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PubMed1999

Investigation of variant Creutzfeldt-Jakob disease and other human prion diseases with tonsil biopsy samples.

BACKGROUND: Prion diseases are associated with the accumulation of an abnormal isoform of cellular prion protein (PrPSc), which is the principal constituent of prions. Prions replicate in lymphoreticular tissues before neuroinvasion, suggesting that lymphoreticular biopsy samples may allow early diagnosis by detection of PrPSc. Variant Creutzfeldt-Jakob disease (variant CJD) is difficult to distinguish from common psychiatric disorders in its early stages and definitive diagnosis has relied on neuropathology. We studied lymphoreticular tissues from a necropsy series and assessed tonsillar biopsy samples as a diagnostic investigation for human prion disease. METHODS: Lymphoreticular tissues (68 tonsils, 64 spleens, and 40 lymph nodes) were obtained at necropsy from patients affected by prion disease and from neurological and normal controls. Tonsil biopsy sampling was done on 20 patients with suspected prion disease. Tissues were analysed by western blot to detect and type PrPSc, by PrP immunohistochemistry, or both. FINDINGS: All lymphoreticular tissues obtained at necropsy from patients with neuropathologically confirmed variant CJD, but not from patients with other prion diseases or controls, were positive for PrPSc. In addition, PrPSc typing revealed a consistent pattern (designated type 4t) different from that seen in variant CJD brain (type 4) or in brain from other CJD subtypes (types 1-3). Tonsil biopsy tissue was positive in all eight patients with an adequate biopsy sample and whose subsequent course has confirmed, or is highly consistent with, a diagnosis of variant CJD and negative in all patients subsequently confirmed to have other diagnoses. INTERPRETATION: We found that if, in the appropriate clinical context, a tonsil biopsy sample was positive for PrPSc, variant CJD could be diagnosed, which obviates the need for a brain biopsy sample to be taken. Our results also show that variant CJD has a different pathogenesis to sporadic CJD.

Adolescent↗

PubMed2001

Post-transplant lymphoproliferative disease in tonsils of children with liver transplantation.

OBJECTIVE: To assess the incidence and characteristics of post-transplant lymphoproliferative disease (PTLD) in tonsils of the liver transplanted children. METHODS: All patients under 14 years of age recipients of a liver transplant at the institution and operated on for tonsillectomy under suspicion of malignancy were included in this study. RESULTS: Seven patients underwent surgery on their tonsils under suspicion of PTLD. One case of B-cell lymphoma, and three cases of polymorphic diffuse B-cell hyperplasia were found. This represents an incidence of 1.4% of PTLD in the tonsils of the 283 pediatric liver transplants performed at the hospital. CONCLUSION: The incidence of PTLD in tonsils after liver transplantation is very low at the institution. However, it is very important to follow-up allograft recipients for early diagnosis of this entity.

Child↗

PubMed2003

Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils.

INTRODUCTION: Hypertrophy of the adenoids and palatine tonsils is the second most frequent cause of upper respiratory obstruction and, consequently, mouth breathing in children. Prolonged mouth breathing leads to muscular and postural alterations which, in turn, cause dentoskeletal changes. OBJECTIVE: The aim of this study was to determine muscular, functional and dentoskeletal alterations in children aged 3-6 years. MATERIALS AND METHODS: Seventy-three children, including 44 with tonsil hypertrophy and 29 controls, were submitted to otorhinolaryngologic, speech pathologic and orthodontic assessment. RESULTS: Otorhinolaryngologic evaluation revealed a higher incidence of nasal obstruction, snoring, mouth breathing, apneas, nocturnal hypersalivation, itchy nose, repeated tonsillitis and bruxism in children with tonsils hypertrophy. Speech pathologic assessment showed a higher incidence of open lip and lower tongue position, and of hypotonia of the upper and lower lips, tongue and buccinator muscle in these children, accompanied by important impairment in mastication and deglutition. Orthodontic evaluation demonstrated a higher incidence of lower mandible position in relation to the cranial base, a reduction in lower posterior facial height, transverse atresia of the palate, and a dolicofacial pattern. CONCLUSION: Postural and functional alterations anticipate dentoskeletal changes, except for the facial pattern. Postural alterations and the skeletal pattern seem to play an important role in infant dentofacial growth.

