Tularemia is a rare infectious disease, due to Francisella tularensis, a virulent bacterium transmitted by a carrier insect (essentially ticks) or by the meat of an infected animal (generally hares). We report 3 cases that occurred in the same family, showing the various symptoms of this disease. Revealing head and neck manifestations may mislead diagnosis.

Tonsillectomy for enlarged tonsils has been so soundly criticized that doctors no longer date to suggest the operation. If they do come to the conclusion that the procedure in inevitable, it is only after an expensive and sometimes aggressive work-up. In order to better establish the criteria which should determine this indication for amygdalectomy, we studied a series of 47 patients undergoing this procedure for enlarged tonsils. We conclude that it is most important to base decisions on a thorough physical examination which includes careful inspection of the pharynx and a complete history. Particular attention must be paid to symptoms, especially nocturnal, and to the failure to gain weight.

To evaluate the interest of examination of the gastric aspirate (GA) as a contribution to decision making of initial antimicrobial therapy, all 3,989 neonates delivered in Orléans Maternity Hospital in 1990 have been studied. Microscopic examination: polymorphonuclear leukocytes (PMN) were, respectively, absent/present/abundant in 180/130/25 treated (T) and in 2,567/1,032/90 untreated (NT) newborns. PMN were demonstrated in 2/5 documented, 4/6 obvious, 2/2 suspected and 34/58 possible infections. Bacteria were, respectively, absent/present/abundant in 201/109/46 T newborns and in 2,722/877/56 NT newborns. Bacteria were demonstrated in 3/5 documented, 4/6 obvious, 2/2 suspected and 32/58 possible infections. Culture: the number of initially T and NT newborns was, respectively, for each bacterial species: Enterobacteriaceae 33/294, streptococci B (GBS), D and alpha-hemolytic 60/107, 12/110 and 18/70, Streptococcus pneumoniae 2/2, anaerobes 12/402, Listeria 3/0, Haemophilus species 4/4, Staphylococcus aureus 5/7, coagulase-negative staphylococci 25/1335, Lactobacillus 14/345, corynebacteria 10/196. In the 5 newborns with documented early onset meningitis and/or septicemia, 3 grew with GBS, Escherichia coli and Listeria. In the 4 newborns (2 meningitis and 2 urinary tract infections) with late-onset infection, no positive GA could be demonstrated. Although microscopic examination and cultures were statistically more frequently positive in T newborns, with variations dependent on the species of bacteria, more newborns without infection were colonized whatever the bacteria. Thus, bacteriological results of GA, if considered out of the clinical context, cannot be an argument for treatment.

An attempt was made to define the value of the bacteriological examination of tracheal aspirations in patients on artificial ventilation. Quantitative cultures of lung biopsies, taken immediately after death, were made on 21 patients in an intensive care unit. The results were compared with the clinical signs, antibiotic therapy and quantitative cultures of tracheal secretions taken before and very soon after death. A comparison of the results shows that microbial species present in tracheal secretions at a level equal to or greater than 10(7)/ml were found in 53 percent of lung biopsies. However, the predominant bacteria found in the lung biopsies were not necessarily similar to those in the tracheal secretions. Also, bacteria minimally present or completely absent in tracheal secretions could be found in lung biopsies. Therapeutic decisions can only be made on clinical and radiological signs; bacteriological examination may be a help in the choice of drugs once such treatment has been decided upon.

Two microbiological assay techniques for estimation of biologically active isoniazid concentrations in human serum were compared : the vertical diffusion method and a large plate method similar to that commonly used for the antibiotics. Four hundred seventy four tests were carried out on the serum from 133 patients. Parallel titrations were determined by two biologists on the same serum samples, with the same standard solutions, by the two methods performed rapidly after the collection of specimens and after they have been stored in the frozen state during one week and were compared. It was found that the variability obtained in these conditions was 26 per cent for the vertical diffusion method and 14 per cent for the large plate method. The correlation coefficients were 0,87 and 0,95 respectively. Also it will be noted that the large plate method is faster, of lower cost and require smaller volumes of serum. However, it also failed to detect levels lower than 0,5 and upper than 2 micrograms/ml, the standard curve is not stable and must be run with each assay and it is also subject to interference by other antibiotics.

