Bacterial Aetiology of Pharyngotonsillitis in Paediatric Age Group in a Tertiary Care Hospital in Kerala

BACKGROUND Pharyngotonsillitis is defined as a spectrum of conditions ranging from inflammation primarily confined to the tonsils to pharyngitis implying generalized inflammation of the whole of pharynx. Children are more prone to get several episodes of pharyngotonsillitis per year during their school years. Pharyngitis caused by Streptococcus pyogenes can cause two non-suppurative complications, acute rheumatic fever and acute glomerulonephritis which is responsible for significant morbidity and mortality. The present study was conducted to identify the prevalence of bacterial pathogens causing pharyngotonsillitis and to study their antibiotic sensitivity pattern that would indicate the optimum line of treatment. METHOD A total of 200 children at the age group of 2 - 12 years who had clinical features of pharyngotonsillitis according to the inclusion criteria were recruited for this study over a period of one year. With the help of a disposable wooden spatula, pus from the pharyngo tonsillar region was collected and processed. Predominant isolates obtained were identified and antibiotic sensitivity was done. RESULTS Bacteria was isolated from 70 samples. Pharyngotonsillitis was found most prevalent at the age group of 8 – 10 years. Intake of cold food stuffs and passive smoking at home was found to have statistically significant association as risk factor for pharyngotonsillitis. Staphylococcus aureus was the most common organism isolated followed by Streptococcus pyogenes. The other organisms isolated were group G and C streptococci, Streptococcus pneumoniae, Pseudomonas aeruginosa and Klebsiella pneumonia sub species (spp) aerogenes. CONCLUSIONS Staphylococcus aureus was the most common organism isolated, followed by Streptococcus pyogenes. All the isolates of beta haemolytic streptococci were found to be sensitive to penicillin. There was increased incidence of resistance to macrolides among the gram-positive isolates except Streptococcus pneumoniae and it may be due to the wide spread use of macrolides injudiciously. All the bacterial pharyngotonsillitis cases were cured with the antibiotic given according to the sensitivity except one case. KEYWORDS Pharyngotonsillitis, Acute Rheumatic Fever, Acute Glomerulonephritis, Bacterial Pathogens, Antibiogram