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Core tonsillar cultures for aerobic and anaerobic bacteria were performed on four normal tonsils removed from four children because of velopharyngeal insufficiency and on four tonsils removed from four children because of recurrent tonsillitis. The data illustrate the presence of polymicrobial flora in the cores of normal noninflamed tonsils and the increase in their number and encapsulation during the inflammatory process.
The role of three oral flora organisms (Prevotella intermedia, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans) was investigated in 31 children with recurrent nonstreptococcal tonsillitis. Antibody titers to the three organisms were measured by enzyme-linked immunosorbent assay in the 31 patients, as well as in 32 control patients who had not suffered from recurrent tonsillitis. None of the individuals in either group suffered from periodontal or dental illness. Significantly higher antibody levels to P intermedia were found in the study group as compared to controls (median 91.0 versus 72.5; p = .02). In contrast, the antibody titers to the other two organisms were generally low (less than 0.30), and no difference was found among the two study groups. The elevated antibody levels to P intermedia, a known oral pathogen that is also isolated from most recurrently inflamed tonsils, suggest a pathogenic role for this organism in recurrent tonsillitis.
M-cells are believed to play a pivotal role in initiation of the immune response. These cells, located in the epithelia that overlie mucosal lymphoid follicles, are responsible for the active uptake of particulate antigens and for their translocation to the underlying lymphoid tissue. The identification of reliable markers for M-cells is therefore extremely important for the study of the initial steps that lead to the immune response. For this purpose, we studied cytokeratin 20 (CK20) expression in the epithelium of rabbit palatine tonsils by immunofluorescence, confocal microscopy, and Western blotting. CK20+ cells were observed in all rabbit palatine tonsils examined. By Western blotting, one CK20-immunoreactive band was identified at 46 kD on samples of proteins from the intermediate filament-enriched cytoskeletal fraction of tonsil epithelium. Double labeling of CK20+ cells with cell-specific markers confirmed that such cells were actually M-cells. Moreover, CK20+ M-cells displayed a mature phenotype (they formed pockets harboring lymphoid cells) and were functionally competent because they could take up particulate antigens from the pharyngeal lumen. We conclude that CK20 is an M-cell marker for rabbit palatine tonsils. Moreover, we can hypothesize the use of M-cells as a possible site for antigen delivery of particle-based vaccines.
A monoclonal antibody dot-blot assay was used to evaluate detergent lysates of tonsil tissue from mule deer to detect PrP(CWD), the marker for the cervid transmissible spongiform encephalopathy chronic wasting disease (CWD). Samples of formalin-fixed brain and tonsil tissues from mule deer were examined for PrP(CWD) using immunohistochemistry (IHC) with Mab F99/97.6.1, the gold standard for diagnosis of preclinical CWD. The contralateral tonsil from each of the 143 deer was prepared for confirmatory IHC and as a 10% (wt/vol) detergent lysate without purification or enrichment steps for monoclonal antibody dot-blot assay. PrP(CWD) was detected by dot-blot assay in 49 of 50 samples considered positive by IHC. Forty-eight of the positive samples were evaluated with a quantitative dot-blot assay calibrated with recombinant PrP. Tonsillar PrP(CWD) concentrations ranged from 34 to 1,188 ng per 0.5 mg starting wet weight of tissue. The abundant PrP(CWD) in mule deer tonsil will facilitate development and validation of high-throughput screening tests for CWD in large populations of free-ranging deer.
BACKGROUND: Lymphoid tissues constitute basic structures where specific immune responses take place. This leads to the development of germinal centres (GCs), migration of cells and the generation of memory cells. Here, we have compared human tumour reactive lymph nodes and tonsils with control lymph nodes. RESULTS: The study by flow cytometry shows that in control lymph nodes the majority of cells were naive T-lymphocytes (CD45RA+/CD7+). In reactive nodes, although the percentage of CD45RO+ T cells remains constant, there is an increase in the number of B-lymphocytes, and a reduction in naive T cells. The percentage of cells expressing CD69 was similar in reactive nodes and in controls. In both cases, we have found two populations of B cells of either CD69- or CD69dull. Two populations of T cells, which are either negative for CD69 or express it in bright levels (CD69bright), were also found. The analysis of tissue sections by confocal microscopy revealed differences between control, tonsils and tumor reactive lymph nodes. In control lymph nodes, CD19 B cells are surrounded by a unique layer of CD69bright/CD45RO+ T cells. GCs from tonsils and from tumour reactive nodes are mainly constituted by CD19 B cells and have four distinct layers. The central zone is composed of CD69- B cells surrounded by CD69bright/CD45RO+ T cells. The mantle region has basically CD69dull B-lymphocytes and, finally, there is an outer zone with CD69-/CD45RO+ T cells. CONCLUSIONS: Human secondary lymphoid organs react with an increase in the proportion of B lymphocytes and a decrease in the number of CD45RA+ T cells (naive). In tonsils, this is due to chronic pathogen stimulation, whereas in lymph nodes draining head and neck carcinomas the reaction is prompted by surrounded tumors. During this process, secondary lymphoid organs develop secondary follicles with a special organization of T and B cells in consecutive layers, that are described here by confocal microscopy. This pattern of cellular distribution may suggest a model of cell migration into the secondary lymphoid follicles.
