An investigation of the significance of Actinomycosis in tonsil disease

Objectives: The objective of the study was to establish the incidence of Actinomycosis in the tonsils of children undergoing tonsillectomy or adenotonsillectomy, and to evaluate its role in clinical tonsillar disease. Methods: This was a prospective controlled study done at the Red Cross Children's Hospital in Cape Town, South Africa over an 8-month period and included all children undergoing tonsillectomy or adenotonsillectomy. All resected tonsils were examined for the presence of Actinomycosis and any signs of significant cryptitis or active tonsillitis. A comparison was made in the incidence of Actinomycosis in children with obstructive steep apnoea, recurrent tonsillitis or obstructive steep apnoea and recurrent tonsillitis. The data was further analysed to determine the statistical significance of the association between Actinomycosis of the tonsils and age, sex and histopathological and clinical diagnosis. Results: A total of 344 tonsils were analysed on 172 patients. We found 20 patients (11.6%) with Actinomycosis in the tonsils. The mean age of patients with Actinomycosis was 7.25 years and without Actinomycosis was 5.4 years (p = 0.002). Most specimens (16) had no evidence of tissue reaction to Actinomyces, and their presence was found to be due, to colonisation of the tonsils only. Actinomycosis was present in 11% of patients with obstructive steep apnoea, 11% of patients with recurrent tonsillitis and in 9% with obstructive steep apnoea and recurrent tonsillitis. The difference in incidence of Actinomycosis between these three groups (p = 0.94), and between the recurrent tonsillitis group alone compared to the obstructive group (p = 0.83), was not statistically significant. There was therefore no statistical significance found between Actinomyces and OSA +/- recurrent tonsillitis. Conclusions: There was no correlation found between the presence of tonsillar Actinomycosis and recurrent tonsillitis and/or obstructive tonsillar hypertrophy. Histopathologic findings showed no evidence of tissue reaction to Actinomyces and its presence was found to be due to colonisation of the tonsils only. The series did however show a statistically significant correlation between Actinomycosis colonisation and age with Actinomycosis being more common in older children, especially those over 5 years of age. (C) 2007 Elsevier Ireland Ltd. All rights reserved.