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PubMed1998

Bacteriology of normal and diseased tonsils assessed by fine-needle aspiration: Haemophilus influenzae and the pathogenesis of recurrent acute tonsillitis.

The pathogenesis of recurrent tonsillitis is largely unknown. Selection of appropriate antibiotic therapy for patients with recurrent tonsillitis is difficult because of the limitations of traditional methods of sampling tonsillar microflora and the increasing incidence of beta-lactamase producing bacteria in the tonsil. In addition, little attention has been paid to the bacteriology of normal tonsils. The tonsil core bacteria was assessed in 124 patients with recurrent acute tonsillitis. Fifty-five of these patients were randomly selected for fine-needle aspiration which revealed a similar profile of bacteria in 85%. Fine-needle aspiration of 10 normal tonsils found few pathogens; the predominant organisms being normal flora. No Haemophilus influenzae were detected in this control group. This study demonstrates the accuracy of fine-needle aspiration in identifying tonsil core bacteriology and its suitability in the clinical setting. It reports on the flora of normal healthy tonsils and it highlights the association between H. influenzae and recurrent acute tonsillitis.

Acute Disease↗
PubMed2006

Actinomycetes colonization of tonsils: a comparative study between patients with and without recurrent tonsillitis.

OBJECTIVE: To determine the prevalence of tonsillar actinomycetes colonization in patients with and without recurrent tonsillitis and to study the association of this condition with recurrent tonsillitis and tonsillar hypertrophy. STUDY DESIGN AND SETTING: A retrospective study of 834 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep-disordered breathing without a history of recurrent tonsillitis (group B). RESULTS: The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for sleep-disordered breathing (44.1 per cent) than in patients who had undergone tonsillectomy for recurrent tonsillitis (33.3 per cent). The prevalence did not differ by sex or age of patient, although the occurrence rate was higher in the adult compared with the paediatric population. There was no statistically significant difference between the mean size of the tonsils removed in the two groups, and actinomycetes colonization did not affect tonsil size. Histopathological analysis of resected tonsils did not show active tissue infection. CONCLUSION: The presence of actinomyces does not indicate active disease. We are of the opinion that, although actinomyces colonization is more prevalent in patients with sleep-disordered breathing, it does not contribute to tonsillar hypertrophy nor to recurrent tonsillitis.

Actinobacteria↗
PubMedDate not supplied

Macroscopic oropharyngeal signs indicating impaired defensive function of palatine tonsils in adults suffering from recurrent tonsillitis.

The present study explored in adults suffering from recurrent tonsillitis the association between macroscopic oropharyngeal signs of recurrent inflammation, immunomorphology of palatine tonsils (counts of neutrophils by CD4 and macrophages by CD68 monoclonal antibodies in tonsillar microcompartments) and the occurrence of post-tonsillectomy bacteremia. The study involved 50 adults (31 females and 19 males) with recurrent tonsillitis. According to predominance of either inflammatory changes or evidence of sclerotic process in palatine tonsils and surrounding tissue macroscopic at oropharyngeal examination, the patients were divided into groups with 'inflammatory-type' and 'sclerotic-type' tonsils. Biochemically detected mean collagen content was significantly higher in 'sclerotic-type' tonsils than in 'inflammatory-type' tonsils (p=0.001). Post-tonsillectomy bacteremia was found in 22 patients (44%). A noteworthy finding was the higher recovery of anaerobes from blood cultures than in previous studies. A logistic regression analysis revealed that the post-tonsillectomy bacteremia was strongly associated with 'sclerotic-type' tonsils (p=0.0015) and with low counts of neutrophils in tonsillar tissue (p=0.047). We conclude that macroscopic oropharyngeal signs of sclerotic process in palatine tonsils indicate impaired tonsillar defense, in terms of lowered counts of neutrophils, increasing the risk of post-tonsillectomy bacteremia.

Adolescent↗
PubMedDate not supplied

Quantitative measurement of beta lactamase in tonsils of children with recurrent tonsillitis.

