Microbiology of parapharyngeal abscesses in adults: in search of the significant pathogens

AbstractWe aimed to describe the microbiology of parapharyngeal abscess (PPA) and point out the likely pathogens using the following principles to suggest pathogenic significance: (1) frequent recovery, (2) abundant growth, (3) growth in relative abundance to other microorganisms, (4) percentage of the isolates recovered in both absolute and relative abundance, (5) more frequent recovery in PPA pus compared with tonsillar surface and tissue. Comprehensive bacterial cultures were performed on specimens obtained from adult patients (n = 60) with surgically verified PPA, who were prospectively enrolled at five Danish ear-nose-throat departments. The prevalent isolates (in PPA pus) were unspecified anaerobes (73%), non-hemolytic streptococci (67%), Streptococcus anginosus group (SAG) (40%), Corynebacterium spp. (25%), Neisseria spp. (23%), Fusobacterium spp. (22%), Fusobacterium necrophorum (17%), Prevotella spp. (12%), and Streptococcus pyogenes (10%). The bacteria most frequently isolated in heavy (maximum) growth were unspecified anaerobes (60%), SAG (40%), F. necrophorum (23%), and Prevotella spp. (17%). The predominant microorganisms (those found in highest relative abundance) were unspecified anaerobes (53%), SAG (28%), non-hemolytic streptococci (25%), F. necrophorum (15%), S. pyogenes (10%), and Prevotella spp. (10%). Four potential pathogens were found in both heavy growth and highest relative abundance in at least 50% of cases: F. necrophorum, Prevotella spp., SAG, and S. pyogenes. SAG, Prevotella spp., F. necrophorum, S. pyogenes, and Bacteroides spp. were recovered with the same or higher frequency from PPA pus compared with tonsillar tissue and surface. Our findings suggest that SAG, F. necrophorum, Prevotella, and S. pyogenes are significant pathogens in PPA development.

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Tonsillar Inflammation, a Rare Cause of Bradycardia and Hypotension

Medical & Clinical Research ◽

10.33140/mcr.03.03.03 ◽

2018 ◽

Vol 3 (3) ◽

Keyword(s):

Streptococcus Pyogenes ◽

Fusobacterium Necrophorum ◽

Outpatient Setting ◽

Peritonsillar Abscess ◽

The Other ◽

Streptococcus Group ◽

Other Hand ◽

Group A

Tonsillitis is a frequently encountered pathology in the outpatient setting, usually caused by viruses [1]. When bacterial, the most common causatory microbe is streptococcus group A [1]. Tonsillar and peritonsillar abscess (PTA) on the other hand are never viral, and are usually caused by streptococcus pyogenes, Streptococcus melleri, fusobacterium necrophorum and staphylococci [1,2]. The overall incidence of PTA is suggested to be 37/100,000 patients, with the highest incidence between ages 14-21 at 124/100,000 [3].

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Members of a new subgroup of Streptococcus anginosus harbor virulence related genes previously observed in Streptococcus pyogenes

International Journal of Medical Microbiology ◽

10.1016/j.ijmm.2017.02.002 ◽

2017 ◽

Vol 307 (3) ◽

pp. 174-181 ◽

Cited By ~ 10

Author(s):

Anshu Babbar ◽

Venkatesan Naveen Kumar ◽

René Bergmann ◽

Israel Barrantes ◽

Dietmar H. Pieper ◽

...

Keyword(s):

Streptococcus Pyogenes ◽

Streptococcus Anginosus

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Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity

PLoS ONE ◽

10.1371/journal.pone.0189423 ◽

2018 ◽

Vol 13 (1) ◽

pp. e0189423 ◽

Cited By ~ 5

Author(s):

T. Prescott Atkinson ◽

Robert M. Centor ◽

Li Xiao ◽

Fuchenchu Wang ◽

Xiangqin Cui ◽

...

Keyword(s):

Young Adults ◽

Sore Throat ◽

Relative Abundance ◽

Fusobacterium Necrophorum ◽

Low Diversity

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Inhibition of hemolytic activity of Streptococcus pyogenes in mechanisms of antibacterial action of zinc ions

Journal of microbiology epidemiology immunobiology ◽

10.36233/0372-9311-2019-5-16-23 ◽

2019 ◽

pp. 16-23

Author(s):

S. B. Cheknev ◽

E. I. Vostrova ◽

M. A. Sarycheva ◽

A. V. Vostrov

Keyword(s):

Growth Inhibition ◽

Streptococcus Pyogenes ◽

Hemolytic Activity ◽

Inhibitory Action ◽

Bacterial Culture ◽

Copper Ions ◽

Zinc Ions ◽

Bacterial Cells ◽

Bacterial Cultures ◽

Culture Growth

Aim. The work was performed with the purpose to study a hemolytic activity in the culture of S.pyogenes under the inhibitory action of millimolar concentrations of zinc ions.Materials and methods. Suspensions of S.pyogenes bacteria which contained 108 CFU/ml were sown by the lawns into the standard Petri dishes coated with the supplemented Blood Nutrient Agar. 30 min later the salt solutions of zinc or copper which contained the metals at the concentrations ranged between 5 x 10-3 M to 5 x 10-1 M were added by the 5 μl drops on the surfaces of the lawns with use of 36-channel stamp replicator. Then the dishes with bacterial cultures were incubated for 24 hrs at 37°C followed by measuring diameter of the area of culture growth inhibition and of the area of inhibition of hemolysis. The study was performed with use of controls towards measuring the state of bacterial cells obtained from different zones of the areas.Results. In presence of the zinc ions concentrations ranged between 50 to 500 mM the area of the growth inhibition of S.pyogenes was surrounded on the lawn of the bacterial culture by the area of the inhibition of hemolysis where the growth inhibition of S.pyogenes was not registered. Copper ions did not form such an area of the hemolysis inhibition.Conclusion. Inhibitory action of zinc ions on the hemolytic S.pyogenes activity in the culture seems to be specific and reversible, and is discussed in a context of the antivirulent zinc ions properties.

