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Immunohistological study of tonsil. Distribution of T cell subsets.

Employing a series of monoclonal antibodies directed against T cell subsets and the ABC (avidin-biotin complex) method as the immunoperoxidase technique, we studied the distribution of T cell subsets in frozen tissue sections of tonsils in 8 cases with various tonsillar lesions. Anti-Leu 1 and anti-Leu 4 antibodies, which react with all peripheral T cells, stained a majority of interfollicular cells and mononuclear cells in the lymphoepithelial symbiosis (LES). Approximately 80% of Leu 1+ and Leu 4+ cells were reactive with anti-Leu 3a antibody, which defines the helper/inducer T cell subset. Small lymphocytes in the mantle zone of the tonsillar follicle had IgD and IgM on their surface, whereas the cells in the germinal center showed membrane and/or cytoplasmic staining with anti-IgM serum. In addition, Leu 3a+ cells were found in the germinal center, especially on the capsular side showing a linear distribution. On the other hand, anti-Leu 2a antibody, which defines the suppressor/cytotoxic T cell subset, stained only a minority of lymphocytes in the interfollicular area and in the LES. Leu 2a+ cells were rarely found in the germinal centers. Anti-HLA-DR-positive cells were found with two types of staining pattern, i.e., with membrane staining found in the small lymphocytes in the mantle zone and the germinal center and with membrane and/or cytoplasmic staining found in large cells with dendritic processes in the germinal center, in the LES, and in the interfollicular areas. These findings demonstrate the presence of intimate cellular interactions in T cells, B cells, and macrophages in the tonsil, and indicate that immunohistological study of the tonsil may provide new insights into the pathogenesis of tonsillar lesions.

Adult↗

Computerized three-dimensional reconstruction of the crypt system of the palatine tonsil.

The purpose of the present study is to note the three-dimensional structure of the tonsillar crypt using computer graphics methods. The tonsils used herein were human tonsils obtained from the surgical operation, and were cut in serial sections according to ordinary procedures. The crypt contours obtained from the serial sections were used as inputs to the computer (PC-9801 VM) through the image-scanner (PC-IN 502). The three-dimensional structure of the human tonsillar crypt revealed by computer graphics, showed that the crypts had not only branches but also anastomosis, and that they could divide into two types, a simple unbranched crypt and a complicated branched one. Generally, the simple type of crypt was located in the peripheral zone of the tonsils and the complicated type in the central zone. These findings are discussed briefly and with reference to previous reports.

Child↗

Experimental and clinical studies of causative bacteria in tonsillitis.

To study the pathogenesis of upper respiratory tract infections, we focused on acute tonsillitis and performed three experimental and clinical studies. From these studies, we found out that there seemed to be an intimate relationship between anatomical structure and adherence of S. pyogenes, and we confirmed that the M protein of S. pyogenes played an important role in adherence to the epithelium and the normal bacterial flora was actively involved in the body's defense against infections. We also identified that nearly half of causative bacteria in tonsillitis in Japan were the genus streptococcus, especially S. pyogenes with 23.4%. The incidence of Methicillin (DMPPC)-resistant Staphylococcus aureus (MRSA) was 27% in middle ear exudate and 14.3% in nasal discharge, but no MRSA was isolated from tonsillitis.

Animals↗

Pharmacokinetics of phenoxymethylpenicillin in tonsils.

The pharmacokinetics of phenoxymethylpenicillin in tonsillar tissue was studied in 33 patients who underwent tonsillectomy, mainly because of repeated tonsillitis or peritonsillitis. The patients were operated on 30-240 min after an oral penicillin dose of 12.5 mg/kg body weight. The mean serum concentration was 2.8 micrograms/ml for 10 patients operated upon 80-95 min after drug administration. The mean tissue concentration for these patients at the same time was 0.6 micrograms/g. The mean concentration of penicillin in tissue after 240 min was 0.05 micrograms/g. 19% of the serum concentration was recovered in the tonsillar tissue. No significant difference between penicillin concentration in the centre or surface of the tonsils was found. The tissue concentration was calculated to be above 0.03 micrograms/ml for at least 4-5 h. 30% of the patients harboured penicillinase producing bacteria on their tonsils, mainly Staphylococcus aureus. These patients had a lower tissue concentration than those lacking the bacteria, but the difference was not statistically significant (p = 0.095).