Tonsils were obtained from 50 children suffering from recurrent tonsillitis. The tonsils' core material was cultured for aerobic and anaerobic microorganisms. Beta lactamase production was assayed in all isolates and beta lactamase activity was measured in the contents of each tonsil. Mixed aerobic and anaerobic flora was obtained in all patients, yielding an average of 7.9 isolates (4.4 anaerobes and 3.5 aerobes) per specimen. Beta lactamase production was noted in 58 isolates recovered from 39 tonsils (78%). These were all 21 isolates of S. aureus and 10 B. fragilis, 18 of 45 B. melaninogenicus (40%), 7 of 14 B. oralis (50%), and 2 of 13 H. influenzae type B (15%). Beta lactamase activity was detected in 33 of the 39 (85%) tonsils which harbored beta lactamase-producing bacteria, and in none of the 11 tonsils which had no beta lactamase-producing bacteria. Our findings indicate the polymicrobial nature of deep tonsillar flora in children with recurrent tonsillitis, and demonstrate the presence of detectable beta lactamase activity in the tonsillar tissue in most of the tonsils which harbored beta lactamase-producing organism.

Bacteroides↗
PubMed2005

Toll-like receptor expression in the human nasopharyngeal tonsil (adenoid) and palantine tonsils: a preliminary report.

OBJECTIVE: The Waldeyer's ring, comprised of the nasopharyngeal tonsil (adenoid), the paired tubal tonsils, the paired palantine tonsils, and the lingual tonsil, is arranged in a circular orientation around the wall of the throat. This orientation allows direct contact between the tissues of the Waldeyer's ring and inhaled or ingested material, which may contain potential antigenic substances. Previous studies involving the tissues of the Waldeyer's ring have been focused on the adaptive immune system, with little consideration toward the innate immune system. Since studies have demonstrated that the adenoids and tonsils are capable of producing proinflammatory cytokines, we postulate that toll-like receptors (TLRs), which recognize components of pathogenic organisms, may be involved in the immune response in these tissues. TLRs are innate pattern recognition receptors, which produce proinflammatory cytokines and chemokines upon ligation. In this pilot study, we address expression of TLRs, which are vital components of the innate immune system, in adenoid and tonsil tissue. METHODS: To determine whether TLRs are expressed in the human adenoid and palantine tonsils, we utilized endpoint RT-PCR and real time RT-PCR. Endpoint PCR was performed on all tissue obtained from adenotonsillectomy patients. Real time RT-PCR was performed only on adenoid tissue. RESULTS: All of the ten TLRs examined are expressed in the adenoid and tonsil tissue with varying band intensities. TLR3, TLR7, TLR8, and TLR9 expression is highly variable between patients. CONCLUSIONS: TLRs are expressed in human adenoid and tonsil tissue, and may play a vital role in the immunological outcomes of these tissues.

Adenoids↗
PubMedDate not supplied

[Metabolic pool of purine and pyrimidine derivatives in the palatine tonsil of patients with chronic tonsillitis].

Tonsils from 10 patients (18-40 years old), with chronic tonsillitis were studied by means of histological methods as well as by high pressure liquid chromatography. In 5 patients with decompensated forms of the disease, accompanied by heart impairments during 1-3 years, only slight alterations in epithelial and follicular parts of tonsils were observed, while pronounced destruction of tonsil cells was detected in other 5 patients suffering from repeated anginas. The following purine and pyrimidine derivatives were identified in faucial tonsil tissue of all the patients with chronic tonsillitis studied: adenine, guanine, adenosine, guanosine, inosine and uridine. Distinct increase in content of these derivatives as well as occurrence of xanthine and uric acid (non-identified in the first group of patients with chronic tonsillitis) was noted in the patients with maximal destruction of faucial tonsil cells.

Adolescent↗
PubMed1996

Experimental study on spontaneous DNA synthesis of tonsillar lymphocytes in chronic recurrent tonsillitis and focal tonsillitis.

The immune function of tonsils and the immunological mechanisms of focal tonsillitis are still controversial. We do have some knowledge about the structure of tonsillar cells, but their functional status is still not clear. In 40 cases of chronic recurrent tonsillitis and 20 cases of focal tonsillitis with glomerular nephritis, cell culture of tonsillar lymphocytes was removed in vitro and 3H-tymidin incorporation applied to investigate the spontaneous DNA synthesis of tonsillar lymphocytes. The results demonstrated that: i) In chronic tonsillitis, spontaneous DNA synthesis of tonsillar lymphocytes in children is significantly stronger than that in adults (19,946 +/- 5,612 vs 9,216 +/- 5,702 cpm) (p <0.01). ii) Spontaneous DNA synthesis of tonsillar lymphocytes in focal tonsillitis is significantly stronger than that in the chronic recurrent tonsillitis in patients of the same age (25,307 +/- 12,231 cpm vs 12,455 +/- 7,914 cpm) (p <0.01). This indicates that the tonsillar lymphocytes are active in focal tonsillitis, can produce large amounts of memory B-cell clones, which reach other parts of the body through the blood and cause autoimmune reaction which can be blocked by tonsillectomy, thus curing the systemic disease.

