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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 3  |  Page : 272-275

Oral microbiota in children with acute tonsillitis


Department of Outpatient Care, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan

Date of Submission06-May-2021
Date of Acceptance12-Aug-2021
Date of Web Publication7-Sep-2021

Correspondence Address:
Dr. Shokhida Tolkunovna Turdieva
100140, 223, Bogi-Shamol St., Tashkent
Uzbekistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_84_21

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  Abstract 


Background: More recently, the human oral microbiota has attracted attention in epidemiological research on health and disease. Against this background, changes in the oral microbiota in acute diseases of the upper respiratory tract are of interest in modern pediatrics and epidemiology. The composition of the bacterial flora is one of the main premorbid backgrounds that determine the clinical course of acute tonsillitis in children. However, the prevalence of bacterial flora and its impact on the clinical course of patients with acute diseases remains unclear. Aims: The aims are to study the state of the oral cavity microbiota in children with acute tonsillitis. Methods: The microbiota of the oral cavity was studied in 221 children aged 3–14 years with acute tonsillitis. General clinical examinations and pharyngoscopy were performed. Bacteriological examination of the oral microbiota was carried out according to the standard method. Results: Colonization by the following was most frequently observed in patients: Staphylococcus aureus (42.2%), Streptococcus pneumoniae (32.0%), Haemophilus influenzae (24.2%), Haemophilus parainfluenzae (18.8%), Streptococcus anginosus (10.9%), Moraxella catarrhalis (9.4%), Streptococcus dysgalactiae ssp. equisimilis (8.6%), and Streptococcus agalactiae (3.1%), which most often occurred as symbionts. Conclusions: In children with acute tonsillitis, colonization of the tonsils by pathogenic bacterial flora increases, changing the composition of the oral microbiota. The most common causes of oral microbiota imbalance in children with acute tonsillitis were S. aureus, Streptococcus pyogenes, and H. influenzae, with varying relative proportions.

Keywords: Acute tonsillitis, bacterium, children, microbiota, oral cavity


How to cite this article:
Turdieva ST, Nasirova GR. Oral microbiota in children with acute tonsillitis. Biomed Biotechnol Res J 2021;5:272-5

How to cite this URL:
Turdieva ST, Nasirova GR. Oral microbiota in children with acute tonsillitis. Biomed Biotechnol Res J [serial online] 2021 [cited 2021 Dec 6];5:272-5. Available from: https://www.bmbtrj.org/text.asp?2021/5/3/272/325615




  Introduction Top


The human oral microbiota has recently attention in epidemiological studies on health and disease outcomes. Its structural changes affect the development of oral diseases[1],[2] but also the systemic diseases.[3],[4],[5] Against this background, changes in the oral microbiota in acute diseases of the upper respiratory tract are a topic of interest in pediatrics and epidemiology.

In particular, interest in the diagnosis and treatment of acute tonsillitis and associated diseases has greatly intensified in recent years. Some authors have associated this condition with the spread of coronavirus disease 2019, as viral infection reduces immunity in children, contributing to changes in the oral microbiota.[6],[7]

Among bacteria, the most significant etiological agent of acute tonsillitis is Group A ß-hemolytic streptococcus.[8],[9],[10] However, oral microbiota their effects on the clinical course of acute tonsillitis in pediatric patients remains unclear.

The aims are to study the state of the oral cavity microbiota in children with acute tonsillitis.


  Methods Top


Study design

We examined 221 children aged 3–14 years with clinically diagnosed acute tonsillitis. The clinical study was conducted in an outpatient setting in collaboration with the clinic of the Tashkent Pediatric Medical Institute. Before the study, written permission for study participation was obtained from the parents or guardians of the children.

Inclusion criteria

Age 3–14 years; diagnosis of acute tonsillitis; diagnosis of acute respiratory infection (rhinitis, sinusitis, nasopharyngitis); and access to an outpatient clinic.

Exclusion criteria

Age younger than 3 years or older than 14 years; hospital treatment; acute respiratory tract diseases (bronchitis, pneumonia, pleurisy); chronic respiratory tract diseases (bronchitis, pneumonia); tuberculosis; immunological or hematological diseases; or allergy to antibiotics.

