Microbiological And Immunological Aspects Of Chronic Tonsillitis In Children: A Review

Abstract

Chronic tonsillitis (CT) remains one of the most common conditions in pediatric otorhinolaryngology, with reported prevalence ranging from 10-15% up to 37-63% in some populations, compared with 2.8-4.1% reported in the mid-20th century. This review summarizes current evidence on the microbiological and immunological aspects of CT in children, with particular attention to the role of group A beta-hemolytic Streptococcus (GABHS), local cytokine dysregulation, recently identified inflammatory biomarkers, and diagnostic and complication-related implications. The clinical and research directions for developing an integrated, evidence-based diagnostic algorithm are discussed.

Keywords:

chronic tonsillitis, children, group A Streptococcus, cytokines

References

Alrayah M. The Prevalence and Management of Chronic Tonsillitis: Experience From Secondary Care Hospitals in Rabak City, Sudan. Cureus. 2023;15(2):e34914.

Boccuzzi E., et al. Group A Streptococcus infections in children and adolescents in the post-COVID-19 era: a regional Italian survey. Ital J Pediatr. 2024.

Levy C., Cohen R., Plainvert C., Tazi A., et al. Severe Group A Streptococcus Infection among Children, France, 2022-2024. Emerg Infect Dis. 2024.

Group A Streptococcal Invasive Infections Among Children in Cyprus. 2024.

Unprecedented Outbreak of Invasive Group A Streptococcus Infections in Children - Colorado, October 2022 to March 2023. Open Forum Infect Dis. 2023.

The intricate pathogenicity of Group A Streptococcus: a comprehensive update. Virulence. 2024;15:2412745.

Tonsillitis Prevalence, Diagnosis, and Treatment among Patients in Al-Baha Region. Saudi J Health Sci. 2023;12(3):227-234.

Kalaiarasi R., Subramanian K.S., Vijayakumar C., Venkataramanan R. Microbiological profile of chronic tonsillitis in the pediatric age group. Cureus. 2018;10:e3343.

Alzahrani E.S., Aseeri I.A., Alzahrani W.J., et al. The Indications of Tonsillectomy Among Pediatric Patients: A Nine-Year Retrospective Review. Cureus. 2023;15(12):e50638.

Mitchell R.B., Archer S.M., Ishman S.L., et al. Clinical practice guideline: Tonsillectomy in children (update)-executive summary. Otolaryngol Head Neck Surg. 2019;160:187-205.

Fine A.M., Nizet V., Mandl K.D. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med.

Cross G., Howell K., Moore M., et al. Rapid tests for group A streptococcal infections in people with a sore throat. NICE Diagnostics guidance. 2019.

Proinflammatory cytokine content in the saliva of children suffering from chronic tonsillitis. Vestn Otorinolaringol. 2019.

Role of Tonsillar Chronic Inflammation and Commensal Bacteria in the Pathogenesis of Pediatric OSA. Front Immunol. 2021;12:648064.

Kaygusuz I., et al. Immunoregulatory cytokines and chronic tonsillitis. Acta Otorhinolaryngol Ital. 2013.

Cytokine production in patients with recurrent acute tonsillitis: analysis of tonsil samples and blood. Eur Arch Otorhinolaryngol. 2020.

Impact of vitamin D in children with chronic tonsillitis (immunohistochemical study of CD68 polarisation and proinflammatory cytokines estimation). Int J Pediatr Otorhinolaryngol. 2023.

Bacterial colonisation of surface and core of palatine tonsils among Tanzanian children with recurrent chronic tonsillitis and obstructive sleep apnoea. J Laryngol Otol. 2024.

AMBOSS Knowledge Base. Acute tonsillitis and pharyngitis: PANDAS, rheumatic fever, poststreptococcal glomerulonephritis. 2026.

Georgalas C., et al. Tonsillitis (Cochrane systematic overview). BMJ Clin Evid / PMC. 2014.

Tonsillopharyngitis: clinical highlights. Ann Otol Rhinol Laryngol.

Sarwar A., et al. Lemierre's Syndrome: A Lethal Complication of Acute Tonsillitis. Cureus. 2022.

Smith K.L., Hughes R., Myrex P. Tonsillitis and Tonsilloliths: Diagnosis and Management. Am Fam Physician. 2023;107:35-41.

Cohen J.F., et al. Rapid antigen detection test for group A streptococcus in children with pharyngitis (Cochrane Review). Cochrane Database Syst Rev. 2016.

A Comparison of Diagnostic Accuracy of a Rapid Antigen Detection Test in Screening for Group A Streptococcal Throat Infection Between Children and Adolescents. Cureus. 2021.

Spectrum and Inoculum Size Effect of a Rapid Antigen Detection Test for Group A Streptococcus in Children with Pharyngitis. PLoS ONE. 2012.

Performance of Rapid Streptococcal Antigen Testing Varies by Personnel. J Clin Microbiol. 2007.

Comparative Evaluation of Strep A Throat Swab Culture Results Using the RapidFor Strep A Rapid Test Kit. Diagnostics (MDPI). 2026.

The Efficacy of Paraprobiotic Lozenges (Lactobacillus helveticus MIMLh5) for the Prevention of Acute and Chronic Nose and Throat Infections in Children. Medicina. 2024;60:1235.

Chronic tonsillitis. The role of probiotics in the treatment of inflammation. Vestn Otorinolaringol. 2025.

Centor scores associated poorly with rapid antigen test findings in children with sore throat. Eur J Pediatr. 2024.

Outcomes of conservative antibiotic therapy in pediatric peritonsillar abscesses: a retrospective observational study. Eur J Pediatr. 2025.