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

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

To the evaluate the interest of examination of the gastric aspirate (GA) as a contribution to decision making of initial antimicrobial therapy,suspected all 3,989 neonates delivered in Orléans Maternity Hospital in 1990 have been studied. Microscopic examination: polymorphonuclear leukocytes (PMN) were, respectively,of 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 contribution 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 leukocytes demonstrated in 3/5 documented, 4/6 obvious, 2/2 suspected and 32/58 possible infections. Culture: the number of initially T and NT species 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 (GBS), pneumoniae 2/2, anaerobes 12/402, Listeria 3/ , Haemophilus species 4/4, Staphylococcus aureus 5/7, coagulase-negative staphylococci 25/1335, Lactobacillus 14/345, corynebacteria 10/196. In 2/2 the 5 newborns with documented early onset meningitis and/or septicemia, 3 grew with GBS, Escherichia coli and Listeria. In the delivered 4 newborns (2 meningitis and 2 urinary tract infections) with late-onset infection, no positive GA could be demonstrated. Although microscopic In examination and cultures were statistically more frequently positive in T newborns, with variations dependent on the species of bacteria, more positive newborns without infection were colonized whatever the bacteria. Thus, bacteriological results of GA, if considered out of the clinical context,and cannot be an argument for treatment.

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

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

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

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

Pharyngotonsillitis of in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children.(p< .001) METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS:widely Tonsils (360) yielded 800 isolates of Streptococcus spp.(51.3%), Staphylococcus spp.(42.3%) and Gram-negative genera (6.4%). Surface and core recovery surface of staphylococci and streptococci were similar (p> .05). More (p< .001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; alpha-haemolytic Streptococcus prevalence culture was higher (p< .001) than ss-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were 6-16 not concordant for streptococci (p< .0004) and alpha-haemolytic Streptococcus (p< .007). Surface and core ss-haemolytic Streptococcus yield was higher (p< .05) in 6-16 (p< .0004) than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs was 70%) and (50. % vs 25. %) in older and younger children respectively. Klebsiella spp.(6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Tonsils Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for younger 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 of purpose of the work was to present the frequency of isolation of particular bacterial species from smear samples obtained from otolaryngological the surface of the palatal tonsils and from aspirates of tonsillar core. The material involved 100 patients, 49 women and of 51 men among them, who were qualified to tonsillectomy based on their history, otolaryngological examination and selected laboratory parameters and the in whom bacteriological examination of smears taken from the right and left palatal tonsil were performed. The material obtained from of superficial tonsillar smears and from tonsillar core aspirates was subject to bacteriological analysis. Frequency of isolation of particular bacterial species material was performed. Higher detectability of beta-haemolytic streptococci was found in tonsillar core aspirates, as compared to superficial smears. Bacteriological analysis from of palatal tonsil core aspirate was shown to be a good method of isolation of pathogenic microbial strains.

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

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

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

To posterior determine the optimal site of throat culture for the detection of potential pathogens by comparing culture results from the tonsillar were surface and the posterior pharyngeal wall in children selected for adenotonsillectomy and in children without upper respiratory disease. Cotton culture site swabs were taken from the tonsillar surface and the posterior pharyngeal wall of 50 children selected for adenotonsillectomy for symptoms potential of recurrent tonsillitis and/or adenotonsillar hypertrophy and of 50 children without upper respiratory disease. Potential respiratory pathogens were identified. In in the overall group (n = 100), positive culture results were found in 67 posterior pharyngeal wall samples and 47 tonsillar micro-organism surface samples (P = .001). Haemophilus influenzae was the most frequently isolated micro-organism both in the posterior pharyngeal wall and 47 the tonsillar surface samples; 55 and 35%, respectively (P = .001). Group A beta-haemolytic streptococci were found in the samples pathogens of the posterior pharyngeal wall and the tonsillar surface in 17 and 13%, respectively (P = .2). When dealing with surface patients with sore throat, sampling both tonsillar surfaces is enough for the detection of group A beta-haemolytic streptococci. When detection samples of other bacteria is also important, such as for research purposes, the posterior pharyngeal wall should be sampled as well.respectively