Laboratory research methods

All the examined children underwent a general clinical examination and pharyngoscopy. To study the oral cavity microbiota, all patient oropharynx smears were subjected to bacteriological examination (bacteriological culture) according to the standard technique. The study was carried out in the bacteriological laboratory of the clinic of the Tashkent Pediatric Medical Institute.

Ethical review

Before the trial, written permission was obtained from the children's parents or guardians. All documentation was recorded in the study log. The Ethics Committee of the Ministry of Health of the Republic of Uzbekistan approved the conduct of this clinical and laboratory study among children in an outpatient setting (protocol no. 1/10-1484 of 27.02.2021). The trial has been registered at https://register.clinicaltrials.gov/ID: NCT04682964. Information about informed consent from the patients was included in the patient's documentation (child's outpatient card form 112/a), with informed consent from the child's parent or guardian.

Statistical analyses

Statistical analysis was carried out based on the obtained results. All analyses were conducted using a statistical program based on Excel 2013 (Microsoft Office 2013). The program is flexible, with a capacity suitable for all kinds of statistical calculations used in biomedicine. Comparisons between groups were performed using the average population per year over the study period. In all the analyses, P ≤ 0.005 was considered significant.


  Results Top


In the course of our study, on the basis of the stage and appearance of the tonsils, we identified the following forms of acute tonsillitis: the catarrhal form – 65.61% (n = 145) of children, follicular form – 22.62% (n = 50) of children, and lacunar form – 11.76% (n = 26) of children. As our studies have shown, the predictor of acute tonsillitis development in children is mainly viral infection (acute respiratory disease), which occurred in 78.3% of the children (n = 173 out of 221). The presence of a viral infection was confirmed by a viral test. All patients underwent bacteriological examination.

Studies of the co-colonization of bacteria and viruses in the pathogenesis of acute tonsillitis showed that the following were most often observed in patients: Staphylococcus aureus (42.2% of 221), Streptococcus pneumoniae (32.0%), Haemophilus influenzae (24.2%), Haemophilus parainfluenzae (18.8%), Streptococcus anginosus (10.9%), Moraxella catarrhalis (9.4%), Streptococcus dysgalactiae ssp. equisimilis (8.6%), and Streptococcus agalactiae (3.1%), which occurred mostly as a co-colonizer.

According to the study results, S. aureus, Streptococcus pyogenes, and H. influenzae, with varying relative proportions, were the predominant species in patients with acute tonsillitis, and streptococcal infection was the dominant infection. In approximately one-fifth of these patients, S. aureus was the only pathogenic agent. Co-colonization with M. catarrhalis appears to increase the risk of acute tonsillitis. It should be noted that colonization by S. aureus is influenced by a variety of virulence factors, especially adhesins or the so-called “microbial surface components that recognize adhesive matrix molecules.”

Staphylococcus adhesion to host cells is often mediated by binding to matrix bridging molecules, which also bind to host cells through specific receptors, such as β-1 integrins. Among bacterial groups, the presence of Candida sp. was observed in 16.4% (n = 21) of the children, indicating the role of mixed infections in the development of acute tonsillitis in children.

During the clinical examinations of these patients, an increase in the size of the pharyngeal adenoids was noted. Hyperplasia of the pharyngeal tonsils developed from increasing reactions in lymphatic tissue. It is assumed that multifactorial development occurs when secretion stagnates due to inflammatory processes and tissue hyperplasia, which contributes to further inflammation. Thus, in these patients, viruses caused an immune and inflammatory response in the upper respiratory tract, and bacterial superinfection led to the development of acute tonsillitis.

Treatment of children with symptomatic, acute tonsillitis was based on generally accepted clinical guidelines. The patients were prescribed complex antibiotic therapy, taking into account possible causative pathogens on the 1st day of diagnosis. Subsequently, antibiotic therapy was adjusted according to the results of the bacteriological examinations. Since the majority of pathogens that cause acute tonsillitis in children are beta-lactamase-producing organisms, high-dose amoxicillin therapy is the first-choice treatment. Complex treatment was carried out in conjunction with an otolaryngologist under visual control.


