Бактерійна адгезія на клітини епітелію піднебінних мигдаликів при інфекційному мононуклеозі

Objective To investigate the clinical features of infectious mononucleosis (IM) in children, especially the key points of differential diagnosis between it and acute purulent tonsillitis, in order to avoid misdiagnosis and wrong treatment. Methods Forty-nine IM children and 228 suppurative tonsillitis children treated in the 924 Joint Service Support Force of the Chinese People’s Liberation Army Hospital from January 2015 to December 2017 were allocated into IM group and suppurative tonsillitis group, respectively. A retrospective analysis was performed on the clinical data from the two groups. Results IM accounted for 0.91%(49/5 400) of hospitalized children in the same period, and the proportion of patients with suppurative tonsillitis was 4.22%(228/5 400). However, the difference in fever days was significant between the two groups (P 0.05); on the contrary, there were significant differences in lymphocyte ratio, lymphocyte count, alanine aminotransferase and aspertate aminotransferase levels between the two groups (P<0.05). The level of C-reactive protein in the suppurative tonsillitis group was higher than that in the IM group (P<0.05). Conclusions Fever, cervical lymph node enlargement and tonsillitis are the typical clinical manifestations of IM. For tonsillitis children with fever and white pus, lymphocyte ratio and lymphocyte count, especially, the C-reactive protein and detection results of liver function should be paid more attention so as to avoid misdiagnosis and wrong treatments. Key words: Infectious mononucleosis; Suppurative tonsillitis; Clinical analysis; Differential diagnosis

The goal - improving the quality of the diagnosis of acute infectious mononucleosis (IM) in adults on the basis of a comparative study of cytokine status in MI, acute tonsillitis and acute viral hepatitis. Materials and methods. We observed three groups of patients hospitalized in «Specialized Clinical Hospital of Infectious Diseases of the Ministry of Health of the Krasnodar Territory» in 2012-2014: 29 patients with myocardial infarction (group 1), 25 - with acute tonsillitis (group 2), 19 - with acute viral hepatitis (group 3) and the control group. The groups were matched by sex, age and severity of the disease. In the acute phase of the disease the level of cytokines IL-1a, IL-1β, RaIL-1, IL-4, INF-y in serum was studied by ELISA. Results. At the height of the infectious mononucleosis increased content of IL-1a, IL-1β and INF-y was observed. In acute viral hepatitis significant increase in IL-1β, a less pronounced increase in INF-y, and no increase in IL-1a were registered. Acute tonsillitis is characterized by no increase in IL-1a and smaller increase in INF-y, compared to infectious mononucleosis. Significant difference between infectious mononucleosis and acute tonsillitis was a considerable rise of IL-1a and INF-y in first case. Acute viral hepatitis differs from infectious mononucleosis with pronounced increase in IL-1β. Conclusion. Determined significant intergroup cytokine status differences in patients with infectious mononucleosis, acute tonsillitis, and acute viral hepatitis may be helpful as additional diagnostic criteria for well examined infections in adults.

BackgroundStreptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously.Case presentationA 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0–200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal <5,0 mg/L). There was no known cardiac involvement. Poststreptococcal reactive arthritis was diagnosed. Left ankle arthralgia persisted for about 5–6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml.ConclusionsClinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.

ABSTRACTBackground:Sore throat is a common complaint encountered in daily clinical practice. It is a defining characteristic of acute tonsillitis which is typically treated with symptomatic care and antibiotics in cases of bacterial infection. Despite being generally uncomplicated, acute tonsillitis can mask sinister pathologies such as diphtheria, infectious mononucleosis, and even malignancy.Case Report:In this report, we present a case of a young adult with nonresolving acute exudative tonsillitis. Upon recognition of unusual alarming features, further investigations have led to the diagnosis of T-cell acute lymphoblastic leukemia (T-ALL).Conclusion:Although unusual, hematological malignancies such as acute leukemia may manifest as acute tonsillitis. The significance of recognizing red flags that may occur in common symptoms such as sore throat is emphasized. It is necessary to be aware of this entity to prevent delayed diagnosis.

Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis

For many decades, the problem of chronic tonsillitis still does not lose its relevance. However, some aspects of the etiology and pathogenesis of chronic tonsillitis remain unexplored. This article presents the results of a study of the bacterial flora and structural components of the tissues of the palatine tonsils in chronic decompensated tonsillitis and appendix in patients with acute tonsillitis, as well as a comparison of some indicators of the general clinical analysis of peripheral blood in patients with these types of pathology. Chronic tonsillitis occurred in the history of patients with acute appendicitis in 78% of cases, which is ten times the frequency of its detection in the urban population. In all patients with acute appendicitis, palatine tonsil hypertrophy was detected, mainly of the III degree, as well as the presence of liquid or thick caseous pus in the gaps. In chronic decompensated tonsillitis, an increase in the seeding of the palatine tonsils of Streptococcus pyogenes occurs, and in acute appendicitis, Staphylococcus aureus and Streptococcus pyogenes appear on the background of Escherichia coli. Unidirectional changes in the areas of structural components of palatine tonsils in patients with chronic decompensated tonsillitis and appendix in patients with acute appendicitis were revealed. Based on the data obtained, we can assume the similarities and interconnections of the pathogenesis of chronic decompensated tonsillitis and acute appendicitis.

The study of pharmacotherapeutic (immunomodulating) action in conditions of in vitro cell cultures is currently considered appropriate and justified for determining the action of drugs at the preclinical level. It is also important to address the pathogenetic nature in using such agents, especially fro local application. This study investigated the efficacy of a multicomponent gel containing decamethoxine and hyaluronic acid in treating chronic catarrhal gingivitis among patients with chronic tonsillitis. The purpose of the work is to assess the efficacy of a gel containing decamethoxine and hyaluronic acid on the tissue of the palatine tonsils in the therapy of chronic catarrhal gingivitis in patients with chronic tonsillitis.&#x0D; Materials and methods. To investigate the effects of the main active components in the gel, we followed the recommendations of I.P. Kaidashev et al. for testing pharmacological preparations in in vitro cultures. Tissue samples from the palatine tonsils were obtained from 20 patients with chronic tonsillitis and chronic catarrhal gingivitis undergoing tonsillectomy. All procedures adhered to the guidelines set by the Laboratory of Pathophysiology and Immunology at Prof. O.S. Kolomiichenko Institute of Otolaryngology, National Academy of Sciences of Ukraine. Palatine tonsil tissue was incubated in 199 medium (Serva, Germany) containing gentamicin sulfate (Darnytsa, Ukraine) at a concentration of 120 μg/ml for 20 minutes at 4-8°C. After that, the hemorrhagic parts were removed from the whole tonsil and placed into Eagle's medium (Sigma, USA) and rinsed three to four times. Subsequently, the prepared tissue was placed in sterile vials containing enriched Eagle's medium supplemented with L-glutamine, sodium bicarbonate, 100x vitamin concentrate, 5% fetal calf serum, and 60 μg/mL gentamicin. Tonsil tissue was dissected using scissors and then washed repeatedly (5-7 times) with fresh medium to remove loosely attached cells, then, the resulting cell suspension was filtered. All procedures were conducted within a sterile laminar flow cabinet. Cell viability was assessed using light microscopy (Olympus-23, Japan) and a hemocytometer. A final cell suspension containing 2.5 million lymphocytes per milliliter of medium was prepared. Suspensions with a viability of less than 90% (blue, "dead" cells) were excluded from further experiments.&#x0D; Results. Treatment of in vitro palatine tonsil cells from patients with chronic catarrhal gingivitis and recurrent tonsillitis with the main components of the developed gel (decamethoxine and hyaluronic acid) did not induce significant changes in the concentration of α and γ-interferons. Our findings suggest that the gel composition reduces the levels of pro-inflammatory factors: interleukin-1β and immune complexes. Additionally, it appears to stimulate the production of the antimicrobial factor antistreptolysin-O by tonsil cells, potentially leading to increased antibody production against hemolytic streptococcus antigens.&#x0D; Conclusion. Based on the in vitro findings, the investigated gel composition containing decamethoxine and hyaluronic acid demonstrates potential anti-inflammatory and antimicrobial properties that stimulate the production of the antimicrobial factor antistreptolysin-O by tonsil cells, which might lead to increased antibody production against hemolytic streptococcus antigens.