BACKGROUND:that We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the culture frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in indicators tonsils and microbiological data assessed by culture, molecular (PCR) and transmission electron microscopy (EM) methods. METHODS: The study involved 62 frequency RT patients admitted for TE (age range 15-35, median 22 years) and 54 healthy volunteers (age range 18-24, median 20 study years). The index of tonsillitis (IT) was calculated by multiplying the number of tonsillitis episodes per year by the morbidity tonsillar period in years. On oropharyngeal examination the presence or absence of three sclerotic signs was evaluated: tonsillar sclerosis, obstruction of on tonsillar crypts and scar tissue on the tonsils. The occurrence of Streptococcus pyogenes was assessed by culture and PCR methods assessed in 24 tonsillar core specimens. The samples for EM investigation of crypt epithelium were taken from 10 removed tonsils. RESULTS:of The IT values were in positive correlation with the number of sclerotic signs on oropharyngeal examination (r = .325, P tissue = .010). Based on the IT values and the presence or absence of tonsillar sclerosis and obstruction of tonsillar crypts damage the receiver-operating curve (ROC) was constructed. It revealed that an IT score of 36 is an optimal cut-off value for examination prediction of sclerotic type tonsils. S. pyogenes was never found by culture, but its presence by PCR in nearly one of third (29%) of diseased tonsillar tissue specimens was tightly associated with longer morbidity. EM revealed coccoid forms of intracellular bacteria (TE) in the crypt epithelium, which was accompanied with the damage of tight junctions between epithelial cells. CONCLUSION: The index of core tonsillitis > or = 36, being a combination between the frequency of tonsillitis and the length of morbidity period, predicts by the sclerotic process in recurrently inflamed tonsils. Therefore, the high IT values could serve as an indicator for TE in RESULTS: adults. The correlation between the longer morbidity period and the presence of S. pyogenes by PCR suggests that persistent infection for may have a role in maintenance of recurrent inflammation in tonsils.

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

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

We only did a comparative analysis between DNA-based subtypes and antimicrobial susceptibility profiles on Haemophilus influenzae and Haemophilus parainfluenzae, isolated from multiple one tonsillar sites per individual from patients with chronic recurrent tonsillitis and/or tonsillar idiopathic hypertrophy and undergoing tonsillectomy and/or adenoidectomy. A DNA-based total of eighty-eight Haemophilus isolates were obtained aseptically from the surface and core of tonsils and/or adenoids of 32 out isolated of 60 patients and identified at the species level by the X and V factors and the API NH Kit.and The H. influenzae and H. parainfluenzae isolates as well as ATCC strains were tested for antimicrobial susceptibility using a panel RAPD of antimicrobial agents. Random amplified polymorphic DNA (RAPD) was done on extracted DNA from all Haemophilus isolates and ATCC strains,H. using one 10 mer and one 18 mer primers to subtype the two species. Antimicrobial susceptibility testing data have shown strains, a variation in generated susceptibility patterns to tested antimicrobial agents among H. influenzae and H. parainfluenzae isolates. This variation was idiopathic demonstrated too among isolates obtained from different tonsillar sites (core and surface) in a single patient. RAPD analysis identified 58/88 1) (66%) different RAPD patterns. Variations in RAPD patterns among H. influenzae and H. parainfluenzae were also observed in isolates obtained susceptibility from different tonsillar sites of the same individual. A correlation between RAPD patterns and antimicrobial susceptibility data, have shown: 1)isolates. the predominance of one strain (RAPD pattern) of either Haemophilus species among isolated organisms per patient, and exhibiting different antimicrobial isolates susceptibility profiles or 2) the existence of multiple strains (RAPD patterns) of either Haemophilis species per patient, and showing either antimicrobial a single or multiple antimicrobial susceptibility profile(s). These observations question the validity of swab cultures obtained from a single tonsillar mer site per patient, for detection, identification and determination of antimicrobial profiles of the etiology of tonsillitis, since swab specimens taken and from only one site may or may not reflect the etiology of infection.