BACKGROUND: Recurrent tonsillitis and sleep apnea are the major indications for tonsillectomy in children. We hypothesized that the recurrent vibration in the upper airway of snoring children would promote inflammatory changes in the tonsillar tissue and would lead to the up-regulation of cysteinyl leukotriene (LT) receptors (Rs). OBJECTIVE: To assess the expression patterns of the human LT-Rs in children undergoing tonsillectomy, and compare those patterns in children having recurrent throat infections (RIs) and children with obstructive sleep apnea syndrome (SA). METHODS: Tonsillar tissue from 17 children with SA and 13 with RIs was subjected to quantitative polymerase chain reaction using specific primers for LT1-R and LT2-R, and to immunohistochemistry and Western blotting for protein expression of LT1-R and LT2-R. RESULTS: Messenger RNA encoding for the expression of LT1-R and LT2-R was detected in the tonsils of all children. Immunoblots revealed significantly higher expressions of LT1-R and LT2-R in the tonsils of children with SA. The topographic pattern of both receptors differed among the tonsils of children with SA and RI. CONCLUSION: LT1-R and LT2-R are expressed in pediatric tonsillar tissue, are more abundant in SA patients, and demonstrate a specific topographic pattern of expression. These findings suggest that an inflammatory process involving LT expression and regulation occurs in children with SA.
The physiopathology of obstructive sleep apnea-hypopnea syndrome (OSAHS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. In obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. Therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese OSAHS patients with tonsil hypertrophy. Seven OSAHS patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. All patients were submitted to pre- and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. Patients' average age was 36.4 +/- 10.3 years and average preoperative body mass index was 36.6 +/- 6.3 kg/m(2). Postoperative weight did not differ significantly from preoperative weight (P = 0.27). Average preoperative apnea and hypopnea index (AHI) was 81 +/- 26/h and postoperative AHI was 23 +/- 18/h (P = 0.0005). Average preoperative minimum oxyhemoglobin saturation (SaO2 min) was 69 +/- 14% and the postoperative value was 83 +/- 3% (P = 0.038). In relation to AHI, 6 (86%) of the 7 patients studied showed a reduction of 50% in relation to preoperative level and of these, 4 (57%) presented AHI of less than 20%. Only one patient presented a reduction of less than 50% in AHI, but even so showed improved SaO2 min. Tonsillectomy treatment for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI, with improvement in SaO2 min. This procedure could be eventually considered as an option of treatment for obese OSAHS patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.
In order to illustrate the significance of pharmacokinetic/pharmacodynamic (PK/PD) parameters of azithromycin (AZM) in tonsillar and respiratory tract infections, we developed original simulation software. As area under the curve over 24 hours divided by the minimum inhibitory concentration (AUC24/MIC) and time over a 24-hour period that the drug concentration exceeds the MIC (t > MIC) are important predictors of the clinical efficacy of macrolides, our software calculates these indices for plasma, tonsil, epithelial lining fluid (ELF), lung tissue (LT) and alveolar macrophages (AM). For an MIC of 0.5 microgram.mL-1, after administration of AZM 500 mg daily for 3 days (tonsillitis) or AZM 500 mg on day 1 and 250 mg daily for the next 4 days (respiratory tract infections) to a 70 kg subject, PK/PD parameters are as follows: AUC24/MIC (h): 9.5 (plasma); 439 (tonsil); 57.5 (ELF); 439 (LT); 1354 (AM); t > MIC is 24 hours in all tissues. Our simulation model illustrates the following: (i) AUC24/MIC values are above the 25-30-hour threshold in S. pneumoniae infection; and (ii) tissue concentrations exceed the MIC for 6 days after the last dose in ELF and for more than 2 weeks in tonsils, LT and AM.
