srjcmsSRJCMSSRJCMS2788-8851https://doi.org/10.47310/srjcms.2025.v05i02.005Tonsillar Bacterial Flora and Its Correlation with Serum Ferritin and White Blood Cell Indices in Chronic TonsillitisDherarMohammed JasimHiwaOthman NoriMohammedAbdulwahab BahjatM.B.Ch.B - F.I.C.M.S.(ENT), Kirkuk Health Directorate, IraqM.B.Ch.B - F.I.C.M.S.(ENT) - C.A.B.M.S. (ORL) - Kirkuk Health Directorate, IraqBackground: Chronic tonsillitis is a recurrent infection of the palatine tonsils, often leading to persistent microbial colonization and systemic inflammatory responses. Objective: This study aimed to investigate the bacterial profile of tonsillar flora in children with chronic tonsillitis and assess its correlation with serum ferritin and white blood cell (WBC) indices. Methods: This cross-sectional observational study was conducted by board-certified otolaryngologists in private ENT clinics across Kirkuk City, Iraq, from June 1, 2023, to December 31, 2024. It aimed to evaluate the correlation between tonsillar bacterial flora and systemic inflammatory markers, specifically serum ferritin and white blood cell (WBC) indices, in paediatric patients with chronic tonsillitis. Fifty children under 12 years scheduled for elective bilateral tonsillectomy were enrolled following strict inclusion and exclusion criteria. All patients underwent standardized ENT evaluation. Tonsillectomies were performed under general anaesthesia using cold dissection or bipolar electrocautery and core tonsillar tissues were aseptically collected for microbiological analysis. Samples were cultured on blood, MacConkey and chocolate agar and incubated under aerobic and microaerophilic conditions. Bacterial identification was performed using conventional and automated methods. Antimicrobial susceptibility testing followed CLSI guidelines using the Kirby-Bauer disk diffusion method. Preoperative blood samples were analysed for serum ferritin using ELISA and for CBC parameters with automated haematology analysers to assess inflammatory response. Results: The study showed that Streptococcus pyogenes was the predominant pathogen, isolated in 20 cases (40%), Staphylococcus aureus followed with a significant proportion of 15 cases (30%). Elevated serum ferritin levels (>100 ng/mL) were observed in 60% of cases. Antibiotic sensitivity was highest for ceftriaxone (88%) and ciprofloxacin (82%). A statistically significant positive correlation was found between serum ferritin and total WBC (r = 0.52, p < 0.01) and neutrophil percentage (r = 0.47, p < 0.05), while no significant correlation was found with lymphocyte count (r = -0.12). Patients infected with S. aureus had the highest ferritin levels (134.6 ± 18.2 ng/mL), compared to those with negative cultures (68.5 ± 9.3 ng/mL). Logistic regression identified S. aureus infection (OR = 3.25, p = 0.02) and neutrophilia (>65%) (OR = 2.89, p = 0.03) as independent predictors of elevated ferritin. Conclusion: Chronic tonsillitis in children is frequently associated with S. pyogenes and S. aureus, which provoke elevated systemic inflammatory markers. Correlating serum ferritin with WBC indices offers valuable insight into disease severity and could guide clinical decision-making.