Microbiology of parapharyngeal abscesses in adults: in search of the significant pathogens

Tejs Ehlers Klug*, Thomas Greve, Camilla Andersen, Pernille Hahn, Christian Danstrup, Niels Krintel Petersen, Mirjana Ninn-Pedersen, Sophie Mikkelsen, Søren Pauli, Simon Fuglsang, Helle Døssing, Anne Louise Christensen, Maria Rusan, Anette Kjeldsen

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We aimed to describe the microbiology of parapharyngeal abscess (PPA) and point out the likely pathogens using the following principles to suggest pathogenic significance: (1) frequent recovery, (2) abundant growth, (3) growth in relative abundance to other microorganisms, (4) percentage of the isolates recovered in both absolute and relative abundance, (5) more frequent recovery in PPA pus compared with tonsillar surface and tissue. Comprehensive bacterial cultures were performed on specimens obtained from adult patients (n = 60) with surgically verified PPA, who were prospectively enrolled at five Danish ear-nose-throat departments. The prevalent isolates (in PPA pus) were unspecified anaerobes (73%), non-hemolytic streptococci (67%), Streptococcus anginosus group (SAG) (40%), Corynebacterium spp. (25%), Neisseria spp. (23%), Fusobacterium spp. (22%), Fusobacterium necrophorum (17%), Prevotella spp. (12%), and Streptococcus pyogenes (10%). The bacteria most frequently isolated in heavy (maximum) growth were unspecified anaerobes (60%), SAG (40%), F. necrophorum (23%), and Prevotella spp. (17%). The predominant microorganisms (those found in highest relative abundance) were unspecified anaerobes (53%), SAG (28%), non-hemolytic streptococci (25%), F. necrophorum (15%), S. pyogenes (10%), and Prevotella spp. (10%). Four potential pathogens were found in both heavy growth and highest relative abundance in at least 50% of cases: F. necrophorum, Prevotella spp., SAG, and S. pyogenes. SAG, Prevotella spp., F. necrophorum, S. pyogenes, and Bacteroides spp. were recovered with the same or higher frequency from PPA pus compared with tonsillar tissue and surface. Our findings suggest that SAG, F. necrophorum, Prevotella, and S. pyogenes are significant pathogens in PPA development.

TidsskriftEuropean Journal of Clinical Microbiology and Infectious Diseases
Udgave nummer7
Sider (fra-til)1461-1470
StatusUdgivet - jul. 2021

Bibliografisk note

Funding Information:
This work was supported by the Lundbeck Foundation (Grant number: R185-2014-2482), Fonden for lægevidenskabens fremme, and Ørelæge Hans Skovby’s og Hustru Emma Skouby’s Fond.

Publisher Copyright:
© 2021, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


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