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Quantitative bacterial culture from adenoid lymphatic tissue with special reference to Haemophilus [corrected]
J Forsgren1, A Samuelson, A Lindberg
1Department of Oto-Rhino-Laryngology, Huddinge University Hospital, Sweden.
Insights
Non-typeable Haemophilus influenzae (NTHI) is frequently found in adenoid tissue of children with hypertrophy, but not in those with secretory otitis media. Adenoids may harbor NTHI, potentially stimulating local immune responses.
Area of Science:
- Microbiology
- Pediatrics
- Otolaryngology
Background:
- Adenoid hypertrophy is a common cause of nasopharyngeal obstruction in children.
- Secretory otitis media (SOM) is a frequent complication of adenoid hypertrophy.
- The role of bacterial colonization in adenoid tissue, particularly in relation to SOM, requires further investigation.
Purpose of the Study:
- To investigate the quantitative aerobic bacterial culture of adenoid tissue in children with and without secretory otitis media.
- To determine the prevalence and concentration of specific bacteria, such as non-typeable Haemophilus influenzae (NTHI), in adenoid tissue.
- To explore the potential link between NTHI in adenoids and the development of nasopharyngeal obstruction and SOM.
Main Methods:
- Quantitative aerobic bacterial culture of homogenized adenoid tissue from 55 children undergoing adenoidectomy.
- Children were divided into two groups: hypertrophy alone (AH) and hypertrophy with longstanding secretory otitis media (SOM).
- Preoperative nasopharyngeal cultures were obtained from a subset of cases.
Main Results:
- Non-typeable Haemophilus influenzae (NTHI) was found in significantly higher prevalence (72% vs 42%) and mean concentrations (5.7 x 10^5 CFU/g vs 1.9 x 10^5 CFU/g) in the adenoid tissue of the AH group compared to the SOM group.
- No significant differences in other aerobic potentially pathogenic bacteria were observed between the groups.
- NTHI was more prevalent in children under 6 years old.
- NTHI was detected in only 50% of nasopharyngeal cultures corresponding to positive quantitative adenoid cultures.
Conclusions:
- NTHI appears to be harbored within adenoid tissue and may chronically stimulate local immune defenses.
- The study suggests that adenoid tissue itself, rather than an overall bacterial overload, might be implicated in NTHI presence.
- Contrary to initial hypotheses, there is no evidence of an aerobic bacterial overload in adenoid tissue of children with SOM compared to those without middle ear disease.
Abstract:
Homogenized adenoid tissue from 55 children (28-153 months) undergoing adenoidectomy because of nasopharyngeal obstruction was investigated by means of quantitative aerobic bacterial culture. The children were divided into two groups, the hypertrophy alone group--AH (n = 29)--and the hypertrophy with longstanding secretory otitis media group--SOM (n = 26). A nasopharyngeal culture was obtained preoperatively from 38 of the cases. Non-typeable H. influenzae (NTHI) was found in twice as many cases in the AH group as in the SOM group, 21/29 (72%) compared to 11/26 (42%) (p < 0.05) and in a significantly higher mean concentrations, 5.7 x 10(5) CFU/g compared to 1.9 x 10(5) CFU/g (p = 0.02). For the other aerobic potentially pathogenic bacteria no such difference was found. The bulk of the NTHI-positive cases and the cases with the highest concentrations were found in the children below the age of 6 years. In the nasopharyngeal cultures NTHI alone or together with S. pneumoniae and/or B. catarrhalis was found in 29% of the cases in both the AH group and SOM group. NTHI was found in only 50% of the nasopharyngeal cultures corresponding to a positive quantitative culture (10/20). These findings suggest that NTHI is harboured within the adenoid and could thereby chronically stimulate the local immune defense. However, the present study indicates that there is no aerobic bacterial overload in the adenoid tissue in children with SOM compared to children without middle-ear disease.