Adenoids↗

PubMed1999

Microscopic detection of occult malignancy in the adult tonsil.

Microscopic evaluation of all adult tonsillar specimens has been considered essential despite the low incidence of unsuspected pathologic conditions. We evaluate whether routine histologic examination of clinically benign adult tonsillar specimens is indicated. We retrospectively reviewed pathology results from all tonsillectomies performed on patients ages 18 years or older at our institution from 1989 through 1996. Three groups were created on the basis of indications for tonsillectomy: (1) routine tonsillectomies for benign disease, (2) asymmetric tonsils, and (3) search for unknown primary lesions. Demographic data and pathologic findings in each group were analyzed. In 1280 tonsillectomies performed for benign disease there were no malignancies (0%) and 32 cases (2.50%) with clinically unsuspected benign pathologic conditions. In 31 cases of tonsillar asymmetry, two cases with malignant lymphoma (6.5%) and three cases with benign pathology (9.7%) were identified. In nine patients with squamous cell carcinoma metastatic to the neck, two occult primary lesions were identified in the ipsilateral tonsil. Our results suggest that histologic evaluation of adult tonsils removed for benign disease may be clinically unnecessary. The elimination of microscopic examination of tonsils removed from patients whose clinical presentation is entirely consistent with benign disease poses minimal risk of missing clinically significant pathologic conditions. Substantial costs for negative examinations may be avoided.

Adolescent↗

PubMedDate not supplied

Isolated tonsillar sarcoidosis manifested as asymmetric palantine tonsils.

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. Isolated sarcoidosis of palatine tonsils in the absence of other systemic localizations is very rare, and only a few cases have been described in literature. We report a case of a 69-year-old woman presenting an asymptomatic unilateral enlargement of palatine tonsils. The pathologic report of the tonsillectomy specimen revealed the presence of noncaseating granulomatous lesions compatible with sarcoidosis. The research of acid-fast bacilli on the biopsy material using the Ziehl-Neelsen stain was negative, and no cultural growth was documented. Further investigations confirmed the diagnosis and excluded other systemic localizations of the disease. In our experience, asymmetric tonsils caused by sarcoid disease should be taken into consideration for the differential diagnosis in tonsillar enlargement. With this report, we underline the possibility of an isolated localization of sarcoidosis in palatine tonsils manifested as asymmetric enlargement, and we point out the value of histopathologic examination after tonsillectomy in selected cases. Once sarcoid lesions are found in tonsillar specimens, further investigations are mandatory to confirm the diagnosis, to detect an eventual multisystemic disease, and to exclude a possible association with malignancy.

Aged↗

PubMed2000

An Actinobacillus pleuropneumoniae PCR typing system based on the apx and omlA genes--evaluation of isolates from lungs and tonsils of pigs.

The genetic variability of a gene coding for an outer membrane lipoprotein (omlA) was used to develop a PCR typing system for Actinobacillus pleuropneumoniae. Sequence differences in the middle region of the gene divided the A. pleuropneumoniae serotypes in five distinct groups. Group I included serotypes 1, 9, 11 and 12 (omlA l), Group II consisted of serotypes 2 and 8 (omlA II), Group III included serotypes 3, 6 and 7 (omlA III), Group IV (omlA IV) consisted of serotype 4 and Group V of serotypes 5a, 5b and 10 (omlA V). The sequence differences were utilized to construct PCR primers specific for each group, except of Group IV, as the amplicon of serotype 4 could be separated from Group III by size. Together with a PCR apx typing system, the omlA PCR typing system could discriminate the majority of A. pleuropneumoniae serotypes of biovar 1 except of serotypes 1, 9 and 11 and serotypes 2 and 8. The PCR typing system was tested on 102 field strains of A. pleuropneumoniae isolated from lungs of diseased pigs. The serotyping results of the investigated field strains were in agreement with the apx and omlA gene patterns found in the reference strains of the bacteria, with the exception of the omlA gene of five strains of serotype 8. To examine the apx and omlA gene pattern of tonsil isolates, the PCR typing system was tested on a total of 280 A. pleuropneumoniae field strains isolated from tonsils of pigs. Agreement between serotyping and DNA typing was found in 96% of the isolates using the apx gene patterns and in 89% of the isolates using the omlA gene. The same serotype specific apx/omlA gene pattern was thus found in the majority of the tonsil isolates and in isolates from diseased lungs. Most of the differences in the omlA gene were found in 18 tonsil isolates of serotype 12. The omlA/apx PCR typing system described in the present study makes it possible to determine the type specificity of the majority of A. pleuropneumoniae isolates by simple PCR technique and enables phenotype independent characterization of isolates non-typable by serotyping.

