens of 54 children, (3 to 12 years) with clinical evidence of chronic tonsillitis and/or "idiopathic" tonsillar hypertrophy, were studied for the effect of the magnitude of aerobic bacterial load on tonsil size and the absolute numbers of B- and T-cell subsets. Tonsillar core specimens obtained from ten children with no history of ear, nose, or throat infections and normal appearing tonsils served as controls. The findings of this study indicate that tonsil size was directly proportional to the mean bacterial load in colony forming units/g tonsil (CFU/g) even in the absence of a clinical history of infection (p less than 0.01). A mean bacterial load of 2.4 +/- 2.1 X 10(5) CFU/g tonsil was seen in diseased tonsils as compared to 1.6 +/- 2.4 X 10(4) CFU/g tonsil in normal controls (p less than 0.01). Hemophilus influenzae (type B and non-B), Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes were the most common pathogens recovered in the largest numbers from diseased tonsils; control tonsils harbored few bacteria in their cores. The absolute number of immunocompetent cells/g tonsil including T-helper, T-suppressor and B-cells (S-Ig+), were significantly greater in diseased tonsils than in controls (p less than 0.001). Increasing microbial load (CFU/g tonsil) correlated with increased numbers of T-helper (p less than 0.01) and B-cells (p less than 0.01). These data strongly support a bacterial etiology for chronic tonsillitis as well as "idiopathic" tonsillar hypertrophy. Bacterial induced proliferation of immunocompetent cells may be one underlying mechanism for chronic tonsillar disease in children.

Is Fine Needle Aspiration of the Tonsil Superior to a Surface Swab for Isolating its Core Flora in Recurrent Tonsillitis?

“…In 36/77 cases (47%), core culture isolated H. influenzae, the most common organism, consistent with other reports. 7,12,13 But the proportion of our H. influenzae cases was much lower than reported by Timon et al 7 (31/34; 93.5%), which could be due to climatic differences. No differences were found in the number of H. influenzae grown by FNA and surface swab, 32/77 (41.5%) each (Figure 2).…”

Estudo microbiológico do core e superfície das amígdalas palatinas em crianças portadoras de faringoamigdalites de repetição e hipertrofia adenoamigdaliana

“…Acredita-se que esta hipertrofia poderia estar relacionada à colonização local por microorganismos, que estimulariam a proliferação de elementos linfóides, que por sua vez seria a principal causa da hipertrofia amigdaliana; e não o aumento do tecido estromal. Estes estudos mostram que a quantidade de células T-helper, T-supressor e células B é muito maior em amígdalas hipertróficas em relação aos controles 1,14 . Apesar de alguns estudos sugerirem a associação do H.influenzae e a hipertrofia amigdaliana 1 , no nosso estudo, nas crianças portadoras de hipertrofia adenoamigdaliana, em todas as faixas etárias estudadas, tanto na superfície quanto no core amigdaliano, a presença do S.aureus foi mais importante do que nas crianças que apresentavam infecções de repetição, sugerindo uma associação entre esta bactéria e o crescimento exagerado das amígdalas.…”

“…O conhecimento da flora bacteriana que coloniza as amígdalas palatinas tem se tornado cada vez mais importante, tanto pela sua relação com as infecções de repetição quanto pela possível associação com a hipertrofia amigdaliana 1,2 . Na população geral, acredita-se que a prevalência do S.pyogenes que coloniza a orofaringe seja ao redor de 25% 3 .…”

Evaluation Of Growth Indices In Children With Recurrent Pharyngotonsilitis Due To Adenotonsilar Hypertrophy: A Case Control Study

“…It's possible that the above mentioned matters and the other problems such as shortage in growth hormone secretion, loss of appetite, dysphagia and cause an interruption in growth procedure, so this research is based on comparison of wheight and height between the children in case and control groups. Due to the reports from Brodsky and coworkers chronic adenotonsilar hypertrophy cause an overload of pathogen bacteria specially b-lactamase enzyme secreting species in tonsils and adenoid tissues [1,2,3,4] .…”