Introduction
Materials and methods
Participants
Patients
Healthy controls
Sample collection
Patients
Healthy controls
Microbiological analyses
Criteria for pathogenic significance
Statistical analyses
Permissions
Results
Patient characteristics
Primary infection | Acute tonsillitis | |||
---|---|---|---|---|
All n = 64 | Without PP n = 39 | With PP n = 25 | Controls n = 55 | |
Males | 24 (38%) | 12 (31%) | 12 (48%) | 28 (51%) |
Age, mean (SD) | 25.7 (5.6) | 26.4 (5.4) | 24.4 (5.8) | 26.3 (1.4) |
Duration of symptoms, days median (range) | 4.0 (1.0–13.0) | 3.0 (1.0–12.0) | 5.0 (1.0–13.0) | |
Reasons for referral | ||||
Suspected peritonsillar abscess | 48 (75%) | 23 (59%) | 25 (100%) | |
Dehydration | 14 (22%) | 12 (31%) | 2 (8%) | |
Pain | 23 (36%) | 18 (46%) | 5 (20%) | |
Other1 | 6 (9%) | 5 (13%) | 1 (4%) | |
Antibiotic treatment prior to admission | 32 (50%)2 | 20 (51%) | 12 (44%) | |
Tobacco smoking (current) | 26 (41%) | 18 (47%) | 8 (32%) | 2 (4%) |
Temperature, mean oC (SD) | 38.4 (0.8) | 38.4 (0.9) | 38.3 (0.8) | |
Biochemistry, mean (SD) | ||||
C-reactive protein, mg/L | 167.0 (112.7) | 177.7 (110.5) | 150.1 (116.3) | |
Leukocyte count, x109/L | 14.6 (5.0) | 14.0 (5.5) | 15.7 (4.0) | |
Neutrophil count, x109/L | 11.6 (4.7) | 10.9 (5.2) | 12.7 (3.8) | |
Lymphocyte count, x109/L | 1.6 (0.7) | 1.6 (0.8) | 1.5 (0.4) |
Culture findings
Primary infection | Acute tonsillitis | |||||||
---|---|---|---|---|---|---|---|---|
All n = 64 | Without PP n = 39 | With PP n = 25 | Controls n = 55 | |||||
Microorganisms | ||||||||
Aerobic bacteria
| ||||||||
Streptococcus pyogenes
| 17 (27%) | 8 (21%) | 9 (36%) | 2 (4%) | ||||
Streptocoocus dysgalactiae
| 7 (11%) | 4 (10%) | 3 (12%) | 3 (5%) | ||||
Streptococcus anginosus group | 5 (8%) | 4 (10%) | 1 (4%) | 5 (9%) | ||||
Non-hemolytic streptococci | 63 (98%) | 38 (97%) | 25 (100%) | 55 (100%) | ||||
Haemophilus influenzae
| 1 (2%) | 1 (3%) | 1 (2%) | |||||
Haemophilus parainfluenzae
| 16 (25%) | 9 (23%) | 7 (28%) | 38 (69%) | ||||
Haemophilus spp. | 1 (2%) | 1 (3%) | 13 (24%) | |||||
Staphylococcus aureus
| 17 (27%) | 10 (26%) | 7 (28%) | 22 (40%) | ||||
Coagulase-negative staphylococci | 5 (8%) | 4 (10%) | 1 (4%) | 3 (5%) | ||||
Eikenella corrodens
| 8 (13%) | 6 (15%) | 2 (8%) | 2 (4%) | ||||
Neisseria spp. | 41 (64%) | 26 (67%) | 15 (60%) | 53 (96%) | ||||
Corynebacterium spp. | 46 (72%) | 26 (67%) | 20 (80%) | 31 (56%) | ||||
Rothia spp. | 49 (77%) | 33 (85%) | 16 (64%) | 45 (82%) | ||||
Aggregatibacter aphrophilus
| 1 (2%) | |||||||
Moraxella catarrhalis
| 1 (2%) | 1 (3%) | ||||||
Enterobacteriaceae | 1 (2%) | |||||||