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A mikrobiológiai vizsgálatok szerepe a peritonsillaris tályog kezelésében hat év anyagának retrospektív elemzése alapján

Orvosi Hetilap ◽

10.1556/650.2020.31843 ◽

2020 ◽

Vol 161 (44) ◽

pp. 1877-1883

Author(s):

Eszter Erdélyi ◽

Andrea Ambrus ◽

Linda Szabó ◽

Ágnes Kiricsi ◽

Erzsébet Nagy ◽

...

Keyword(s):

Antibiotic Therapy ◽

Streptococcus Pyogenes ◽

Healing Process ◽

Fusobacterium Necrophorum ◽

Peritonsillar Abscess ◽

International Studies ◽

Deep Neck Infection ◽

Adequate Treatment ◽

Neck Infection ◽

Disease Pattern

Összefoglaló. Bevezetés és célkitűzés: A peritonsillaris tályog a leggyakoribb mély nyaki infekció. Olyan fül-orr-gégészeti kórkép, amely megfelelő kezelés nélkül életveszélyes szövődményekkel járhat. Döntő jelentőségű az empirikus antibiotikumválasztás, melyhez ismerni kell a leggyakoribb kórokozókat és a várható rezisztenciát. Módszerek: A 2012 és 2017 között peritonsillaris tályog miatt kezelt esetek retrospektív feldolgozását végeztük. Összesítettük a sebészi beavatkozás során vett minták aerob és anaerob irányú tenyésztési eredményeit, valamint az empirikusan választott antibiotikumokat. A rutinszerű mikrobiológiai tenyésztés alapján meghatároztuk a leggyakoribb kórokozókat. Az adatokat nemzetközi felmérések eredményeivel hasonlítottuk össze. Eredmények: A vizsgált 6 év során 217 esetben kezeltünk peritonsillaris tályogos beteget. A tenyésztési eredményeket csak 146 esetben tudtuk elemezni. Ebből 47 esetben került sor Fusobacterium species (ebből 25 esetben Fusobacterium necrophorum), 31 esetben Actinomyces species és 29 esetben Streptococcus pyogenes izolálására. Az esetek kétharmadában vegyes aerob/anaerob baktériumflórát izolált a laboratórium. Következtetés: A tályogok kezelésében önmagában a sebészi beavatkozás – az anaerob környezet megszüntetésével – jelentős klinikai javulást eredményez. A jól választott antibiotikum meggyorsíthatja a lefolyást, és csökkentheti az esetleges szövődményeket. Nagy jelentősége van a megfelelő mikrobiológiai mintavételnek, nem vagy nehezen gyógyuló esetekben ez teremtheti meg a célzott antibiotikumterápiára történő váltás lehetőségét. Felmérésünk alapján a peritonsillaris tályogok jelentős részét vegyes baktériumflóra okozza, így a szájüregi anaerob baktériumokra is ható amoxicillin–klavulánsav vagy antibiotikum kombinációjának (2. vagy 3. generációs cefalosporinok kombinálva klindamicinnel vagy metronidazollal) alkalmazása javasolt mint empirikus antibiotikumterápia. Orv Hetil. 2020; 161(44): 1877–1883. Summary. Introduction and objective: Peritonsillar abscess is the most common deep neck infection. Without adequate treatment, this otolaryngological disease pattern can cause life-threatening complications. The empirical choice of antibiotics is crucial which requires knowledge of the most common pathogens and the potential resistance. Methods: A retrospective analysis of cases treated for peritonsillar abscess was performed between 2012 and 2017. We summarized the aerobic and anaerobic culture results of the surgical samples and the empirically selected antibiotics. The most common pathogens were determined via routine microbiological culture tests. We compared our data with the results of international studies. Results: During the 6-year study at our Clinic, 217 patients with peritonsillar abscess were treated. The microbiological tests were available for analysis in only 146 cases. In 47 cases, Fusobacterium species (including 25 cases with Fusobacterium necrophorum), in 31 cases Actinomyces species and in 29 cases Streptococcus pyogenes were isolated. In 2/3 of the patients, polymicrobial infection was detected. Conclusion: In the treatment of peritonsillar abscesses, surgical intervention can result in clinical improvement because of the elimination of the anaerobic milieu. A well-chosen antibiotic can accelerate the healing process and reduce the complication rate. Proper microbiological sampling is of great importance, and in cases of non-recovery or poor recovery, this may create the opportunity to switch for targeted antibiotic therapy. The results of this study show that polymicrobial flora is very important for the development of the peritonsillar abscess, thus the recommended antibiotic therapy is amoxicillin–clavulanic acid or 2nd/3rd generation cefalosporin combined with metronidazol or clindamycin. Orv Hetil. 2020; 161(44): 1877–1883.

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