CHANGES IN THE CORE TONSILLAR BACTERIOLOGY OF RECURRENT TONSILLITIS -1977-1993

Microbiological studies of the core of tonsils removed from children w ith recurrent tonsillitis due to group A beta-hemolytic streptococci w ere conducted during three periods, with 50 patients in each period: 1 977-1978 (period 1), 1984-1985 (period 2), and 1992-1993 (period 3). M ixed flora were present in all tonsils, with 8.1 organisms per tonsil (3.8 aerobes and 4.3 anaerobes). The predominant isolates in each peri od were Staphylococcus aureus, Moraxella catarrhalis, Peptostreptococc us species, pigmented Prevotella species, Porphyromonas species, and F usobacterium species. The rate of recovery of Haemophilus influenzae t ype b increased from 24% in period 1 to 76% in period 2 (P <.001); a d ecline to 12% in period 3 correlated with a concomitant increase in th e frequency of recovery of non-type b strains of H. influenzae from 4% and 10% in periods 1 and 2, respectively, to 64% in period 3 (P <.001 ). Both the rate of recovery of P-lactamase-producing bacteria and the number of these organisms per tonsil increased over time. Specificall y, P-lactamase-producing strains were detected in 37 tonsils (74%) dur ing period 1, in 46 tonsils (92%) during period 2, and in 47 tonsils ( 94%) during period 3, and the number of such strains per tonsil increa sed from 1.1 in period 1 to 2.9 and 3.3 in periods 2 and 3, respective ly.