Adolescent↗
PubMed2006

Toll-like receptors in cellular subsets of human tonsil T cells: altered expression during recurrent tonsillitis.

BACKGROUND: The palatine tonsils have a pivotal role in immunological detection of airborne and ingested antigens like bacteria and viruses. They have recently been demonstrated to express Toll-like receptors (TLRs), known to recognize molecular structures on such microbes and activate innate immune responses. Their activation might also provide a link between innate and adaptive immunity. In the present study, the expression profile of TLR1-TLR10 was characterized in human tonsil T cells, focusing on differences between subsets of CD4+ T helper (Th) cells and CD8+ cytotoxic T lymphocytes (CTL). The study was also designed to compare the TLR expression in T cells from patients with recurrent tonsillitis and tonsillar hyperplasia. METHODS: Tonsils were obtained from children undergoing tonsillectomy, and classified according to the clinical diagnoses and the outcome of tonsillar core culture tests. Two groups were defined; recurrently infected tonsils and hyperplastic tonsils that served as controls. Subsets of T cells were isolated using magnetic beads. The expression of TLR transcripts in purified cells was assessed using quantitative real-time RT-PCR. The corresponding protein expression was investigated using flow cytometry and immunohistochemistry. RESULTS: T cells expressed a broad repertoire of TLRs, in which TLR1, TLR2, TLR5, TLR9 and TLR10 predominated. Also, a differential expression of TLRs in CD4+ and CD8+ T cells was obtained. TLR1 and TLR9 mRNA was expressed to a greater extent in CD4+ cells, whereas expression of TLR3 mRNA and protein and TLR4 protein was higher in CD8+ cells. CD8+ cells from infected tonsils expressed higher levels of TLR2, TLR3 and TLR5 compared to control. In contrast, CD4+ cells exhibited a down-regulated TLR9 as a consequence of infection. CONCLUSION: The present study demonstrates the presence of a broad repertoire of TLRs in T cells, a differential expression in CD4+ and CD8+ cells, along with infection-dependent alterations in TLR expression. Collectively, these results support the idea that TLRs are of importance to adaptive immune cells. It might be that TLRs have a direct role in adaptive immune reactions against infections. Thus, further functional studies of the relevance of TLR stimulation on T cells will be of importance.

Bacterial Infections↗
PubMedDate not supplied

[Beta-hemolytic streptococci in tonsil hypertrophy and recurrent tonsillitis].

BACKGROUND: The recurrence of streptococci acute tonsillitis is a complication that often motivates the tonsillectomy. We studied the colonisation of tonsils and adenoids by S. pyogenes and other beta haemolytic streptococci in both surgical indications, recurrent tonsillitis and tonsillar hypertrophy. METHODS: We made for aerobic culture the following specimens, throat swabs, tonsils and adenoids tissue corresponding to 47 children referred for tonsillectomy. RESULTS: S. pyogenes was isolated in 11 cases (23.4%) of tonsils and other beta haemolytic non A streptococci was isolated in 11 cases, of them, group C streptococci was the most frequent with six cases. However in the recurrent tonsillitis group, S. pyogenes was isolated more significantly (47%) that other beta haemolytic streptococci (5.8%). Otherwise in the tonsilar hypertrophy group, S. pyogenes was isolated in the 10% while that other streptococci was isolated in the 33.3%. The culture of 38 adenoids yielded S. pyogenes and beta haemolytic group C streptococci in 6 cases each one (15.7%). CONCLUSIONS: S. pyogenes was isolated more frequently in recurrent tonsillitis that other micro-organisms while that in the tonsilar hypertrophy group predominated streptococci beta haemolytic non A, S. aureus and H. influenzae. Is of interest that the adenoids in our study showed an important reservoir of beta haemolytic streptococci. The throats swabs yielded less of the half of all beta haemolytic streptococci isolated in tonsilar tissue cultured.

