Differences in tonsil core bacteriology in adults and children: a prospective study of 262 patients

The tonsillar microflora of 262 patients with recurrent acute tonsillitis studied in 1989-1990 is presented. The patient population was divided into three age groups to determine any age-related features. One-hundred and forty-nine patients (57%) were in the 2-7-year-old group, 72 (28%) the 8-14-year-old age group, and the remaining 41 (15%) were over 15 years of age. H. influenzae was the single most common bacterium isolated from the centre of the tonsil (referred to as 'tonsil core'), and this was more prevalent in the 2-7-year-old age group. Staph aureus was the next most commonly isolated bacterium and was most frequently seen in the 8-14-year-old age group (29%). Anaerobic bacteriology was performed in 120 patients. Strict anaerobic species were isolated in significant numbers from the tonsil core in 5% but were present in the superficial culture in all. Anaerobes were present in moderate to heavy numbers in 32% of superficial swabs overall and this was more frequently seen in the older age groups. Mixed pathogens were found throughout all age groups and were most prevalent in the 8-14-year-old age group at 46%. The commonest mixture was H. influenzae and Staph aureus. Normal flora only was commonly found in the superficial swab and rarely in the tonsil core. The number of specimens containing a beta-lactamase producer was assessed for each group; this was similar in all of the groups ranging from 43% in the 2-7-year-old group and 53% in the 8-14-year-old group to 39% in the greater than 15-year-old group.