Actinobacillus Infections↗

PubMed1999

Early in vivo interactions of Actinobacillus pleuropneumoniae with tonsils of pigs.

Twenty gnotobiotic piglets were inoculated with 5 x 10(8) colony forming units of an Actinobacillus pleuropneumoniae biotype 1-serotype 9 strain onto their tonsils. Five other piglets (controls) were inoculated with phosphate-buffered saline solution. Pigs were euthanized at 30 min, 90 min, 180 min, 6 h, 9 h, 12 h or 24 h after inoculation. At necropsy, samples were taken from the tonsils for bacteriological, histological, immuno-histochemical and electron microscopical examination. A. pleuropneumoniae was isolated from tonsils of all the infected pigs, but not from tonsils of the control pigs. Early after inoculation bacteria were mainly associated with the stratified squamous epithelium and detached epithelial cells. Vacuolization and desquamation of the epithelium was observed and many transmigrating neutrophils were present. At later times after inoculation, bacteria were found closely associated with the crypt-walls and with detached cells present in the crypts. A strong neutrophil migration was observed mainly in the deeper parts of the crypts. It is concluded that attachment of A. pleuropneumoniae to tonsillar epithelial cells probably constitutes a first step in establishing bacteria at this body site.

Actinobacillus Infections↗

PubMed1999

Quantitative analysis of CD1a (T6) positive Langerhans cells in human tonsil epithelium.

Fifty-one human palatine tonsils of both sexes and 4-54 years of age were studied for quantitative analysis of Langerhans cells in the epithelium using CD1a (T6), which is a specific immunological marker for Langerhans cells and indeterminate cells. Cryo-sections were stained using the avidin biotin peroxidase method. Using light microscopy, CD1a-positive dark brown cells with dendritic processes were identified as Langerhans cells, which were located in the epithelium, subepithelial tissue, follicles and interfollicular areas. The Langerhans cells were counted only in the tonsil epithelium per zone of 1.1 mm length of basement membrane. For each biopsy, 25 such zones were studied. The mean number (SEM) of Langerhans cells per zone of tonsil epithelium was found to be 37 (+/- 0.5). In the male, it was 36 (+/- 0.7) but in the female, it was 38 (+/- 0.2). In different age subgroups, the mean number (SEM) varied between 40 (+/- 1.7) and 14 (+/- 1.1). In the age subgroups of 11-15, 16-20, and 21-25 years, the mean number showed significant sex differences. Since the 11-15, 16-20, and 21-25 age subgroups in the female showed an increased number of Langerhans cells, it is concluded that the immunological role of the palatine tonsils is increased during puberty and adolescence. In the female, there was a negative correlation (r = -0.196, p < 0.01) between age subgroups and mean numbers, but in the male there was no correlation (r = 0.008). Overall, in all the 51 biopsies together, there was a negative correlation (r = -0.017, p < 0.01) and significant (p < 0.001) sex and age differences.

Adolescent↗

PubMed2006

Evaluation of inspiratory pressure in children with enlarged tonsils and adenoids.

UNLABELLED: Children with enlarged tonsils and adenoids usually present breathing abnormalities such as snoring, mouth breathing and sleep apnea. It is known that upper airway obstruction and consequent mouth breathing may result in pulmonary diseases. AIM: The goal of this preliminary study was to evaluate the inspiratory pressure in children with upper airway obstruction due to enlarged tonsils. STUDY DESIGN: Clinical with transversal cohort. MATERIAL AND METHOD: We evaluated 37 children (4-3 years old, female/male) with enlarged tonsils who would be submitted to a T&A surgery in the Department of Otolaryngology, Medical School, University of Sao Paulo, from October 2002 to March 2003. The control group comprised 28 children without tonsillar disease submitted to the same tests. Inspiratory pressure was obtained using a manometer and vacuum meter. RESULTS: We could observe lower inspiratory pressures in children with upper airway obstruction. The mean of inspiratory pressure in the upper airway obstruction group was 14.607 cm/H2O and in the control group was of 27.580 cm/H2O. CONCLUSIONS: Enlarged tonsils and adenoids were associated with poor inspiratory pressure, resulting in increased breathing effort and work of the involved muscles.