  Discussion Top


The oral microbiota is one of the main premorbid backgrounds that cause the chronicity of many childhood diseases.[11],[12]

Because of multiple variables, the classification of the level of evidence for different treatment approaches requires thorough assessment. Therefore, numerous evidence-based studies are needed to assess the evidence in this study.[13] If this need is met, it can be expected that therapeutic approaches will be of great importance in the coming years.[14]

The study of pathological processes in children is a topical trend in medicine. In recent years, due to the increased incidence of respiratory diseases in children, challenges associated with diagnosis and treatment of acute oropharyngeal inflammation are being addressed.[10] One of these pathologies in childhood is acute tonsillitis.

Tonsils serve to contribute to the immune system and provide immune defense through the production of antigens; they contain T lymphocytes, macrophages, and germinal centers of B lymphocytes.[15] They are the first and most accessible station of the mucosa-associated lymphoid tissue system in humans.[16] The main phase of immune acquisition lasts up to 6 years, and the tonsils are physiologically hyperplastic at this time. Then, involution occurs, which mainly manifests as regression for up to 12 years.[17]

Acute tonsillitis (according to international classification of diseases (ICD) J03.0‒J03.9) is one of the most common otolaryngological pathological processes in childhood and adolescence; it has a number of English synonyms, such as severe tonsillitis, true tonsillitis, and acute tonsillitis and refers to both viral and bacterial tonsillitis.

Based on our observations, acute tonsillitis in children manifested as odynophagia (71.88%), swelling and redness of the tonsils (92.19%), the occurrence of tonsils exudates (46.09%), cervical lymphadenopathy (84.38%), and fever >38°C (83.59%). Some authors believe that monophagy within 24–48 h should be considered a prodromal symptom of rhinitis due to viral upper respiratory tract infection; however, acute tonsillitis is excluded from the definition.[9],[18]

As noted by Jensen et al., who performed species-level molecular characterization of the tonsillar crypt microbiota associated with health and recurrent tonsillitis, the main representatives of the microbiota were H. influenzae, Neisseria, and S. pneumoniae, which were identified in all the children. Porphyromonas, Gemella, Neisseria, Veillonella, Capnocytophaga, Parvimonas, Rothia, Actinomyces, and Treponema have also been reported.[12]

In our study, the most frequently detected pathogens were S. aureus (42.2% of 221 children), S. pneumoniae (32.0% of 221 children), H. influenzae (24.2% of 221 children), and H. parainfluenzae (18.8% of 221 children).

The least frequently pathogens identified were S. agalactiae (3.1% of 221), Gemella (2.7%), Neisseria (2.7%), Veillonella (1.36%), and Parvimonas and Rothia (one sample each – 0.45% of 221 children).

Symbiotic bacteria also affect the course of the disease. According to Windfuhr et al., the symbiosis of Fusobacterium nucleatum and Borrelia vincentii is one of the main causes of the development of acute tonsillitis in children.[9]

Yeoh et al. investigated the microbiota in adult patients. According to the authors, in patients with acute tonsillitis, Neisseria, Haemophilus, Fusobacterium, Streptococcus, Lautropia, and Rothia were most often detected, and Prevotella was predominant. The results indicate that the microbiota of the oral cavity changes with age in acute tonsillitis patients.[10] Consequently, scientific research in this field requires further study in children in different regions.


  Conclusions Top


In children with acute tonsillitis, colonization of the tonsils by pathogenic bacterial flora increases, changing the composition of the oral microbiota. The most common causes of oral microbiota imbalance in children with acute tonsillitis were S. aureus, S. pyogenes, and H. influenzae, with varying relative proportions.

Financial support and sponsorship

This study is financially supported by administration of the Tashkent Pediatric Medical Institute and the family polyclinic of the Tashkent region. The author is grateful to the rector of the Tashkent Pediatric Medical Institute, Professor B.T. Daminov (for technical support) and the chief physician of the family polyclinic of the Tashkent region, Isaeva U.A., for help in conducting and organizing this study.

Conflicts of interest

There are no conflicts of interest.



 
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