Abstract

ABSTRACT:
BACKGROUND:
Tonsillitis is one of the commonest infectious disease occurring in the young age group. Tonsillectomy is generally indicated when there are frequent attacks of acute tonsillitis, usually six attacks or more per year for two successive years. Other indications of tonsillectomy include obstructive sleep apnea, quinsy ( usually after the second attack of quinsy) and suspicion of malignancy
OBJECTIVE:
The aim of the present study is to: i) identify the types of bacteria in the tonsil core and to study the sensitivity of bacterial isolates to some antibiotics. ii) estimate serum concentration of Antistreptolysin O (ASO), C-Reactive Protein (CRP) and Epstein Barr Virus (EBV) serology in patients subjected to tonsillectomy compared to control group. iii) study the histopathological changes of routine tonsillectomy specimens.
METHODS:
This case series included hundred patients who underwent tonsillectomy at Al-jamhori Teaching Hospital from January 2010 to July 2012. The main indication for surgery was recurrent attacks of tonsillitis for two or more successive years. Core of the tonsil was studied regarding bacteriology and sensitivity of the cultured bacteria to some antibiotics. At the same time blood sample was obtained and analyzed for ASO, EBV and CRP. Finally the removed tonsils were sent for histological examination.
RESULTS:
The mean age of our patients was 10.32 years with a range of 3-35 years. The study included 60 males (60%) and 40 females (40%) with a ratio of 1.5 :1. Group A beta hemolytic Streptococcus pyogenes was the commonest isolate from tonsil core (21.4%) and was most sensitive to azithromycin. Serological tests for ASO, CRP and EBV were positive in 24%, 22% and 20% compared to 22%, 8% and 10% in control group respectively. CRP was significantly higher among patients than control group. Histological examination revealed chronic non-specific tonsillitis with reactive lymphoid hyperplasia.
CONCLUSION:
The resistance of many bacteria to penicillin and amoxicillin, and the high percentage of beta-lactamase secreting microbes in recurrent tonsillitis mandate the need to consider a combination of amoxicillin and clavulanic acid or second generation cephalosporin. ASO titer is not an accepted indication for tonsillectomy.