Biapenem (L-627) was given intravenously to 17 children with acute bacterial infections including 3 with purulent tonsillitis, 1 with bronchitis, 4 with pneumonia, 2 with sepsis, 3 with pyelonephritis, 2 with SSSS. (2 cases are omitted from evaluation because of Mycoplasma pneumonia and infectious mononucleosis). Daily dosages per kg bodyweight ranging from 18.3 to 60 mg were given in 3 divided doses per day for 4 to 6 days. Clinical responses were excellent in 12 (80%), good in 2 (13.3%), fair in 1 (6.7%) and poor in 0 (0%), with an overall efficacy rate of 93.3%. Good bacteriological responses were obtained in all of the 9 cases from which pathogens were identified. A side effect is observed in only 1 case with mild diarrhea. The above results suggest that L-627 is a useful new carbapenem derivative for the treatment of bacterial infections in children.

Bacteremia during tonsillectomy

Background. Nowadays, population generally has high contamination with herpes virus infections. Infection commonly is asymptomatic, and the virus persists in the human body over a lifetime. Excessive diagnosis of herpes virus infections as well as overestimation of their role in the genesis of various diseases in immunocompetent people are common in Russian pediatrics.Objective. The aim of the study is to assess the frequency and efficacy of serological testing in the suspected correlation of herpes virus infections and infectious and somatic diseases in a multidisciplinary hospital.Methods. The study included patients hospitalized in the multidisciplinary hospital in Moscow, who were assigned serological examination for herpes viruses. The laboratory study was carried out by enzyme-linked immunosorbent assay with the revealing the markers of herpes simplex virus type 1 and 2, Epstein-Barr virus, and cytomegalovirus. The results of the examination were analyzed according to the nosology and their role in diagnosis and management.Results. The identification of herpes virus infections’ markers was performed for 996 patients undergoing medical treatment in 17 different hospital departments within 2 months. Most commonly the examination was prescribed in infectious disease, pediatric, and hematological departments and covered more than 140 different nosologies. Acute respiratory infection, reactive arthritis, thrombocytopenia, infectious mononucleosis, acute tonsillitis, gastrointestinal pathology, acute bronchitis, and pneumonia were the most common nosologies. Positive markers of acute infection were revealed in 1.71% of cases for HSV-1/HSV-2, in 4.89% — for EBV, in 3.81% — for CMV. Moreover, positive results of serological examination were mostly noted in the cases of infectious diseases: infectious mononucleosis, tonsillitis, or acute respiratory infections. Tests were assigned for all three infections at the same time in most cases.Conclusion. Widespread examination for herpes virus infections is the typical variant of overdiagnosis and it is usually less informative. Generally positive markers are observed in typical course of herpes virus infections when clinical picture is enough for diagnosis verification.

Validation of Roche LightCycler Epstein-Barr Virus Quantification Reagents in a Clinical Laboratory Setting

IntroductionThe palatine tonsils are one of the most important elements of the lymphatic system in the throat. Their main function is to protect the body against microorganisms. In the differential diagnosis of palatine tonsils, there are three most common disease states: acute tonsillitis (purulent tonsillitis), detritus in the crypts and changes associated with infectious mononucleosis. The article also discusses retention cysts, which, although less common, also pose a significant diagnostic problem.AimThe aim of the study is to analyze the differential diagnosis of selected tonsil diseases based on the results of our own research based on clinical and microscopic examinations.Material and methodsThe study analyzed the cases of 15 patients reporting to an ENT clinic with symptoms indicating tonsillitis. The diagnosis was based on: clinical examination and photographic documentation of the tonsil image, sampling of pathological content, histopathological analysis of samples fixed in formalin and stained with the hematoxylin-eosin method.Results and discussionThe value of histopathological diagnostics in differentiating palatine tonsil diseases may prove important in the future. It is currently not routinely used in clinical practice. In this study, histopathological tests were performed to confirm the diagnosis made at the initial stage.ConclusionsDifferential diagnosis of palatine tonsils requires a comprehensive approach, including both clinical and histopathological evaluation. A precise diagnosis enables the implementation of targeted treatment, which significantly accelerates the improvement of the patient's health condition.