The DNA and RNA content and also the thymidine and uridine incorporation kinetics were determined in peripheral lymphocytes and lymphatic cells of the tonsil. The existence of a proliferation pool of lymphoid cells in the tonsil could be established by the comparison of all data. An age-conditioned reduction of the pool size was assumed from the uridine incorporation rate which takes place faster than the organo-specific cell decrease likewise conditioned by age in the tonsil. The abscess tonsil could be explained as a pathological state with considerable reduction of proliferation.
The experiment was performed in order to approach the question whether denatured epithelial debris in the tonsillar crypts could be an antigenic substance which might be responsible for inducing autoallergic reactions in the skin. Identical antigenicity of the tonsillar epithelium and of the skin was determined by immunofluorescence study. Then heat-denatured skin extract was used as a model system for studying the antigenicity of denatured epithelial debris. A blastoid transformation study of tonsil and peripheral blood lymphocytes obtained from patients with pustulosis palmaris et plantaris and control individuals was carried out by stimulating with heat-denatured skin extract. Tonsil lymphocytes responded well to skin extract, but peripheral blood lymphocytes scarcely responded at all. Skin extract induced transformation of tonsil lymphocytes occurred in the T-cell fraction, but not in the B-cell fraction. The results indicate that denatured tonsillar epithelium can induce an immune response of tonsil lymphocytes as autoantigen, and that the blastogenesis observed was dependent upon T cells.
In a histopathological analysis of the palatine tonsils resected in 70 patients (28 adults and 42 children) with persistent angina, several Langhans'-type giant cells without epithelioid granuloma were detected in the serial specimens of all tonsils from 3 adult patients with pustulosis palmaris et plantaris. By contrast, in the tonsils of the other 67 patients, without pustulosis palmaris et plantaris, only a few atypical multinucleated giant cells including those of foreign body type were found, in the serial specimen of 4 cases. On the basis of these results, the appearance of Langhans'-type giant cells in the tonsil should be noted in persistent angina with pustulosis palmaris et plantaris.
Ciliocytophthoria (ccp) in nasal or nasopharyngeal secretion from the patients with acute tonsillitis, acute rhinosinusitis and allergic rhinitis was studied. The ratio of the presence of ccp among acute tonsillitis, acute rhinosinusitis and allergic rhinitis was compared. Acute tonsillitis had a much more positive ccp test than other diseases. This might be related to the anatomical feature of palatine tonsil having a complicated hollow-crypt. The presence of Haemophilus influenzae was the most frequent in patients with positive ccp test. Further study will be necessary to determine possible relationship between viral infection and bacteria or endotoxin from bacteria.
Tonsillectomy and adenoidectomy are among the most frequently held operations in the ENT field. In our hospital, the number of cases of tonsillectomy has been decreasing recently as compared with 10 to 15 years ago. Especially the number of cases under 10 years old has shown a decrease. It is sometimes difficult to decide the indication for tonsillectomy even for habitual tonsillitis. In this paper, the post operative course of tonsillectomy with habitual tonsillitis was investigated during 1976 to 1986 using a questionnaire. Answers evaluable were obtained from 207 cases. The efficacy of the operation on sore throats, high temperatures and recurrent colds was very high, but a few cases complained that a foreign sensation of the throat had occurred or worsened after operation. The incidence of nasal allergy gradually increased after tonsillectomy, but further studies may be necessary to decide the exact relationship. Laboratory examinations, such as ASLO, CRP, white blood cell counts, immune complex, C3a and C5a, were not particularly helpful in deciding the indication of tonsillectomy for habitual tonsillitis. In general, it is thought that tonsillectomy is very effective for habitual tonsillitis, but we must be more careful in deciding such an indication.
Out of 169 patients with streptococcal tonsillitis treated with phenoxymethylpenicillin, 13 (8%) developed a new clinical infection with the same streptococcal strain within 2 weeks of completing the therapy (clinical treatment failure) and 24 (14%) were clinically healthy but harboured the same streptococcal strain after treatment (bacterial treatment failure). Patients with clinical treatment failure showed beta-lactamase activity in their saliva pellet significantly more often than patients with bacterial treatment failure, healed streptococcal tonsillitis or non-streptococcal tonsillitis as well as healthy controls. In an interference study, clinical treatment failures were compared with healthy streptococcal carriers, i.e. persons living in the same household and harbouring the same beta-streptococcal strain. 11/12 healthy carriers had alpha-streptococci with interfering activity against their own beta-streptococcal strain, while the corresponding figure for the clinical treatment failures was 2/13. Furthermore, 6/12 healthy carriers had beta-streptococci inhibiting their own alpha-strains, while the streptococci in 11/13 clinical treatment failures had this ability. The beta-lactamase activity and the interference between alpha- and beta-streptococci may be a contributory cause to treatment failure in streptococcal tonsillitis.