The minimal inhibitory and bactericidal concentration of 18 antibiotics for 412 isolates of group B streptococci from newborns, mothers or pregnant women were determined. 3.2% of these strains were less susceptible to penicillin G, 1% failed to be inhibited by erythromycin and 1% by chloramphenicol. Antibiotic-killing kinetics was studied with beta-lactams, aminoglycosides, and in combination for 20 isolates. Killing was accelerated by the combination. For these reasons, at least at the beginning of the treatment, the association of ampicillin and an aminoglycoside can be recommended.

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

Abstract Conclusions: The results of this study suggest that atypical bacteria may be involved not only in acute upper airway diseases but also in recurrent infections requiring adenoidectomy and/or tonsillectomy. Therefore, their identification, followed by an appropriate treatment, should be considered. Objective: Although viruses and group A beta-haemolytic streptococci (GABHS) represent the most frequent bacterial aetiological agents of paediatric upper respiratory tract infections (URTIs), chlamydia and Mycoplasma pneumoniae have also been found in acute tonsillopharyngitis. Nevertheless their relevance in chronic or recurrent URTI has never been evaluated. This study aimed to further address the role of atypical bacteria in recurrent URTIs requiring adenoidectomy and tonsillectomy. Methods: Samples from 55 consecutive children who underwent adenoidectomy and/or tonsillectomy for recurrent or chronic URTI were cut transversely into smaller sections of 5 mm. Each section was pooled and assayed by specific PCR for viruses and bacteria. Results: Adenovirus was detected in 10 patients (18.2%), influenza A virus in one patient and influenza B virus in another. None of the other tested viruses was found. GABHS was found in 37 patients (67.3%). Moraxella catarrhalis and Haemophilus influenzae were detected in 30 patients (54.5%). M. pneumoniae was detected in 6 patients (10.9%) and C. pneumoniae was found in 10 patients (18.2%).

Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp.(51.3%), Staphylococcus spp.(42.3%) and Gram-negative genera (6.4%). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; alpha-haemolytic Streptococcus prevalence was higher (p<0.001) than ss-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were not concordant for streptococci (p<0.0004) and alpha-haemolytic Streptococcus (p<0.007). Surface and core ss-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs 70%) and (50.0% vs 25.0%) in older and younger children respectively. Klebsiella spp.(6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for alpha haemolytic streptococci. Older children grow more beta-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested.

The purpose of the work was to present the frequency of isolation of particular bacterial species from smear samples obtained from the surface of the palatal tonsils and from aspirates of tonsillar core. The material involved 100 patients, 49 women and 51 men among them, who were qualified to tonsillectomy based on their history, otolaryngological examination and selected laboratory parameters and in whom bacteriological examination of smears taken from the right and left palatal tonsil were performed. The material obtained from superficial tonsillar smears and from tonsillar core aspirates was subject to bacteriological analysis. Frequency of isolation of particular bacterial species was performed. Higher detectability of beta-haemolytic streptococci was found in tonsillar core aspirates, as compared to superficial smears. Bacteriological analysis of palatal tonsil core aspirate was shown to be a good method of isolation of pathogenic microbial strains.

OBJECTIVE: This study was conducted to investigate whether there is any difference between tonsillar surface and deep tissue cultures in patients who underwent tonsillectomy for recurrent tonsillitis. METHODS: Tonsillar surface and core tonsillar cultures were taken in all patients. The samples were inoculated into 5% sheep blood, chocolate, and MacConkey agar. The bacteria isolated were identified by using standard methods as well as API kits (Bio Mérieux) if necessary. RESULTS: Pathogenic bacteria were isolated in 77 patients, and no pathogenic bacteria were recovered in 39 of 116 patients included in the study. Of these 77 patients, in 52 patients, different types of bacteria were recovered from the surface and deep tissue cultures, whereas in 25 patients, the same types of bacteria were isolated from both surface and deep tissue cultures. The estimated probabilities of tonsillar bacteriology via surface swabs for Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococci were 27.2%, 38.4%, 66.6%. and 62.5%, respectively. H influenzae was less frequently predicted by surface culture than others. CONCLUSIONS: We think that the swab cultures taken from the tonsillar surface may not always reveal the real pathogen of the tonsils. In addition, the estimated probability of tonsillar bacteriology by surface swabs varies with the type of the pathogen. If medical therapy is planned on the basis of the tonsillar surface culture, then antibiotics also effective against H influenzae besides the target microorganisms may be chosen.