Adenoids↗
PubMed2002

CD4+CD25+ T lymphocytes in human tonsils suppress the proliferation of CD4+CD25- tonsil cells.

Animal studies define CD4+CD25+ T cells as a subset that protect against autoimmune inflammation. We wanted to investigate whether CD4+CD25+ T cells from patients with recurrent tonsillitis could suppress the proliferation of other tonsil cells, in vitro, as this immunological tissue also may serve as a model for chronic inflammation. Tonsil CD4+CD25+ cells markedly suppressed the proliferation of CD4+CD25- T cells in Concanavalin A-stimulated cocultures compared with cultures containing CD4+CD25- T cells only. The suppression exerted by the CD4+CD25+ cells was abrogated if these cells were irradiated before coculture or if interleukin (IL)-2 was added to the culture medium. CD4+CD25+ T cells proliferated poorly in response to mitogen, when cultured alone. Substitution with CD4+CD25+ T cells isolated from peripheral blood, enriched by similar methods, did not downregulate the proliferation of CD4+CD25- responder cells from tonsils. The augmented suppressive ability of tonsil CD4+CD25+ T cells compared with cells of this phenotype from blood, on CD4+CD25- responder cells from tonsils, suggests that there may be a functional difference between CD25+ cells from the two locations. In conclusion, CD4+CD25+ T cells from inflamed tonsils distinctly suppressed T-cell responses to mitogen in vitro, pointing to a regulatory role for CD4+CD25+ cells retrieved from inflammatory reactions in humans.

Adolescent↗
PubMed2004

Immunity of tonsil and IgA nephropathy--relationship between IgA nephropathy and tonsillitis.

Our study hypothesized that cytokines or chemokines induced in tonsils by infectious stimulations play an important role on the exacerbation of the glomerular injuries in patients with IgA nephropathy (IgAN). Tonsils from six patients with IgAN diagnosed by renal biopsy were studied after getting their written informed consents Tonsils from six patients with tonsil disorders with non-renal disorders were examined as controls. Tonsillar mononuclear cells (TMCs) were isolated and resuspended with RPMI 1640 with 10% FCS. These cells were incubated for 48 h with staphlococcus enterotoxin-B (SEB) or lipopolysaccaride (LPS). The levels of IL-6, IL-8, IL-12 and MCP-1 in the supernatants were measured by solid-phase enzyme-linked immunosorbent assay (ELISA) kits. The actual cytokine concentrations were calculated by determining the standard curves. The experiments were performed in duplicate, and the mean value was calculated. We found that tonsillar mononuclear cells of IgA nephropathy produced mesangial proliferative chemokines (MCP-1, IL-8) in higher amounts compared to tonsils from non-IgA nephropathy. This result suggests that upper respiratory tract infections such as tonsillitis may be one of the risk factors of the aggravation in patients with IgA nephropathy.

Cells, Cultured↗
PubMed2000

[The evaluation of the palatine tonsil function in patients with chronic tonsillitis].

The authors review the results of the research performed in patients with chronic tonsillitis in 1997-1999. Immunological activity of their palatine tonsils was evaluated according to the original technique which demonstrated relations between external functional activity of the palatine tonsils and age as well as symptoms of chronic tonsillitis. Additional information is presented on interrelations between lymphocytopoietic production of the palatine tonsils and hormonal status, metabolism, ecological and physical factors. The study of lifetime activity of the palatine tonsils is necessary for examination of local immunity of the mucous membranes of the lymphoid pharyngeal ring.

Adolescent↗
PubMed1984

N-Acetyl-L-tyrosine ethyl ester (ATEe) hydrolytic activities of diseased human palatine tonsils. Possible pathogenesis of recurrent acute tonsillitis.

The N-acetyl-L-tyrosine ethyl ester (ATEe)-hydrolysing activities of tonsillar extracts in cases of recurrent acute tonsillitis decreased more than those in less severe cases of chronic tonsillitis and in cases of obstructive enlargement of the palatine tonsil. Since ATEe is hydrolysed by C1-esterase, the ATEe hydrolytic activity of the tonsil might be related to the C1-activating system of the tonsil. This indicates that tonsils in which ATEe hydrolytic activities are low, repeatedly and severely, become infected, possibly due to easy invasion of micro-organisms.