Treatment outcomes of tonsillectomy were studied in 7 Japanese patients with psoriasis--3 males and 4 females aged 9 to 46 years (median: 23 years)--followed up 2 to 9 years after tonsillectomy. All skin lesions disappeared in 3 patients, 80% of those in 2, and no change in the remaining 2 during follow-up. Of 5 in whom skin lesions improved, 4 were females and had a history of tonsillitis making skin lesions worse. In quantitative immunohistologic analysis on tonsillar tissues by CD20 and anti-ssDNA antibodies, areas of T cell-nodules were significantly expanded, but those of the B-lymphoid follicles were smaller, and the number of apoptotic cells increased in tonsils from patients with psoriasis and PPP compared to those with recurrent tonsillitis. The area of T cell-nodules and the number of apoptosis cells were significantly larger in tonsils from 4 patients with complete recovery after tonsillectomy compared to the remaining 9 without complete recovery. This suggests that histologic evaluation may be helpful in estimating the effectiveness of tonsillectomy.
OBJECT: Co-stimulatory molecules are important for cell-cell interactions between immune cells, not only for cell activation, but for suppression. Several new co-stimulatory molecules have recently been discovered, and in this study we used immuno-histological and -cytological methods to investigate the distribution of such molecules in the germinal center of human tonsils. MATERIALS AND METHODS: Tonsils surgically removed from patients with sleep apnea and habitual tonsillitis were examined. Expression of co-stimulatory molecules in immune cells was investigated immuno-histologically in frozen sections, and immuno-cytologically by flow cytometry. RESULTS: PD-L1 was found to be expressed on both GCDCs (germinal center dendritic cells) and FDCs (follicular dendritic cells). ICOS and PD-1 were expressed on activated CD4 T cells located in the light zone of the germinal centers. 4-1BB was expressed on the FDCs, in human tonsils, but not on activated T cells. CONCLUSION: GCDCs and FDCs are likely to function not only T cell activation but in negative regulation of T cells through PD-L1 expression. ICOS molecules contributing to positive signals, and PD-1 to negative signals were simultaneously expressed on a subset of activated T cells, suggesting that signal balance between ICOS and PD-1 is important for T-cell fate.
No other infectious diseases in the field of otolaryngology cause rapid and lethal course than cervical abscess. A case of cervicomediastinal abscess secondary to acute tonsillitis was presented. The patient was a 43-year-old male with liver cirrhosis and primarily had the treatment of tonsillitis. The complication of duodenal perforation caused marked general deteriotation, and cervical abscess occured. Immediately after transfer to our department, he was treated by cervical drainage, laparotomy and chemotherapy. However, hepatic failure occured, and he died of sepsis on the 16th day after the onset of tonsillitis. Cervicomediastinal abscesses were classified according to severity in Stage 1-4. 34 cases of advanced cervical abscess were reported in Japan from 1976 to 1989. These cases were analyzed statistically in terms of primary focus of infection, surgical procedures, clinical isolates and chemotherapy, etc., and following results were obtained. 1) Primary focus; approximately 50% was due to the infection of the tonsills and the pharynx occupied about 50%, and the odontogenic infections, approximately 40%. 2) Surgical procedures; the neck doranaige approaching through the vertical incision resulted more effective. 3) Clinical isolates; aerobes and anaerobes accounted for 50% each of all strains. alpha-Streptococcus was predominant among aerobes, and Peptostreptococcus and Bacteroides were predominant among anaerobes. In order to confirm pathogenic bacteria of cervical abscess, clinical isolates of peritonsiller abscess and mandibular ostesis were compared with those of cervical abscess, because these infections are primary infectious diseases of cervical abscess.(ABSTRACT TRUNCATED AT 250 WORDS)
Lymphocytes in the lingual tonsil were analyzed using monoclonal antibodies to cell surface markers. Immunohistologic staining of lingual tonsillar tissue showed localization of the various lymphocyte subsets in the germinal center, mantle zone, and inter-follicular area. Populations of lymphocyte subsets, i.e., T cells, B cells, CD4 positive cells, CD8 positive cells, alpha beta T-cells, gamma delta T-cells, and NK cells were assessed by laser flow cytometry analysis, and we compared the following tissues: peripheral blood, lingual tonsils, palatine tonsils, and pharyngeal tonsils (adenoids).