Tonsillectomy and its effect on ASO titre
DOI:
https://doi.org/10.18203/2320-6012.ijrms20172097Keywords:
ASO titre, Tonsillectomy, Throat swab cultureAbstract
Background: Acute tonsillitis is one of the most common manifestations of the upper respiratory tract infections. It is common in children and accounts for an incidence of about 32 per 1000 patients per year. The objective of this study was to determine the effect of tonsillectomy on ASO titre and to evaluate the sensitivity and specificity of throat swab culture.
Methods: Present study performed a prospective study, a total number of 50 children were screened, out which 25 patients under the age of 15 years (16 male and 9 female), were included in the study, who were having chronic tonsillitis with raised anti-streptolysin O titre (>200IU/ml). All the patient underwent tonsillectomy and serological estimation of ASO titre was done at the end of first, second and third month post-surgery. Throat swab culture was performed prior to tonsillectomy and at the third month of follow up.
Results: Twelve children (48%), twenty children (80%) and twenty-two children (88%) became serologically negative for ASO antibody at the end of first, second and third month respectively, with a statistically significant p value of 0.0001. The sensitivity and specificity of throat swab culture was 16% and 100% respectively.
Conclusions: Tonsillectomy has a significant role in reducing the serological levels of anti-streptolysin O antibody and its reactivation, thereby decreasing the rate of complications associated with Group A-beta haemolytic streptococci.
References
Nussinovitch M, Finkelstein Y, Amir J, Varsano I. Group A beta-hemolytic streptococcal pharyngitis in preschool children aged 3 months to 5 years. Clin Pediatr (Phila). 1999;38(6):357-60.
Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatr. 2010;126:e557-64.
Bisno AL. Acute pharyngitis. N Engl J Med. 2001;344:205-11.
Gerber MA. Nelson, Textbook of pediatrics, International editions. 18. Vol. 182. Group A Streptococcus; 2007:1135-1139.
Todd EW. Antigenic streptococcal hemolysin. J Exp Med. 1932;55:267-80.
Read SE, Zabriskie JB. Streptococcal disease and immune response. New York: Academic Press; 1980.
Kaplan EL, Rothermal CD, Johnson DR. Antistreptolysin O and anti-deoxyribonuclease B titres: normal values for children ages 2 to 12 in the United States. Pediatr. 1998;101(1 Pt1):86-8.
Bisno AL. Non-suppurative poststreptococcal sequelae: rheumatic fever and glomerulonephritis. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. Vol. 2. New York, N.Y: Churchill Livingstone; 1995:1799-1810.
Burton MJ, Glasziou PP. Tonsillectomy or adenotonsillectomy versus nonsurgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2009;CD001802.
Awad Z, Al-Yaghchi C, Anwar M, Georgalas C, Narula A. Does tonsillectomy help children with recurrent tonsillitis? Otolaryngol Head Neck Surg. 2010;143(Suppl):113-6.
Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S, Bayer A, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatr. 1995;96(Pt I):758-64.
Stevens DL, Yan S, Bryant AE. Penicillin binding protein expression at different growth stages determines penicillin efficacy in vitro and in vivo: an explanation of the inoculum effect. J Infect Dis. 1993;167:1401-5.
Paradise JL, Bluestone CD, Bachman RZ. Efficacy of tonsillectomy for recurrent throat infection in severly affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310(11):674-83.
Meland E, Digranes A, Skjaerven R. Assessment of clinical features predicting streptococcal pharyngitis. Scand J Infect Dis. 1993;25:177-83.
Mlynarczyk G, Mlynarczyk A, Jeljaszewicz J. Epidemiological aspects of antibiotic resistance in respiratory pathogens. Int J Antimicrob Agents. 2001;18:497-502.
Rosen G, Samuel J, Vered I. Surface tonsillar microflora versus deep tonsillar microflora in recurrent acute tonsillitis. J Laryngol Otol. 1977;91:911-3.
TO TREAT (Tonsillitis Outcomes Toward Reaching Evidence in Adults and Tots). Quality of life after tonsillectomy in children with recurrent tonsillitis. Otolaryngol Head Neck Surg. 2008;138:S9-S16.
Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M. Update on the management of acute pharyngitis in children. Italian J Pediatr. 2011;37:10.
Eggertsen S, Schneeweiss R, bergman J. A case against the use of the throat culture in the management of streptococcal pharyngitis. J Fam Pract. 1979;9(4):572-6.
Feery BJ, Forsell P, Gulasekharam M. Streptococcal sore throat in general practice: a controlled study. Med J Aust. 1976;1(26):989-91.
Brook I, Yocum P, Shah K. Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis. JAMA. 1980;244(15):1696-8.
Uppal K, Bais AS. Tonsillar microflora- superficial surface vs deep. J Laryngol Otol. 1989;103(2):175-7.
Schachtel BP, Fillingim JM, Beiter DJ, Lane AC, Schwartz LA. Subjective and objective features of sore throat. Arch Intern Med. 1984;144(3):497-500.
Hembrom R, Roychaudhuri BK, Saha AK. Evaluation of the validity of high serum antistreptolysin O titre only, as an indication for tonsillectomy. Indian J Otolaryngol Head Neck Surg. 2014;66(3):232-6.
Viswanathan N, Nair SK, Thulseedharan S, effect of tonsillectomy on aso-titre. Indian J Otolaryngol Head and Neck Surg. 2000;52(4).
Mohamed A, Tabbakh ME, Zeitoun A, Hennawi D. Acute phase reactants in children with recurrent tonsillitis treated by tonsillectomy versus long-acting penicillin. Egypt J Otolaryngol. 2013;29:99-103.