OBJECTIVES: This study was undertaken to seek the correlation between tonsillar core and tonsillar crypt cultures and study the incidence of beta- lactamase producing bacteria (BLPB) in chronic tonsillitis patients. MATERIAL AND METHOD: The study was carried out in Department of Otolaryngology from Feb 2000 to Dec 2001. Patients with chronic tonsillitis who underwent tonsillectomy were enrolled, and culture results from tonsillar crypts were compared with tonsillar core. RESULTS: The tonsil were removed from 61 patients. Age ranging from 2-14 years (n=21) and 15-50 years (N= 40); H. influenza (25.2%), S. aureus (23.4%), and S. viridian (11.3%) were isolated from tonsillar core, while 25.9% and 24% of organisms isolated from tonsillar crypt were H. influenza and S. aurieus, respectively. Correlations between tonsillar core and tonsillar crypt culture were 100% specificity for Group A beta hemolytic streptococcocus (GABHS), 86.2% for H. influenza and 81.5% for S. aureus. Regarding beta-lactamase production, 29.2% of H. influenza were beta lactamase producing bacteria (BLPB), while 88.9% of S. aureus were BLPB. CONCLUSION: The present study demonstrates a high correlation in cultures obtained from tonsillar crypt and tonsillar core. The difference in isolated technique may account for the higher correlation when compared to previous studies. The incidence of beta- lactamase producing bacteria in chronic tonsillitis was high.

BACKGROUND: The reasons for recurrent adenotonsillitis are poorly understood. METHODS: The in situ composition of microbiota of nasal (5 children, 25 adults), hypertrophied adenoid, and tonsillar tissue (50 children, 20 adults) was investigated using a broad range of fluorescent oligonucleotide probes targeted to bacterial rRNA. None of the patients had clinical signs of infection at the time of surgery. RESULTS: Multiple foci of ongoing purulent infections were found within hypertrophied adenoid and tonsillar tissue in 83% of patients including islands and lawns of bacteria adherent to the epithelium with concomitant marked inflammatory response, fissures filled with bacteria and pus, diffuse infiltration of the tonsils by bacteria, microabscesses and macrophages containing phagocytosed microorganisms. Haemophilus influenzae mainly diffusely infiltrated the tissue; Streptococcus and Bacteroides were typically found in fissures; Fusobacteria, Pseudomonas and Burkholderia were exclusively located within adherent bacterial layers and infiltrates. The microbiota were always polymicrobial. CONCLUSIONS: Purulent processes persist during asymptomatic periods of adenotonsillitis. Most bacteria involved in this process are either covered by a thick inflammatory infiltrate, are deeply invading, or are located within macrophages. The distribution of the bacteria within tonsils may be responsible for the failure of antibiotic therapy.

To determine the optimal site of throat culture for the detection of potential pathogens by comparing culture results from the tonsillar surface and the posterior pharyngeal wall in children selected for adenotonsillectomy and in children without upper respiratory disease. Cotton culture swabs were taken from the tonsillar surface and the posterior pharyngeal wall of 50 children selected for adenotonsillectomy for symptoms of recurrent tonsillitis and/or adenotonsillar hypertrophy and of 50 children without upper respiratory disease. Potential respiratory pathogens were identified. In the overall group (n = 100), positive culture results were found in 67 posterior pharyngeal wall samples and 47 tonsillar surface samples (P = 0.001). Haemophilus influenzae was the most frequently isolated micro-organism both in the posterior pharyngeal wall and the tonsillar surface samples; 55 and 35%, respectively (P = 0.001). Group A beta-haemolytic streptococci were found in the samples of the posterior pharyngeal wall and the tonsillar surface in 17 and 13%, respectively (P = 0.2). When dealing with patients with sore throat, sampling both tonsillar surfaces is enough for the detection of group A beta-haemolytic streptococci. When detection of other bacteria is also important, such as for research purposes, the posterior pharyngeal wall should be sampled as well.

