Modern understanding about the role of group A β -hemolytic streptococcus in acute tonsillitis

Objective: assess the modern value of group А β-hemolytic streptococcus in patients with acute tonsillitis and the effectiveness of the rapid streptococcal antigen detection method.Materials and methods: microbial landscape assessment of acute tonsillitis was based on retrospective analysis of 902 bacterial culture results of a throat swab of patients with syndromes of acute tonsillitis treated in the Infectious Diseases Clinic of the Military Medical Academy named after S.M. Kirov during the period of 2019-2020. The effectiveness of the rapid streptococcal antigen detection method in the oropharynx was determined by a prospective study involving 35 patients with acute tonsillitis.Results: in the study, we have found that bacterial culture results of a throat swab, the following were more common: Nesseria species (39 %), Streptococcus viridans (23 %), and Staphylococcus aureus (17 %). The frequency of detection of β-hemolytic streptococcus was 1 %. The rapid diagnostic system «Streptatest» in patients with acute tonsillitis has demonstrated efficiency, under which that sensitivity of test was 80 %, specificity – 90 %, positive predictive value – 57,14 %, negative predictive value – 96,43 %.Conclusions: the frequency of group A β-hemolytic streptococcus in patients with lesion of lymphoid tissues of the oropharynx has declined significantly nowadays. The rapid diagnostic system «Streptatest» is a highly effective medical product that can be used in both hospital and pre-hospital stage.

Purpura Fulminans in a 20-Year-Old Female

A previously healthy 20-year-old female presented with extensive retiform purpura located at the face, upper and lower limbs, one week after an episode of acute tonsillitis. Despite the exuberance of the cutaneous findings and progression to skin necrosis she had no accompanying symptoms. Laboratory investigation revealed a heterozygous protein C mutation (exon 9, c.1332G> C, p.Trp444Cys), accounting for a partial deficiency of this anticoagulant protein. The patient was started on broad spectrum antibiotics, anticoagulation and systemic corticosteroids, with no lesional progression and complete resolution of cutaneous ulceration within 6 months. This is a singular case of purpura fulminans, since two different causative factors precipitated the events. The previous tonsillitis reported by the patient is significant, because the serum concentration of protein S may also decrease after an infectious event - post-infectious purpura fulminans. This case illustrates that purpura fulminans due to autoantibodies against protein S, although rare, should be considered, especially in the absence of a severe acute infection. It also illustrates how in a given patient different independent factors can act simultaneously, triggering potentially devastating clinical scenarios.

Tonsillitis-Related Arthritis: Advanced Understandings of Tonsillitis and Sterile Inflammatory Arthritis

A 49-year-old man developed acute aseptic arthritis of the nonmigratory and asymmetrical type in his knee, ankle, and bilateral metatarsal joints 13 days after treatment with antibiotics for acute tonsillitis. He was diagnosed with tonsillitis-related arthritis after other rheumatic diseases were ruled out. Treatment with salazosulfapyridine, methotrexate, and methylprednisolone for 3 months did not completely improve. Then, tonsillectomy was undertaken and arthritis rapidly improved. Finegoldia magna (previously Peptostreptococcus magnus) was cultured from the microabscesses of the resected tonsils. After outpatient follow-up, the patient did not experience a relapse of arthritis for more than 2.7 years without any treatment. Poststreptococcal reactive arthritis (PSRA) is well described. However, up to 40% of patients with tonsillitis-related arthritis did not demonstrate evidence of streptococcal infection. It is noted that tonsillectomy is necessary to remove the tonsillar microabscesses and eradicate bacterial infection of the tonsils, especially for patients with a prolonged and/or recurrent course of PSRA and/or tonsillitis-related arthritis.

Method for predicting the course of peritonsillar abscess in patients with exacerbation of chronic tonsillitis

Objectives clinical and laboratory examination of patients with acute tonsillitis for early diagnosis and prognosis of peritonsillar abscess. Material and methods. The study included 101 patient with lacunar tonsillitis complicated by peritonsillar abscess and 64 donors (control group). Immunological studies were performed according to WHO recommendations, on the basis of the immunological department of the EMB Research Institute and the immunological laboratory of the SamSMU. Results. Immunological examination of patients with abscess showed an increase in: neutrophil phagocytic activity, CD4+/CD8+, the number of cells expressing HLA-DR+ markers, complement activity, IgA, IgM, IgG plasma concentration, fibronectin level, pro-inflammatory cytokines IL-8, IL-1, IL-1 and a decrease in: the level of TNF-, myeloperoxidase activity, number of cells containing CD4+, CD8+, CD16+, CD20+, CD25+ markers. High correlation was registered between total lymphocytes and CD3+ and CD4+ cells (p 0.01); between CD3+ and CD4+ markers (p 0.01); as well as high correlation of IL-1 levels with IL-8 and IL-1 (p 0.01). Cluster analysis revealed different types of immune homeostasis. The first type (cluster) had high values of leukocytes (total), lymphocytes (total), cells with CD3+, CD4+, CD8+, CD16+, CD20+, CD95+ and HLA-DR+ markers; the second type (cluster) was characterized by significantly lower levels of these immune status indicators. 41 patient had the first type of immune response, with an explicit clinical picture and rapid formation of an abscess. The second type of immune response was registered in 60 patients having a torpid course of the disease with delayed development of abscess. Further, to assess the type of immune reactions, it is necessary to substitute the values of indicators into the model and calculate the integral coefficient of the body's reaction (ICTROI and ICTROII).

