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

We 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.

Overview of Helicobacter pylori Detection Using Rapid Urease Test and Giemsa Modification Staining in Chronic Tonsillitis Patients

BACKGROUND: Helicobacter pylori (H. pylori) is a Gram-negative bacteria and has been known for its role in causing gastric infection aused diseases such as gastric ulcer. H. pylori also implied to play a role in chronic tonsillitis, but this theory remains controversial. Many researches have different and contradictory results due to difficulty to accurately detect H. pylori in tonsillar tissue. There is still no appropriate method that able to detect H. pylori in tonsil tissue. AIM: The aim of the study was to detect H. pylori colonization in chronic tonsillitis and understand some of the methods of examination that can be done to detect H. pylori in tonsillar tissue. METHODS: This study is a descriptive study conducted on 25 respondents. Each sample was taken from patients with chronic tonsillitis who underwent tonsillectomy. Then, the rapid urease test (RUT) and the Giemsa modification staining were carried out to determine the presence of H. pylori. RESULTS: There were 19 people (76%) positive and 6 people (24%) negative for H. pylori using RUT. On examination with Giemsa modification staining obtained 19 people (76%) positive and 6 people (24%) negative for H. pylori. CONCLUSION: H. pylori can be found in most of chronic tonsillitis. Combination RUT and Giemsa modification staining examination can be a good option in detecting H. pylori in chronic tonsillitis.

Hemangioma of the Oral Cavity; Un Unusual Presentation

Hemangioma is a developmental vascular malformation capillaries that do not involute but persist and grow very slowly over years. The diagnosis of hemangiomas is mainly based on clinical evaluation. They tend to occur in the oral cavity, on the tongue, buccal mucosa and labial mucosa. Isolated hemangiomas in the tonsillar tissue is a rare occurrence. In this we report a case of adult tonsillar hemangioma of left side associated with recurrent tonsillitis. She was effectively managed surgically with preoperative embolization.

PD-L1 Immunohistochemistry on Cell Block Preparations From Different Fixatives: A Pilot Study

Objectives Immunohistochemistry especially for biomarkers such as PD-L1 in personalized medicine is increasingly being performed on cell blocks from cytopathology samples. We evaluated the effects of staining cell blocks (CBs) from different cytologic fixatives using four different commercially available PD-L1 antibody clones. Methods PD-L1 immunohistochemistry (IHC) using four different commercially available clones was performed on eight cell blocks processed from two different fixatives and also on eight formalin-fixed tissues. The clones used were 22C3 at 1:50 dilution and 1:100 dilution, SP263, SP142, and E1L3N. The cell block (CB) samples contained cells that strongly express PD-L1 and either fixed in CytoLyt (methanol-based fixative, n = 4) or CytoRich (ethanol-formalin-based fixative, n = 4). Formalin-fixed control tissues (tonsillar tissue, n = 4; stomach, n = 4) were also included. Results Expression for PD-L1 was noted on all the CytoRich fixed cell blocks (n = 4) for all four antibody clones, with the intensity and distribution of expression comparable to the formalin fixed tissues (n = 8). However, consistent absence of expression for PD-L1 was noted on all the CytoLyt fixed cell blocks (n = 4) for all four antibody clones. Conclusion The results of this pilot study demonstrate that PD-L1 IHC on cell blocks is feasible. However, there is a need to validate IHC protocols according to specific fixation methods.

A Correlative Study between Chronic Tonsillitis and Helicobacter Pylori

Introduction : Chronic tonsillitis is characterized by persistent inflammation of the palatine tonsils and seen commonly in patients attending ENT OPD. Bacterial infection is usually the cause but anaerobes and viruses may also be implicated. The possibility that tonsillar tissue possesses Helicobacter pylori or that H. pylori can colonize the palatine tonsils is explored. Materials and Methods : Hundred patients aged between 5-50 years of either sex diagnosed with chronic tonsillitis undergoing elective tonsillectomy and willing to participate in the study were selected. Informed and written consent was taken from all the patients (in case of minor patients, consent was taken from parents). Specimen (tonsillar tissue) was harvested from the surgically removed tonsils and put through Rapid urease test. The results were analysed statistically using Chi square test and Unpaired t test and inference was drawn. Results : Amongst 100 patients, 61 (61%) patients were females and 39 (39%) patients were males. Helicobacter pylori could be detected in Chronic Tonsillitis in 64 (64%) patients. Conclusion : According to our study, Helicobacter pylori was found to be a common finding in cases of chronic tonsillitis. Even after regular treatment with antibiotics, the chances of getting acute infection in chronic tonsillitis still persist. We can try treatment for H. pylori and look for changes in recurrence of tonsillitis and also it can be tried in patients who are not willing/fit to undergo tonsillectomy.

Prevalence of Helicobacter pylori colonisation in tonsillar tissue in cases of chronic tonsillitis: a prospective study

<p class="abstract"><strong>Background:</strong> Human stomach is not the only reservoir of <em>Helicobacter pylori</em> but it has been detected in dental plaques, oral lesions and saliva. It could play role in the pathogenesis of various otorhinolaryngologic problems and remains debatable. This study was aimed to find out the prevalence of <em>H. pylori</em> in tonsillar tissue of patients with chronic tonsillitis by rapid urease test in a tertiary hospital in Kerala.</p><p class="abstract"><strong>Methods:</strong> Prospective cross sectional study was done in patients who attended the outpatient department of ENT with a history suggestive of chronic tonsillitis. The patient satisfied the criteria for chronic recurrent tonsillitis were subsequently posted for tonsillectomy. Each specimen was subjected to rapid urease test. </p><p class="abstract"><strong>Results:</strong> Total 228 patients were included in this study with age ranging between 3 and 31 years (10.0±7.1), with most common age being &lt;10 years in 159 patients (69.7%). Male to female ratio was 1.4:1. Among these, the presence of <em>H. pylori</em> was seen in only 6/228 patients.</p><p class="abstract"><strong>Conclusions:</strong> The possibility of tonsillar tissue acting as a reservoir for <em>H. pylori </em>infection is very low.</p>