Abstract
Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms by using the pharynx palatine tonsils epithelium electron microscopic examination of the patients with infectious mononucleosis and acute streptococcal tonsillitis.
 Materials and methods. Two patients – patient P., 12 years old with a confirmed diagnosis of infectious mononucleosis and patient A., 8 years old with confirmed acute streptococcal tonsillitis. The patients were taken a bacteriological examination of the mucus and epithelium scraping from the surface of the pharyngeal tonsils. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University.
 Results and discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria: Diphtheroides sp., Neisseria sp., Corynebacterium spp. were identified as result of the patient P. bacteriological examination of mucus from the surface of the pharyngeal tonsils. Staph. aureus, Str. viridans, Str. pneumoniae were identified during a bacteriological examination of patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient’s tonsils with acute tonsillitis. Research showed that bacteria were accumulated not only in the structure of extracellular detritus. Numerous bacteria accumulations were also found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis. The cell's shape looked like a bunch of grapes.
 Conclusions. The electron microscopic examination showed differences in the coccal flora localization: the extracellular localization of bacteria in the patient with acute bacterial tonsillitis and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.
Highlights
One of the most common symptoms of infectious mononucleosis (MI), which is caused by Epstein-Barr virus (EBV), is tonsillitis in which the pathological process involves the palatine tonsils, which are covered with a dense, membrane-like exudate [1]
Studies have shown that the adhesion of bacteria to the epitheliocytes of the tonsils, as well as the epithelium of the nasopharynx is inversely proportional to the age of patients; at the same time, the intensity of this process increases in accordance with the increase in the duration of the disease [6]
Under conditions of acute streptococcal tonsillitis in detritus, which covered the surface of the epithelium of the tonsil, an accumulation of bacteria was found, which in shape and location could be regarded as cocci; at the same time, pathological inclusions and bacteria were not visualized in the cytoplasm of epitheliocytes (Fig. 1–3)
Summary
One of the most common symptoms of infectious mononucleosis (MI), which is caused by Epstein-Barr virus (EBV), is tonsillitis in which the pathological process involves the palatine tonsils, which are covered with a dense, membrane-like exudate [1]. According to Stenfors et al [3] in infectious mononucleosis on the surface of one epithelial cell located on the surface of the palatine tonsil can be fixed more than 500 different bacteria [4, 5]. Studies have shown that the adhesion of bacteria to the epitheliocytes of the tonsils, as well as the epithelium of the nasopharynx is inversely proportional to the age of patients; at the same time, the intensity of this process increases in accordance with the increase in the duration of the disease [6]. Persistence of EBV can activate the penetration of certain bacterial pathogens into the epithelial tissues of the tonsils [7]
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