BACKGROUND: We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in tonsils and microbiological data assessed by culture, molecular (PCR) and transmission electron microscopy (EM) methods. METHODS: The study involved 62 RT patients admitted for TE (age range 15-35, median 22 years) and 54 healthy volunteers (age range 18-24, median 20 years). The index of tonsillitis (IT) was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. On oropharyngeal examination the presence or absence of three sclerotic signs was evaluated: tonsillar sclerosis, obstruction of tonsillar crypts and scar tissue on the tonsils. The occurrence of Streptococcus pyogenes was assessed by culture and PCR methods in 24 tonsillar core specimens. The samples for EM investigation of crypt epithelium were taken from 10 removed tonsils. RESULTS: The IT values were in positive correlation with the number of sclerotic signs on oropharyngeal examination (r = 0.325, P = 0.010). Based on the IT values and the presence or absence of tonsillar sclerosis and obstruction of tonsillar crypts the receiver-operating curve (ROC) was constructed. It revealed that an IT score of 36 is an optimal cut-off value for prediction of sclerotic type tonsils. S. pyogenes was never found by culture, but its presence by PCR in nearly one third (29%) of diseased tonsillar tissue specimens was tightly associated with longer morbidity. EM revealed coccoid forms of intracellular bacteria in the crypt epithelium, which was accompanied with the damage of tight junctions between epithelial cells. CONCLUSION: The index of tonsillitis > or = 36, being a combination between the frequency of tonsillitis and the length of morbidity period, predicts the sclerotic process in recurrently inflamed tonsils. Therefore, the high IT values could serve as an indicator for TE in adults. The correlation between the longer morbidity period and the presence of S. pyogenes by PCR suggests that persistent infection may have a role in maintenance of recurrent inflammation in tonsils.

OBJECTIVE: The purpose of this study is to compare transient bacteriemia ratios between cold dissection tonsillectomy and bipolar cauterizing tonsillectomy, and also to analyze the bacteria detected with superficial/central tonsillar cultures. METHODS: A total of 86 patients that were grouped as 46 patients of cold dissection tonsillectomy and 40 patients of bipolar cauterizing tonsillectomy were included in this study. Preoperative surface swab cultures, intraoperative central swab cultures of tonsils, and preoperative and postoperative blood culture samples were obtained. Antibiotic sensitivity tests were determined. Fischer exact chi 2 test was performed to compare the results of postoperative bacteriemia of both techniques statistically. RESULTS: Postoperative bacteriemia was detected in 6 (13%) patients of cold dissection tonsillectomy group. In 5 (83.3%) of the 6 postoperative bacteriemia patients of cold dissection tonsillectomy group, isolated microorganism was confirmed both in the blood cultures and in the central swab cultures of tonsils, and resistance to penicillin was established. No patient of bipolar cauterizing tonsillectomy group appeared with postoperative bacteriemia. There was a statistically significant difference (P=.028) for postoperative bacteriemia between cold dissection tonsillectomy group and bipolar cauterizing tonsillectomy group. CONCLUSION: We recommend bipolar cauterizing tonsillectomy for high-risk patients.

Acute otitis media (AOM) is the most common reason for outpatient antimicrobial therapy. Mixed infections pose a potential problem, since the first-line drug used for the treatment of AOM, amoxicillin, can be neutralized by beta-lactamase-producing pathogens of the upper respiratory tract. To study the effects of a 5-day course of amoxicillin on a mixed middle ear infection, rats were challenged with Streptococcus pneumoniae alone or in combination with beta-lactamase-producing nontypeable Haemophilus influenzae. Amoxicillin was introduced at the clinical peak of the infection. Local and systemic changes were monitored by otomicroscopy, bacterial culture, and analysis of histological changes and the expression of the transforming growth factor beta (TGF-beta) gene. beta-Lactamase-producing H. influenzae did not demonstrate an ability to protect S. pneumoniae. Amoxicillin eradicated the pneumococci in all treated animals but increased to some degree the ability of H. influenzae to persist at the site of infection. Thus, only an insignificant acceleration of the resolution of the AOM caused by a mixture of pathogens was observed during treatment. Moderate to major morphological changes could not be avoided by treatment of the mixed infections, but a slight downregulation of TGF-beta expression was observed. In contrast to infections caused by a single pathogen, the mixed infections induced white plaques in the tympanic membrane at a remarkably high frequency independent of treatment. These experimental findings constitute support for further studies of antimicrobial drugs and AOM caused by bacteria with and without mechanisms of antibiotic resistance.