Adenoids↗

PubMed2001

A comparison of sleep quality in normal children and children awaiting (adeno)tonsillectomy for recurrent tonsillitis.

Poor quality sleep and sleep-related hypoxia have been described in children awaiting (adeno)tonsillectomy even in the absence of a history which would suggest such problems. However, restless sleep has also been commonly reported in children from a normal population. It has not been shown whether an increasing frequency of tonsillitis is associated with deterioration in sleep quality. This study directly compares sleep quality in three groups of children: (1) a normal population; (2) children from a normal population who have tonsillitis but are not awaiting tonsillectomy; and (3) children awaiting tonsillectomy for recurrent tonsillitis. A questionnaire was completed by the parents and the answers compared using the chi2 and Spearman's rank correlation tests. The results show that children awaiting tonsillectomy have poorer sleep quality than their normal peers. However, there is no dose-response effect between deteriorating sleep quality and increasing frequency of tonsillitis.

Adenoidectomy↗

PubMed2001

Experimental IgG antibody production in vitro by peripheral blood and tonsil surface gamma+ B lymphocytes from Plasmodium falciparum-immune West Africans.

Antigen reactive B cells in tonsil specimens from teenagers from a region moderately exposed to P. falciparum were capable of being differentiated in vitro and producing specific immunoglobulin (Ig)G in up to 33% of individual experiments. Mononuclear cells or purified (s)gamma+ CD19+ B cells from peripheral blood or tonsil specimens from P falciparum-immune Senegalese subjects produced antigen-specific IgG upon appropriate stimulation in vitro. One fraction of this IgG was produced de novo by differentiated B cells and another fraction was likely bound on the surface of circulating or resident CD19+ sgamma+ B cells which were found in significantly greater numbers in individuals from rural Senegal as compared to nonimmune European controls. This study further documents the baseline levels of in vitro driven anti-P. falciparum IgG antibody production by mononuclear cells from blood and tonsils in immune populations exposed to P. falciparum differentially. Furthermore, this study demonstrates the relevance and potential utility of tonsils as a source of B lymphocytes to characterize further specific antibody responses to P. falciparum antigens in immune populations.

Adult↗

PubMed2001

Neutrophil migration in tonsils.

Recent studies have indicated the existence of an active cellular defence in the secretion on the tonsillar surface. This defence seems to consist partly of physiologically active neutrophils and is present in health and during disease. The present study was undertaken to examine the migration of these neutrophils to the secretion on the mucosal surface. Tonsils from 6 patients with acute tonsillitis and 5 patients with snoring problems were removed and sectioned. Sections were stained immunohistochemically against CD15 to visualise neutrophils. Other sections were stained with acridine orange to detect bacteria. Clusters of neutrophils were frequently seen in tonsils both from patients with acute tonsillitis and from snorers. They were observed to be accumulated within the tonsillar epithelial layer. Streaks of neutrophils could be observed running not only from vessels mainly near or within the epithelium to the epithelial surface, but also from vessels far from the epithelium through the extrafollicular areas to the epithelial surface. Bacteria were not present in the epithelium. We consider that the findings indicate an active physiological migration of neutrophils to the tonsillar surface.

Acridine Orange↗

PubMed2000

Detection of Lawsonia intracellularis in the tonsils of pigs with proliferative enteropathy.

