Timon C I, McAllister V A, Walsh M, Cafferkey M T
Department of Otolaryngology/Head and Neck Surgery, St James' Hospital, Dublin, Ireland.
Respir Med. 1990 Sep;84(5):395-400. doi: 10.1016/s0954-6111(08)80074-1.
Recurrent acute tonsillitis is a common problem. Despite this, there still remain many controversies regarding aetiology and correct management. The tonsillar microflora of 33 children with recurrent acute tonsillitis studied in 1980 and 58 patients studied in 1989 is presented. A comparison of the microbiology in the two periods studied a decade apart suggests that the pathogenic profile is changing. Haemophilus influenzae increased from 39 to 62% in the deep tonsillar tissue in the decade. There was a concomitant increase in incidence of Staphylococcus aureus from 6 to 40% of cases. In the same interval, mixed microflora increased from 18 to 52%. Anaerobic organisms were isolated in insignificant numbers. Unique to this study, 44% of H. influenzae isolates in 1989 were beta lactamase producers, increasing from only 2% in 1980. All of the S. aureus were beta lactamase producers. In the majority, the throat swabs grew only organisms commensal to the upper respiratory tract however, the deep tonsillar tissue excised at tonsillectomy carried significant growths of pathogenic organisms confirming the inadequacy of the superficial tonsillar swab as an indicator of treatment.
复发性急性扁桃体炎是一个常见问题。尽管如此，关于其病因和正确治疗仍存在许多争议。本文介绍了1980年研究的33例复发性急性扁桃体炎患儿以及1989年研究的58例患者的扁桃体微生物群。对相隔十年的两个时期的微生物学比较表明，致病谱正在发生变化。在这十年间，流感嗜血杆菌在深部扁桃体组织中的占比从39%增至62%。金黄色葡萄球菌的发病率也随之从6%增至40%。在同一时期，混合微生物群从18%增至52%。分离出的厌氧菌数量微不足道。本研究的独特之处在于，1989年分离出的流感嗜血杆菌中有44%是β-内酰胺酶产生菌，而1980年这一比例仅为2%。所有金黄色葡萄球菌都是β-内酰胺酶产生菌。大多数情况下，咽拭子仅培养出上呼吸道的共生菌，然而扁桃体切除术中切除的深部扁桃体组织中却有大量致病微生物生长，这证实了浅表扁桃体拭子作为治疗指标的不足。