Adolescent↗

[The measurement of superoxide dismutase levels in recurrent tonsillitis. Its practical use].

Superoxide radicals generated in the palatal tonsils by recurrent local infections cause an organic response consistent in synthesis of superoxide dismutase. Tonsillar concentrations of this enzyme correlate with the incidence of tonsillitis. Moreover, superoxide dismutase levels in erythrocytes rise in children proportional to tonsillar concentration in a statistically significant way (y = 0.2356x - 64.918; R2 = 0.9266). The similarities in local and systemic changes in recurrent tonsillitis suggest that the determination of superoxide dismutase in peripheral blood could be a good screening method for determining who should undergo tonsillectomy.

Child↗

Significance of free radicals in chronic tonsillitis.

The present study was carried on adolescents suffering from chronic tonsillitis. Blood (pre and post tonsillectomy) as well as tonsil samples were evaluated for -MDA, SOD and Catalase. Our results showed a decrease in level of MDA and increase in SOD and Catalase levels post tonsillectomy. Presence of MDA and SOD in tonsillar tissue reinforce involvement of oxidative stress in pathophysiology of chronic tonsillitis.

Adolescent↗

[New method of biopsy of palatine tonsils and its role in the indication for tonsillectomy (preliminary report)].

In our work we presented a new method of chronic tonsillitis diagnosis and evaluated its usefulness in qualification to tonsillectomy. Oligobiopsies were obtained from right and left palatine tonsils of 36 patients who were qualified to tonsillectomy on the basis of past medical history, otolaryngological examination and laboratory tests findings. Following gauge of biopsy instruments were used: 2 mm, 3 mm, 4 mm. The material obtained at biopsies and tonsillectomies was histopathologically evaluated. Histopathological findings of specimens obtained at oligobiopsies and post tonsillectomies were compared. The presence of interstitial fibrosis, neutrophils infiltrates, hyperplastic changes of lymphoid follicles of palatine tonsils were evaluated in oligobiopsy specimens in comparison to the results of postoperative specimen findings. Full concordance of histopathological findings obtained at oligobiopsy and post tonsillectomy was noted with the use of biopsy instruments of 3 mm and 4 mm gauge. Specimens obtained at oligobiopsies had a great diagnostic value. It was proved that the biopsy performed according to our method has a great diagnostic value and helps surgeon to qualify patient to tonsillectomy.

Adult↗

[Chronic tonsillitis in childhood: a bacteriological study in connection with benzathine penicillin treatment and the role of bacterial flora in tonsillar hypertrophy].

In this study the authors evaluated the importance of bacteriological study in the diagnostics of chronic tonsillitis in children and investigated the eventuality of modification in superficial as well as parenchymal tonsillar microflora brought about by preventive treatment with benzylpenicillin G. The study further aimed at revealing an eventual relationship between microflora and classic laboratory parameters (haemochromocytometric examination, leukocytic formula, VES, ASLO and urine analysis) as well as at evaluating the possibility of a correlation between the degree of tonsillar hypertrophy and microflora. The 100 patients studied had chronic tonsillitis, were between the ages of 4 and 12 and were all candidates for tonsillectomy. The subjects were divided into two groups of 50 patients each; one group had not had any antibiotic treatment for at least 30 days prior to the study, while the second group had undergone antibiotic treatment during the days or weeks immediately before the study and was administered benzylpenicillin G 24 hours prior to sampling. The superficial and intraparenchymal tonsillar tampon samples taken in both groups underwent bacteriological studies. The most frequently isolated bacteria was Haemophilus Influenzae (40% of the cases). A clear-cut prevalence of this bacteria was observed in those patients treated with benzylpenicillin G as opposed to those not treated. Haemolytic Group A Streptococcus was found almost exclusively in the tonsils of those patients not treated with antibiotics (14 out of 15 cases). Various degrees of tonsillar hypertrophy were observed although no sure correlation between the presence of the pathology and the bacteria found, either superficially or in the parenchyma, was established. Furthermore, no significant was revealed between the presence of superficial or intraparenchymal bacteria.

Bacteria↗

[Peritonsillar abscess. Occurrence of disease requiring surgery in the remaining tonsil after unilateral tonsillectomy à chaud].