The presence of Lawsonia intracellularis, the obligate intracellular bacterium causing proliferative enteropathy (PE), in the tonsils of pigs as a locus for infection or extraintestinal occurrence of the bacterium was investigated by PCR and immunohistochemistry. Tonsillar occurrence of L. intracellularis could be part of the pathogenesis of PE and an important risk factor in the spread of the disease. L. intracellularis was detected by only PCR in the tonsils of 2/32 pigs without PE at necropsy but with a clinical history of diarrhoea and detection of the bacterium in faeces 1 to 3 weeks prior to necropsy but not in four pigs with moderate PE lesions. However, L. intracellularis was detected in the tonsils of 4/9 pigs with PE complicated with necroses and in 4/4 pigs with proliferative haemorrhagic enteropathy in which L. intracellularis antigen also was demonstrated in tonsillar macrophages and as intact bacteria in the lumen of the crypts. The results show that L. intracellularis is detectable in the tonsils of pigs and that the tonsillar presence of L. intracellularis appears to be correlated to the severity of the intestinal lesions possibly as a result of local retention and not as part of the pathogenesis of PE.

Animals↗

PubMed2004

T-cell repertoire in the tonsils of patients with IgA nephropathy.

It is known that IgA nephropathy (IgAN) often progresses to end-stage renal failure within a period of 20 years. There are many reports suggesting the relationship between the tonsillar autoimmune response and the pathogenesis of IgA nephropathy, however, definitive evidence has not been detected. Recently, studies of T-cell receptor variable (TCR V) region gene usage in human autoimmune disease showed that the TCR V beta repertoire of pathogenic T cells was highly restricted. In this study, we examined expression of TCR V beta families in tonsils from IgAN patients. The study group consisted of 7 IgAN patients and 7 obstructive sleep apnea syndrome (OSAS) patients. Total RNA was extracted from the tonsils of each patients, and expression of each TCR V beta subfamily gene were examined by reverse transcription-polymerase chain reaction (RT-PCR) method. V beta 6 is more frequently used in tonsils of IgAN patients than in those of OSAS patients (p = 0.01), and V beta 20 is more frequently used in OSAS patients than IgAN patients (p =0.01). It was already reported that the frequency of V beta 6 subfamily usage is elevated in both peripheral blood lymphocytes (PBL) and renal tissues of IgAN patients Therefore, our results suggested that the tonsils may be one of the sources of specific T cells related to the pathogenesis of IgAN.

Adult↗

PubMed2004

Involvement of tonsils in IgA nephropathy.

This study was intended to clarify the involvement of tonsils in the pathogenesis of IgA nephropathy. In 62 patients with IgA nephropathy and 20 patients with other renal diseases, their tonsils were stimulated by an ultra short wave. Forty of 62 patients with IgA nephropathy (65%) showed a deterioration of urinary findings after the stimulation compared with six of 20 patients with other renal diseases (30%). Previous episodes of gross hematuria following upper respiratory tract infections existed in 17 of 40 patients (Group A) who showed a deterioration of urinary findings after tonsil stimulation (43%) as against in four of 22 (Group B) without the deterioration (18%). The level of serum secretory IgA was higher in Group A than in Group B. It is suggested that chronic tonsillitis may play an important role in the development of IgA nephropathy. Thirty-six patients received tonsillectomy from 1980-2002. The frequency of gross hematuria at upper respiratory infection decreased in 56% of the patients The amount of urinary protein decreased in 33% of the patients and RBC counts decreased in 56% of the patients Eight patients with tonsillectomy were followed up longer than 16 years Two of them went to hemodialysis and five of them showed no urinary abnormalities at present. The effect of tonsillectomy in the long term was not clarified in this study.

Adolescent↗

PubMed2002

Craniofacial morphology in preschool children with sleep-related breathing disorder and hypertrophy of tonsils.

UNLABELLED: The purpose of this study was to examine craniofacial morphology, pharyngeal airway space and hyoid bone position in preschool children with sleep-related breathing disorder associated with hypertrophy of tonsils (SBDT). Thirty-eight preschool children, mean age 4.7 y, with SBDT and with an apnoea index (AI) of 0 < AI < 5, were divided into two groups. One consisted of 15 children with sleep-related breathing disorder (SBD) and more than 75% of the tonsils visible (GIII) and the other of 23 children with SBD and 25-75% of the tonsils visible (GII). The control group consisted of 31 children without ear, nose and throat disease and with GI (barely visible) tonsils. Compared with the controls, GIII children had a retrognathic mandible, a large posterior facial height, a large interincisal angle with retroclined lower incisors, a narrow pharyngeal airway space, an anterior tongue base position and a long soft palate. Compared with the controls, GII children had a large anterior lower facial height and a short nasal floor. However, like the controls, GII children did not have a retrognathic mandible. CONCLUSION: The findings show that children with SBDT display a characteristic facial appearance at an early age. Since the condition has an effect on growth, it needs to be prevented by controlling morphology and function at the preschool age.