Gemella spp. | 1 (2%) | |||||||
Granulicatella adiacens
| 3 (5%) | 3 (12%) | ||||||
Anaerobic bacteria
| ||||||||
Fusobacterium necrophorum
| 7 (11%) | 2 (5%) | 5 (20%) | 5 (9%) | ||||
Fusobacterium spp. | 2 (3%) | 2 (5%) | 17 (31%) | |||||
Prevotella spp. | 53 (83%) | 31 (79%) | 22 (88%) | 55 (100%) | ||||
Veillonella spp. | 26 (41%) | 16 (41%) | 10 (40%) | 22 (40%) | ||||
Leptotrichia spp. | 5 (8%) | 1 (3%) | 4 (16%) | 25 (45%) | ||||
Lactobacillus spp. | 13 (20%) | 8 (21%) | 5 (20%) | 6 (11%) | ||||
Actinomyces odontolyticus
| 11 (17%) | 7 (18%) | 4 (16%) | 20 (36%) | ||||
Actinomyces spp. | 8 (13%) | 5 (13%) | 3 (12%) | 12 (22%) | ||||
Capnocytophaga spp. | 1 (2%) | |||||||
Lachnoanaerobaculum orale
| 1 (2%) | 1 (4%) | 9 (16%) | |||||
Campylobacter spp. | 1 (2%) | 1 (3%) | 1 (2%) | |||||
Dialister spp. | 2 (3%) | 2 (5%) | ||||||
Propionibacterium acnes
| 1 (2%) | 1 (4%) | ||||||
Anaerobes (unspecified) | 3 (5%) | 2 (5%) | 1 (4%) | 8 (15%) | ||||
Fungi
| ||||||||
Candida | 5 (8%) | 2 (5%) | 3 (12%) | 1 (2%) | ||||
Number of species, mean (SD) | 6.5 (1.6) | 6.4 (1.5) | 6.7 (1.6) | 8.3 (1.4) |
Semi-quantitative analyses
All n = 64 | Controls n = 55 | p1 | |
---|---|---|---|
Microorganisms | |||
Aerobic bacteria
| |||
Streptococcus pyogenes
| 3.1 (0.7) | 2.0 (0.0) | 0.045 |
Streptococcus dysgalactiae
| 3.4 (1.0) | 2.7 (0.6) | 0.17 |
Streptococcus anginosus group | 2.8 (1.1) | 2.2 (0.4) | 0.37 |
Non-hemolytic streptococci | 3.4 (0.6) | 3.3 (0.5) | 0.43 |
Haemophilus influenzae
| 2.0 (----) | 2.0 (----) | - |
Haemophilus parainfluenzae
| 2.3 (0.4) | 2.1 (0.3) | 0.18 |
Haemophilus spp. | 2.0 (----) | 2.2 (0.4) | 0.60 |
Staphylococcus aureus
| 2.4 (0.8) | 2.3 (0.5) | 0.94 |
Coagulase-negative staphylococci | 2.2 (0.4) | 2.0 (0.0) | 0.44 |
Eikenella corrodens
| 2.4 (0.5) | 2.0 (0.0) | 0.33 |
Neisseria spp. | 2.4 (0.7) | 2.6 (0.6) | 0.015 |
Corynebacterium spp. | 2.3 (0.5) | 2.2 (0.4) | 0.15 |
Rothia spp. | 2.9 (0.7) | 2.7 (0.7) | 0.20 |
Aggregatibacter aphrophilus
| 2.0 (----) | - | |
Moraxella catarrhalis
| 2.0 (----) | - | |
Enterobacteriaceae | 2.0 (----) | - | |
Gemella spp. | 2.0 (----) | - | |
Granulicatella adiacens
| 2.0 (0.0) | - | |
Anaerobic bacteria
| |||
Fusobacterium necrophorum | 2.4 (0.5) | 1.4 (0.5) | 0.017 |
Fusobacterium spp. | 2.0 (0.0) | 2.0 (0.0) | - |
Prevotella spp. | 2.8 (0.5) | 2.8 (0.5) | 0.94 |
Veillonella spp. | 2.2 (0.4) | 2.0 (0.2) | 0.23 |
Leptotrichia spp. | 2.2 (0.4) | 2.0 (0.0) | 0.49 |
Lactobacillus spp. | 2.0 (0.0) | 2.0 (0.0) | - |
Actinomyces odontolyticus
| 2.5 (0.5) | 2.4 (0.5) | 0.47 |
Actinomyces spp. | 2.5 (0.5) | 2.3 (0.5) | 0.30 |