The occurrence of disease requiring surgery of the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess was studied in 536 patients. None of the patients histories of previous severe tonsillitis at the time of the unilateral had tonsillectomy. 9.3% of the patients under 30 years of age were readmitted for surgery on the remaining tonsil during the follow up period. Only 0.5% of the patients over 30 years were readmitted. Previous investigations have shown increasing frequency of pharyngitis after bilateral tonsillectomy. The present authors suggest bilateral tonsillectomy in all patients under 30 years of age who suffer from peritonsillar abscess irrespectively of previous tonsillar disease. In patients over 30 years, unilateral ablation is recommended unless clear indication for bilateral tonsillectomy are present.

Adolescent↗

[Anaerobic bacteria and their role in recurrent tonsillitis].

The presence of anaerobic bacteria in 100 palatal tonsils obtained during the tonsillectomy, was evaluated in quality and in quantity. 17 species of anaerobic bacteria were found. The most frequent were: Bacteroides melaninogenicus, Peptostreptococcus anaerobius, Peptostreptococcus intermedius, Propionibacterium, Veillonella parvula and Peptococcus asaccharolyticus. In most evaluations their density was 10(5)-10(6) in gram of tonsil tissue, sometimes 10(7). Its role in recurrent tonsils infections was discussed.

Adolescent↗

[Evaluation of liposomal forms of rifampicin and prodigiozan in the treatment of experimental chronic tonsillitis].

Therapeutic effect of liposomal dosages of rifampicin and prodigiozan was studied on rabbits with simulated chronic tonsillitis in comparison to that of commercial ones of the drugs. The treatment schemes included daily intra-tonsillar++ injections of the dosage forms for 5 days. A high efficacy of their liposomal dosage forms in treatment of experimental chronic tonsillitis was confirmed microbiologically and immunologically. Approval of the liposomal dosage forms used in the therapy of patients with chronic tonsillitis requires clinical trials.

Adjuvants, Immunologic↗

Tonsils and lympho-epithelial structures in the pharynx as immuno-barriers.

The tonsils are mucosa-associated lymphoid organs. Several details regarding their normal function and pathological alteration are still unknown. In this review the relationship of the tonsils to similar lymphoid organs is discussed, the possibilities of antigen uptake (M cells and micropores of the crypt epithelium) are demonstrated, and alterations of the crypt epithelium due to recurrent tonsillitis are described. Further studies are required for the better understanding of tonsillar diseases.

Epithelium↗

Impact of phenoxymethylpenicillin and clindamycin on microflora in recurrent tonsillitis.

A total of 75 patients with recurrent tonsillitis, between 15 and 44 years of age, were divided into three groups, two of which were treated with antibiotics before surgery. Bacteriological specimens were collected before treatment started and the microflora of the excised tonsils were analyzed. Bacteroides species were found in the tonsils of 83% of the patients, and 50% of these microorganisms were beta-lactamase producers. Other bacteria found were Staphylococcus aureus in 45%, beta-streptococci group A in 4%, and beta-streptococci groups C and G in 24%. Hemophilus species were isolated from 50%, but no strains produced beta-lactamase. Fusobacteria were recovered from 41%; one strain produced beta-lactamase. After administration of phenoxymethylpenicillin in doses of 1 g twice a day for nine days, the beta-streptococci were eliminated, but no change of the amount of S aureus, Hemophilus, Bacteroides, or fusobacteria was seen. Clindamycin in doses of 0.15 g four times daily for nine days diminished almost all bacteria except for the Hemophilus species.

Adolescent↗

[Tonsils in diphtheria and the Corynebacterium diphtheriae carrier state].

Investigations of 16 archive autopsy observations of diphtheria of the fauces confirmed bacteriologically revealed that Corynebacteria diphtheriae multiplied mainly on the surface of the mucous membrane. Fibrinous inflammation on the tonsillar surface is most typical for this agent. In all cases with manifestations of acute inflammation the lesion was caused by C. diphtheriae in combination with other bacteria, most frequently streptococci. The latter were harboured deep in the tonsills and caused there an inflammatory process with characteristic lesions. Examinations of the tonsills removed from 72 C. diphtheriae carriers showed that longterm persistence of the bacteria in the tonsills was primarily due to the specific structure of the cryptae, particularly great branchiness and depth contributing to the retention of the content. Long-term carrier state leads to a statistically significant increase of the degree of their plasmatization as compared with the control group. This occurs in parallel with changes in the general responsiveness of the host.