Acute Disease↗
PubMed1981

[Palatal tonsil changes and interstitial microbial foci in chronic tonsillitis].

Bacteriological, histological, immunomorphological, and bacterioscopic methods were used to study faucial tonsils removed in 85 patients with chronic tonsillitis and 100 cadavers of apparently normal subjects dying of trauma. The main feature of chronic tonsillitis was interstitial streptococcal infection. The size of interstitial microbial foci with broken integrity of the histohematic barrier and typical morphological signs defining the chronic tonsillitis as a whole are important. Three main morphological signs determining the presence of chronic tonsillitis should be distinguished: (1) microbial (large interstitial streptococcal foci and colonies of the microbes), (2) immunomorphological (hyperplasia of lymphoid follicles and plasmatization of the lymphoid tissue, cryptal epithelium and the surrounding tissue with accumulation of the cells containing IgM and IgG, and in adults also increase content of IgA producers); (3) pathological (foci of perivascular sclerosis, granulation tissue, wide cryptae filled with necrotic masses and microbes). These lesions indicate transformation of faucial tonsils into a focus of infection with an appropriate complex of tissue changes in which streptococci frequently break the integrity of barriers and penetrate into the blood and lymph vessels.

Cadaver↗
PubMed1983

T-cell maturation in the human thymus and tonsil: peanut agglutinin binding T lymphocytes in thymus and tonsil differ in maturation stage.

The finding of peanut agglutinin (PNA) binding capacity, supposed to be a marker of immature lymphocytes, within the T-cell population of the human thymus (58%) and tonsil (10%) prompted the comparison of maturation stages of PNA binding (PNA+) and nonbinding (PNA-) T cells in both organs. The proliferative response after mitogenic stimulation of purified PNA+ fractions was significantly less than that of purified PNA- fractions. The results of mitogen dose-response experiments, of variation in time of culture harvest, and of addition of irradiated allogeneic peripheral blood non-T cells indicated the intrinsic mitogen unresponsiveness of cells in the PNA+ fractions. The mitogen response of tonsil fractions was higher than that of thymocyte fractions. Cells with an immature immunologic phenotype were enriched in the thymocyte PNA+ fraction, and almost absent in the tonsil fractions. Both tonsil fractions contained cells with the immunologic phenotype of mature T cells, and showed a purine interconversion enzyme makeup comparable to mature T lymphocytes. It is concluded that the tonsil PNA+ T cell is a functionally immature lymphocyte which is in a further maturation stage than PNA+ or PNA- thymocytes. The presence of PNA+ T cells outside the thymus is of relevance for the clinical evaluation of PNA binding assays and suggests the occurrence of T-cell maturation within the tonsil environment.

Cell Separation↗
PubMed1983

Bacteroides melaninogenicus. Its recovery from tonsils of children with acute tonsillitis.

The presence of encapsulated and abscess-forming organisms belonging to the Bacteroides melaninogenicus group was investigated in 25 children with acute tonsillitis, and in 23 children without tonsillar inflammation (control). Encapsulated organisms of the B melaninogenicus group were found in 23 of 25 children with acute tonsillitis as compared with five of 23 controls. Subcutaneous inoculation into mice of the Bacteroides strains isolated from patients with tonsillitis produced abscesses in 17 of 25 instances, as compared with nine of the 23 of the controls. Group A streptococci were recovered from the tonsils of five children with tonsillitis and from four of the control group. These findings suggest a possible pathogenic role for the B melaninogenicus group in acute tonsillar infection in children.

Abscess↗
PubMed2000

Bacteriology of the tonsil core in recurrent tonsillitis and tonsillar hyperplasia--a short review.

In recurrent tonsillitis, the tonsil core harbours numerous bacteria, some of which are pathogenic and may occur in great numbers. The most frequent bacteria are Haemophilus influenzae, followed by Staphylococcus aureus and Streptococcus pyogenes. A high tissue concentration of these bacteria correlates with clinical parameters of infection and hyperplasia of the tonsils. The role of Streptococcus pyogenes, while undisputed in acute and epidemic tonsillitis, should perhaps be re-evaluated in recurrent and/or hyperplastic tonsillitis.

Bacterial Infections↗