Capnocytophaga spp. | 2.0 (----) | - | |
Lachnoanaerobaculum orale
| 4.0 (----) | 2.1 (0.3) | - |
Campylobacter spp. | 2.0 (----) | 2.0 (----) | - |
Dialister spp. | 2.0 (0.0) | - | |
Anaerobes (unspecified) | 2.0 (0.0) | 2.0 (0.0) | - |
Fungi
| |||
Candida | 2.0 (0.0) | 2.0 (----) | - |
Impact of antibiotic treatment prior to admission
Time of infection and follow up
Obtained from cultures at time of infection only | Obtained from cultures at time of infection and follow up | Obtained from follow up cultures only | p1 | ||||
---|---|---|---|---|---|---|---|
Microorganisms | |||||||
Aerobic bacteria
| |||||||
Streptococcus pyogenes
| 7 (17%) | 1 (2%) | 0.016 | ||||
Streptococcus dysgalactiae
| 7 (17%) | 0.016 | |||||
Streptococcus anginosus group | 1 (2%) | 1 (2%) | 5 (12%) | 0.22 | |||
Non-hemolytic streptococci | 40 (98%) | 1 (2%) | 1.00 | ||||
Haemophilus influenzae
| 1 (2%) | 1.00 | |||||
Haemophilus parainfluenzae
| 5 (12%) | 7 (17%) | 20 (49%) | 0.004 | |||
Haemophilus spp. | 1 (2%) | 1 (2%) | 1.00 | ||||
Staphylococcus aureus
| 6 (15%) | 5 (12%) | 2 (5%) | 0.29 | |||
Coagulase-negative staphylococci | 2 (5%) | 2 (5%) | 6 (15%) | 0.29 | |||
Eikenella corrodens
| 5 (12%) | 1 (1%) | 3 (7%) | 0.73 | |||
Neisseria spp. | 7 /17%) | 18 (44%) | 9 (22%) | 0.80 | |||
Corynebacterium spp. | 5 (12%) | 23 (56%) | 11 (27%) | 0.21 | |||
Rothia spp. | 1 (2%) | 28 (68%) | 12 (29%) | 0.003 | |||
Moraxella catarrhalis
| 1 (2%) | 1.00 | |||||
Actinetobacter spp. | 1 (2%) | 1.00 | |||||
Pseudomonas spp. | 1 (2%) | 1.00 | |||||
Gemella spp. | 3 (7%) | 0.25 | |||||
Granulicatella adiacens
| 3 (7%) | 0.25 | |||||
Leuconostoc spp. | 1 (2%) | 1.00 | |||||
Anaerobic bacteria
| |||||||
Fusobacterium necrophorum
| 4 (10%) | 0.13 | |||||
Fusobacterium spp. | 1 (2%) | 3 (7%) | 0.63 | ||||
Prevotella spp. | 10 (24%) | 25 (61%) | 2 (5%) | 0.039 | |||
Veillonella spp. | 6 (15%) | 12 (29%) | 10 (24%) | 0.45 | |||
Leptotrichia spp. | 2 (5%) | 2 (5%) | 8 (20%) | 0.11 | |||
Lactobacillus spp. | 2 (5%) | 4 (10%) | 8 (20%) | 0.11 | |||
Actinomyces odontolyticus
| 6 (15%) | 2 (5%) | 9 (22%) | 0.61 | |||
Actinomyces spp. | 5 (12%) | 2 (5%) | 7 (17%) | 0.77 | |||
Capnocytophaga spp. | 5 (12%) | 0.063 | |||||
Lachnoanaerobaculum orale
| 3 (7%) | 0.25 | |||||
Campylobacter spp. | 1 (2%) | 1.00 | |||||
Dialister spp. | 2 (5%) | 0.50 | |||||
Anaerobes (unspecified) | 1 (2%) | 1.00 | |||||
Parvimonas micra
| 1 (2%) | 1.00 | |||||
Propionibacterium acnes
| 1 (2%) | 1.00 | |||||
Fungi
| |||||||
Candida | 2 (5%) | 0.50 | |||||
Number of species, mean (SD) | 6.5 (1.7) | 7.5 (1.6) | 0.006 |