On the issue of the etiology of acute inflammatory pathology of the pharynx in children

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OBJECTIVE

To compare the microbiota of the oropharynx in healthy children and children with acute tonsillitis and pharyngitis.

MATERIAL AND METHODS

The study included two groups of patients (139 people) aged from 1 year to 17 years inclusive. The main group consisted of children with acute tonsillitis and acute pharyngitis (111 patients, average age 7±4 years), the control group consisted of 28 healthy children (average age 7±6 years) without signs of upper respiratory tract infection. All patients were examined and material was taken from the mucous membrane of the posterior pharyngeal wall and palatine tonsils, the samples obtained were subjected to bacteriological examination to isolate a pure culture and identify bacterial microorganisms and virological examination by polymerase chain reaction in order to isolate a number of typical respiratory viruses and herpes viruses.

RESULTS

It was found that viral-bacterial associations predominate (66.7%) in patients with acute tonsillitis and pharyngitis (32% in healthy volunteers). The detection rates of typical respiratory viruses and herpes viruses in patients with acute tonsillitis and pharyngitis are comparable (44% and 40.5%, respectively). Streptococcus pyogenes (beta-hemolytic streptococcus group A, 6.3%), as well as Streptococcus pneumoniae, Moraxella catarrhalis, Klebsiella pneumoniae and Pseudomonas aeruginosa were detected only in patients with acute tonsillitis. Other microorganisms were isolated both in healthy patients and in children with acute tonsillitis and pharyngitis, but in the presence of inflammatory changes in the pharynx, the concentration of microorganisms was slightly higher than in a healthy state, which is especially significant for Staphylococcus aureus. In patients without signs of inflammation, typical respiratory viruses (rhinovirus, 14%) and herpes viruses (with a predominance of type 6 herpes virus — 28%) were also found in a percentage comparable to that of patients with acute tonsillitis and pharyngitis.

CONCLUSION

The etiology of acute tonsillitis and pharyngitis in children is dominated by viral-bacterial associations, while rhinovirus (34%) and herpes virus type 6 (28%) are among the viruses. The detection rate of Streptococcus pyogenes in patients with acute tonsillitis was 6.3%. Typical respiratory viruses and herpes viruses can be found on the mucous membrane of the oropharynx and outside the phenomena of inflammation. This once again proves the importance of comparing the clinical manifestations observed in a patient and data on the structure of the microbiota of a particular locus, including to address the need for systemic or local antimicrobial therapy.

Keywords:

children

pharyngitis

tonsillitis

microbiota

Authors:

Evsikova M.M.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-7694-058X

Radtsig E.Yu.

Pirogov Russian National Research Medical University;
Morozovskaya Children’s City Clinical Hospital

ORCID: 0000-0003-4613-922X

Gurov A.V.

Pirogov Russian National Research Medical University;
Sverzhevsky Research Clinical Institute of Otorhinolaryngology

ORCID: 0000-0001-9811-8397

Received:

14.02.2024

Accepted:

05.10.2024

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