Peritonsillar Abscess Treatment under Local Anaesthesia: Incision and Drainage versus Needle Aspiration

Background: Peritonsillar abscess is usually complication of acute tonsillitis which itself is prevalent in society. As a general surgical principle, abscess any were, has to be drained so same applies for quinsy but methodology for this drainage is not being agreed. Aim: To find best modality for drainage of this abscess and see its incidence in which age group and sex. Study design: Prospective study Place and duration of the study: Department of ENT, Rai Medical College, Sargodha from 1st Feb. 2017 to 31st Jan. 2019. Methodology: One hundred and thirty five patients above 15 years of age and those in need of hospital admission due to severity of symptoms were included. Paediatric, immunocompromised, requiring general anesthesia and acute tonsillitis patients were excluded. Results: There were 65.2% males and 34.8% females. Commonly affected age group was 21-40 years. Needle aspiration was found more effective for management of peritonsillar abscess. Conclusion: No consensus for single modality and both needle aspiration and incision/drainage is advocated and needle aspiration proved fruitful in management. Keywords: Quinsy, Peritonsillar abscess, needle aspiration

Possibilities of inhalation bacteriophage therapy in treatment of children with acute tonsillitis

Introduction. At the same time, in the last decade, pediatricians have increased interest in the study of the therapeutic effect of bacteriophages in infectious diseases of rhinolaryngological organs.Objective. The analysis of results of the use of inhalation bacteriophage therapy in children with acute tonsillitis, on an outpatient basis.Materials and methods. Examined 212 children from 4 to 15 years old with acute tonsillitis. Conducted general clinical research, pharyngoscopy, bacteriological examination of a smear of tonsils. Bacteriophage therapy carried out using the Pyobacteriophage complex liquid (PCL).Results. In the course of an objective clinical analysis, on the day of seeking outpatient care, patients noted asthenovegetative disorders in all patients (100%), in the form of general weakness (96.8%), loss of appetite (94.8%), and headache (92.5%). During the examination, cervical lymphadenopathy (98.6%), tonsil hyperemia and hyperplasia (98.1%), and exudates (48.1%) noted. It revealed that the main causative agents of acute tonsillitis in children were the bacteria Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae, with different relative proportions (from 24.2% to 59%). Inhalation bacteriophage therapy carried out from the first days of the disease. Against the background of therapy, it was noted - a decrease in swelling in the tonsils by 2-3 days with a decrease in general intoxication signs. On the 6th day from the beginning of bacteriophage therapy, asthenovegetative disorders stopped 2.2 times faster in relation to patients who did not receive bacteriophage therapy, against the background of a decrease in the manifestation of objective clinical signs of the disease.Conclusion. The use of inhalation bacteriophage therapy as part of the conservative treatment of acute tonsillitis in children contributes 1.4 times to the fastest relief of the acute period and an improvement in the subjective assessment of well-being is 25% higher concerning the comparison group.

Evaluation of Antibacterial Activity between Medical Plant Extracts and Antibiotics against Bacterial Isolates from Tonsillitis

Objectives: Acute tonsillitis is an inflammatory process of tonsil tissue and is usually infectious. Acute tonsillitis starts suddenly and usually disappears within one to two weeks. This study aims to isolate bacteria from patients with infectious tonsillitis and determine the antibacterial activity of Mentha piperita L, Citrus aurantium, banana peel extract and antibiotics including penicillin, ampicillin, oxacillin, meropenem, tobramycin, gentamicin, levofloxacin, and clarithromycin against bacteria. Methods: Were Collected 60 clinical samples of sputum and throat swabs from patients with tonsillitis admitted to AL-Furat Alawsait Hospital in Najaf. The samples were cultured in blood, MacConkey agar, and incubated at 37°C for 24 hours, and then the Vitek2 system was used for diagnosis to detect G + ve and G-ve bacteria. Results: It was found that out of 60 sputum samples and throat swabs, 15 cases were gram positive bacteria, while 45 gram negative bacteria. As revealed by the in vitro agar well diffusion method, it was found that the aqueous extracts of these plants, especially Mentha piperita, have strong antibacterial activity against a variety of pathogens. The results show that Mentha is very effective at all concentrations used in this study (125, 250, 500, 1000) mg / ml in all bacteria isolated from tonsillitis. The zone of greatest inhibition of Mentha, Citrus anrantium and banana peel extract was 30, 28, 25 mm at concentrations of 1000 mg / ml respectively. Used eight selected antibiotics, including (penicillin, ampicillin, oxacillin, meropenem, tobramycin, gentamicin, levofloxacin, and clarithromycin). To shows the susceptibility of all bacteria isolates used in this study, the best antibiotics to sensitive for all bacteria (Meropenem and Levofloxacin ), while the resistance to oxacillin. Conclusion: The selected commonly used aqueous extracts have been tested for their antibacterial activity against multi drug-resistant bacteria, and it is believed that their extracts can be used for multi drug-resistant bacteria that can cause nosocomial and community-acquired infections.