Autopsy↗

Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis.

Specimens from both the surface and the core of tonsils from 23 children with recurrent tonsillitis were cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all patients. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium nucleatum, anaerobic Gram-positive cocci, and Eubacterium sp. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, beta-hemolytic streptococci, and Haemophilus sp. beta-Lactamase production was noted in 49 isolates from 19 patients (83%). Seventy percent of the aerobic isolates were recovered in both core and surface specimens, compared with 57% of the anaerobic isolates. Ten percent of aerobes were recovered only in the core, compared with 33% of the anaerobes, and 20% of the aerobes in the surface only, compared wtih 10% of the anaerobes. These data demonstrate the discrepancies between surface and core cultures in the isolation of anaerobic bacteria, and raise the question whether surface cultures can accurately predict the presence of beta-lactamase-producing organisms or other pathogens in the recurrently infected tonsil.

Adolescent↗

Histopathological and histochemical studies on the tonsils in children with rheumatic heart disease.

The tonsils were studied histologically and histochemically in 67 children with rheumatic heart disease, 33 children with chronic tonsillitis and 5 normal children. The tonsils of rheumatic children showed hyperplasia and hyperactivity of lymphocytes and paucity of phagocytes. It was suggested that these peculiar findings might contribute to the pathogenesis of rheumatic fever.

Acid Phosphatase↗

[Bacterial flora in pharyngitis and tonsillitis].

The aim of the study was a microbiological analysis of pharyngeal swabs obtained from 158 patients with the diagnosis of pharyngitis and purulent exudates from the tonsillar crypts of 10 patients treated for chronic purulent tonsillitis. Beta haemolytic streptococci groups A, B, C and G were isolated from 30% of the patients. The most frequently isolated were Streptococcus pyogenes--12% of patients and Streptococcus group C--10.7%. Other streptococci were isolated less frequently: Streptococcus group B--44%, group G--2.5%. The majority of isolated bacteria belonged to potential pathogenic flora (70% patients). Staphylococcus aureus (37%) and Haemophilus spp. (36%) were isolated most frequently. Other bacteria were isolated in the following sequence: Moraxella catarrhalis--22%, Streptococcus pneumoniae--17% and Gram-negative rods from the Enterobacteriaceae family--6%. One case of Plaut-Vincent tonsillitis was diagnosed. Aerobic and anaerobic bacteria were isolated from purulent exudates from the tonsillar crypts of 10 patients treated for chronic purulent tonsillitis. The isolated anaerobic bacteria belonged to genus of Prevotella, Fusobacterium, Peptostreptococcus and Gemella.

Bacteria↗

Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever.

OBJECTIVE: To find a quickly available screening tool for the differentiation of patients with glandular fever from those with acute purulent tonsillitis. The null hypothesis was that there was no difference between the lymphocyte-white blood cell count (L/WCC) ratio between the 2 patient groups. DESIGN: Retrospective pilot study based on laboratory tests for lymphocyte counts, white blood cell counts, and the mononucleosis spot test. SETTING: Ear, Nose, and Throat Department, St George's Hospital, London, England. PATIENTS: One hundred twenty patients with glandular fever and 100 patients with bacterial tonsillitis. MAIN OUTCOME MEASURES: Results from the mononucleosis spot test in conjunction with the clinical picture and the L/WCC ratio were analyzed. Significant differences were evaluated using the Mann-Whitney test and Fisher exact test. RESULTS: The L/WCC ratio was significantly different in the 2 groups (P<.001). The mean L/WCC ratio in the glandular fever group was 0.54 and the mean L/WCC ratio in the bacterial tonsillitis group was 0.10. A ratio higher than 0.35 had a specificity of 100% and a sensitivity of 90% for the detection of glandular fever. CONCLUSIONS: We recommend that the L/WCC ratio should be used as an indicator to decide whether mononucleosis spot tests should be requested. A ratio higher than 0.35 had a high specificity in our study group.

Acute Disease↗