Histopathological and Microbiological Changes in Chronic tonsillitis: Tissue Response to Infection Despite Effective Management—A Case Series

Abstract

Palatine tonsils play a crucial role in the immune response to inhaled and ingested pathogens as part of Waldeyer’s ring, which includes the nasopharyngeal tonsils (adenoids), lingual tonsils, tubal tonsils, and pharyngeal bands. Frequent infections can lead to significant tonsillar hypertrophy, particularly in children, which may necessitate tonsillectomy to avoid nonsuppurative postinfectious complications. Despite appropriate medical management and follow-up, many patients continue to experience recurrent infections that impact their quality of life. Understanding the histopathological changes in response to infection is essential for improving the management of recurrent tonsillitis. This study examines the histopathological alterations in palatine tonsils, identifies bacterial pathogens within the tonsillar core, and evaluates antibiotic resistance patterns in patients undergoing tonsillectomy. A case series study was conducted in Zawia, Libya, from January to July 2023, including 40 tonsils collected from patients with recurrent tonsillitis (≥2 episodes per month). One tonsil from each patient was preserved in 10% formalin for histopathological analysis, while the other was placed in normal saline for microbiological examination. The results indicated equal gender distribution, with 70% of cases occurring in younger children. Significant associations were observed with halitosis and snoring, whereas no significant correlation was found with gender, passive smoking, or family history. Microbiological analysis revealed Streptococcus pyogenes (20%) as the most frequently isolated pathogen, followed by Klebsiella pneumoniae and Staphylococcus aureus. Antibiotic susceptibility testing showed high resistance to Ampicillin, Methicillin, and Erythromycin, while Meropenem exhibited 100% sensitivity. Augmentin, Ceftriaxone, and Doxycycline demonstrated moderate sensitivity. Histopathological examination revealed stratified squamous epithelium with focal hyperplasia (50%), along with lymphoid follicular hyperplasia (80%), germinal centers (20%), and neutrophilic infiltration (75%). Fibrotic changes were present in 75% of specimens, with no evidence of malignancy. In conclusion, this study highlights the intricate relationship between chronic inflammation, microbial colonization, and antibiotic resistance in chronic tonsillitis. The persistent inflammatory process alters the cytoarchitectural structure of the palatine tonsils, compromising their immune defense and contributing to recurrent infections following antibiotic cessation, these findings highlight the need for further research in this field to develop more effective treatment strategies and improve patient outcomes.