Case-Control Studies↗

PubMed1988

Isolation and characterization of human tonsil dendritic cells.

Human dendritic cells were isolated from tonsils by density gradient separation followed by FACS IV sorting with mAbs to remove contaminating cell populations. The resulting dendritic cell population consisted of large cells with plentiful basophilic cytoplasm, lacking in granules but containing a prominent Golgi apparatus and numerous mitochondria. The cell membrane was irregular, and marked cell protrusions were obvious when stained with anti-HLA class II reagents. Their nuclei were irregular and often indented with a visible nucleolus. These cells were not phagocytic and stimulated autologous and allogeneic lymphocytes more effectively than other tonsil cell types in MLR. Phenotypic analysis of these cells confirmed that they expressed the leucocyte common antigen and stained strongly for HLA-class II antigens. Tonsil dendritic cells also coexpressed the LFA-1 alpha and LFA-1 beta chains but did not stain with a wide variety of anti-monocyte or anti-macrophage antibodies. The cells also lacked Fc and complement receptors and failed to stain with CD1 antibodies. Extensive testing with mAbs revealed only a few positive reactions, and these were consistent with reports of these antibodies staining interdigitating cells in tissue sections. This established that tonsil dendritic cells belong to the unique haemopoietic cell lineage of dendritic cells. No cytoplasmic staining of IL-1 alpha or IL-1 beta was demonstrated, although these lymphokines were readily detected in activated monocytes.

Antibodies, Monoclonal↗

PubMed2003

Porcine reproductive and respiratory syndrome virus persistence in blood, spleen, lymph nodes, and tonsils of experimentally infected pigs depends on the level of CD8high T cells.

Porcine reproductive and respiratory syndrome virus (PRRSV) induces a persistent viral infection suggesting an inefficient cellular immune response. The aim of the study was to evaluate the relationship between viral persistence and cytotoxic cells in blood, spleen, mediastinal lymph nodes (MLN) and tonsils of PRRSV experimentally infected pigs. Groups of four to six specific pathogen-free (SPF) pigs were infected with the LHVA-93-3 isolate, and blood and lymphoid organs were collected from 3 to 60 days post-infection (p.i.). Infectious particles and viral RNA were more or less rapidly eliminated in serum, spleen, lungs and MLN but persisted the longest in tonsils. Lymphocytes CD2+ CD4+, CD2+ CD8high, CD2+ CD8low and NK cells populations were phenotyped and their reactivity to PHA and ConA were tested. Analysis of T cell subsets in blood and lymphoid organs indicated that the percentages of CD2+ CD8+ T cells slightly increased in spleen at 17 days p.i, whereas no changes were observed in CD2+ CD4+ cells in blood or lymphoid organs. However, discrimination of CD8+ cells in CD8high and CD8low subsets revealed that the percentages of CD2+ CD8high cells increased in spleen and blood from 10 to 45 or 60 days p.i. while they transiently increased in MLN and decreased in tonsils. The CD8low/CD8high ratio increased in the blood of PRRSV-infected animals at three days p.i. due to a transient decrease of CD2+ CD8high cells. This same ratio decreased in the spleen of infected pigs from 10 to 45 days p.i. due to an increase of CD2+ CD8high cells. The CD2+ MIL-4+ cell subset (NK cells) was not significantly modified in blood or lymphoid organs. In addition, the ability of lymphoid T cells from blood and lymphoid organs to respond to ConA or PHA stimulation was transiently impaired in blood and spleen during the PRRSV persistent infection. Taken together, these results suggest that, in persistently infected pigs, an impaired CD2+ CD8high cell response in MLN and tonsils favors viral persistence in these organs, in contrast with the response seen in blood and spleen where viral elimination appears to occur sooner.

Animals↗