Tonsillar Actinomycosis as a Cause of Asymmetric Tonsil Hypertrophy
Tonsillar Actinomycosis and Tonsil Hypertrophy
DOI:
https://doi.org/10.5281/zenodo.17639612Keywords:
Actinomyces, Hypertrophy, Palatine Tonsil/pathology, TonsillectomyAbstract
Background: Actinomyces are organisms in the oropharynx that can colonize tonsillar tissue. This study aimed to determine the prevalence of tonsillar actinomycosis in patients with asymmetric tonsil enlargement and identify associated clinical factors.
Methods: This retrospective cohort study included 132 adult patients who underwent tonsillectomy for asymmetric tonsil enlargement between 2019 and 2024. Clinical data, including age, sex, and tonsil grade, were collected. All specimens underwent histopathological examination with hematoxylin and eosin staining to identify Actinomyces colonization.
Results: Actinomyces colonization was identified in 18 of 132 patients (13.64%). The mean age of Actinomyces-positive patients was significantly higher than Actinomyces-negative patients (58.78 ± 19.43 vs. 41.05 ± 18.47 years, p=0.0009). Age-stratified analysis showed a progressive increase in prevalence with age, reaching 34.38% in patients ≥61 years. No significant sex difference was observed (p=0.447). Higher tonsil grades were strongly associated with Actinomyces colonization, with Grade 4 tonsils showing prevalence rates of 31.25% (right) and 37.50% (left).
Conclusions: Tonsillar actinomycosis should be considered in the differential diagnosis of asymmetric tonsil hypertrophy, particularly in older patients with higher-grade enlargement. Histopathological examination remains essential for accurate diagnosis and appropriate management.
References
Valour F, Sénéchal A, Dupieux C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-197. doi:10.2147/IDR.S39601
Zięba N, Miśkiewicz-Orczyk K, Misiołek M, Ścierski W. The clinical significance of tonsillar Actinomyces in histopathological samples after tonsillectomy. Pathogens. 2023;12(12):1384. doi:10.3390/pathogens12121384
Hari KR, Maharaj S, Motakef S, Essa R. The role of tonsillar actinomycosis in adult patients. Aust J Otolaryngol. 2020;3:30. doi:10.21037/ajo-19-38
Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ. 2011;343:d6099. doi:10.1136/bmj.d6099
Gaffney R, Harrison M, Walsh M, Sweeney E, Cafferkey M. The incidence and role of Actinomyces in recurrent acute tonsillitis. Clin Otolaryngol Allied Sci. 1993;18(4):268-271. doi:10.1111/j.1365-2273.1993.tb00845.x
van Lierop AC, Prescott CAJ, Sinclair-Smith CC. An investigation of the significance of Actinomycosis in tonsil disease. Int J Pediatr Otorhinolaryngol. 2007;71(12):1883-1888. doi:10.1016/j.ijporl.2007.08.021
Pransky SM, Feldman JI, Kearns DB, Seid AB, Billman GF. Actinomycosis in obstructive tonsillar hypertrophy and recurrent tonsillitis. Arch Otolaryngol Head Neck Surg. 1991;117(8):883-885. doi:10.1001/archotol.1991.01870200077012
Kutluhan A, Salviz M, Yalçıner G, Kandemir O, Yeşil C. The role of the Actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population. Int J Pediatr Otorhinolaryngol. 2011;75(3):391-394. doi:10.1016/j.ijporl.2010.12.014
Bhargava D, Bhusnurmath B, Sundaram KR, et al. Tonsillar actinomycosis: a clinicopathological study. Acta Trop. 2001;80(2):163-168. doi:10.1016/s0001-706x(01)00172-3
Guimarães AC, de Carvalho GM, Correa CRS, Gusmão RJ. Association between unilateral tonsillar enlargement and lymphoma in children: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2015;93(3):304-311. doi:10.1016/j.critrevonc.2014.11.003
Mughal Z, Jangan A, Ahmad A, Turner N, Mughal F. Assessing asymmetrical tonsils in children: an evidence-based review for primary care. Br J Gen Pract. 2024;74(739):93-94. doi:10.3399/bjgp24X736377
Yadav SP, Chanda R, Gathwala G, Yadav RK. Actinomycosis of tonsil masquerading as tumour in a 12-year old child. Int J Pediatr Otorhinolaryngol. 2002;63(1):73-75. doi:10.1016/S0165-5876(01)00647-4
Karaca R, Karaca S. Tonsillar actinomycosis that mimics tonsillar neoplasm. Oral Radiol. 2022;38(1):171-174. doi:10.1007/s11282-021-00535-5
Melgarejo Moreno P, Hellin Meseguer D, Marco Garrido A, et al. A correlation between age and Actinomyces in the adenotonsillar tissue of children. B-ENT. 2006;2(2):95-97.
Maharjan S. Actinomycosis with tonsillar diseases and its clinical significance. Glob J Otolaryngol. 2017;7(4):555714. doi:10.19080/GJO.2017.07.555714
Toh ST, Yuen HW, Goh YH. Actinomycetes colonization of tonsils: a comparative study between patients with and without recurrent tonsillitis. J Laryngol Otol. 2007;121(8):775-778. doi:10.1017/S0022215106003185
Kansu L. Relation of Actinomyces with tonsillar hypertrophy and antibiotic use. Turk Arch Otolaryngol. 2017;55(1):17-21. doi:10.5152/tao.2017.2176
Lord FT. The etiology of Actinomycosis the presence of Actinomycetes in the contents of carious teeth and the tonsillar crypts of patients without Actinomycosis. JAMA. 1910;55(15):1261-1263. doi:10.1001/jama.1910.04330150021008
Rasić D, Perić A, Vukomanović-Durdević B. A case of an unilateral tonsillar hypertrophy caused by actinomycosis. Acta Med (Hradec Kralove). 2010;53(1):31-33. doi:10.14712/18059694.2016.60
Herrero Martínez JA, Gómez Gómez J, García Vázquez E, Hernández Torres A. Actinomicosis. Medicina (B Aires). 2014;11(58):3419-3425. doi:10.1016/S0304-5412(14)70794-2
Downloads
Published
How to Cite
License
Copyright (c) 2025 Başak Yalçıner
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0)