160 children with an average age of 9 years (range 6-15) affected by acute bacterial tonsillitis, were selected and assigned, following an open, parallel group design to: a) brodimoprim at the dose of 10 mg/kg on the first day, in single administration, and of 5 mg/kg on the following days; b) cotrimoxazole suspension, at the dosage of 6 mg of trimethoprim/kg/day, in two daily administrations; c) amoxicillin with clavulanic acid suspension (amoxi-clavulanate) 50 mg/kg every 12 hours. Quantity of pharynx and tonsillar exudate, pharynx pain, dysphonia and dysphagia were checked at the basal time, 3rd, 7th and at the last day of therapy. These symptoms were evaluated using a four-step rating scale. The evolution of body temperature was measured at two different times (1 and 5 o'clock p.m.), until the end of treatment, foreseen five days after disappearance of fever. Microbiological evaluation through a pharynx swab was performed at the beginning and at the end of therapy. Side-effects were registered during all the observation period. Lab-tests were carried out at the enrollment and at the end of treatment. The frequency and intensity of symptoms decreased significantly in all treatment groups. In comparison with amoxi-clavulanate, the brodimoprim group showed an earlier improvement (3rd day) of the clinical situation and a significantly better regression of pharynx exudate (p < 0.01), pharynx pain (p < 0.05) and dysphonia (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

BackgroundPrevious studies have reported high levels of inappropriate ambulatory antibiotic prescribing in the United States. This population-based cohort study examines temporal trends in appropriateness of ambulatory antibiotic prescribing in South Carolina.MethodsAggregated pharmacy claims data for oral antibiotic prescriptions among South Carolina residents < 65 years old were matched with primary diagnosis codes from medical claims within 14 days of the pharmacy claim from 2012–2017. Appropriateness of antibiotics was defined as maybe indicated or not indicated based on diagnosis codes. Chi-square tests were used to examine overall temporal trend in appropriateness and the trends across age group and gender.ResultsDuring the 6-year period, 3,133,379 prescriptions were identified. Overall, 25.6% of antibiotic prescriptions filled were not indicated. This decreased from 27.9% in 2012 to 22.7% in 2017 (p < 0.001). The most common not indicated conditions were viral upper respiratory infections (39.1%), bronchitis (26.7%), and serous otitis (10.9%). The most common maybe indicated conditions were bacterial otitis (27.5%), acute bacterial tonsillitis (24.8%), and sinusitis (23.6%). While females filled more antibiotic prescriptions, they were less likely than males to have a not indicated condition (24.7% vs. 27.1%, p < 0.001). Prescribing for not indicated conditions was more likely in adults aged 40–64 (33.7%) than those aged 18–39 (23.5%) and < 18 (24.2%).ConclusionThe observed decline in inappropriate ambulatory antibiotic prescribing from 2012 to 2017 in South Carolina represents welcomed news. Further improvements in ambulatory antibiotic stewardship efforts are needed particularly in men ≥ 40 years old with acute respiratory infections.DisclosuresJulie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)

We have carried out bacteriological and clinical studies on L-627. The results are summarized as follows. Treatment with L-627 was made in 14 cases of pediatric bacterial infections including 5 cases of pneumonia and 2 cases each of tonsillitis, urinary tract infection and one case each of colitis, and phlegmon. Results obtained were excellent in 11 cases, good in 2 cases and poor in one case. The bacteriological effect of L-627 was excellent, all causative organisms (Staphylococcus aureus one strain, Streptococcus pyogenes 2 strains, Streptococcus pneumoniae 3 strains, Escherichia coli 3 strains, Haemophilus influenzae one strain, Haemophilus parainfluenzae one strain) were eradicated. No significant side effects due to the drug were observed in any cases, except 2 cases each of elevated eosinophil counts and elevated platelet counts.