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PubMed1995

Investigation of oral alpha-streptococcus showing inhibitory activity against pathogens in children with tonsillitis.

The incidence of oral alpha-streptococcus with inhibitory activity against group A streptococcus, as a defense mechanism against bacterial infection in the oral cavity, was investigated in pediatric individuals with tonsillitis. Infection by group A streptococcus appeared to be common in children, because the detection rate of inhibitory alpha-streptococcus in healthy children as well as pediatric patients with tonsillitis was lower than in adults and elderly patients. In particular, the detection rate of these strains was predominantly low in patients with beta-streptococcus. Among pediatric patients scheduled for tonsillectomy, the detection rate of inhibitory alpha-streptococcus was low preoperatively. However, the rate was markedly increased after surgery. The high postoperative detection rate of these strains reflected the decreased incidence of group A streptococcal infection. The results of this investigation of bacterial interference between oral alpha-streptococcus and group A streptococcus suggested that surgical treatment is a more effective approach for improving the oral bacterial flora in children with recurrent tonsillitis.

Adult↗
PubMed1996

Otitis media: relationship to tonsillitis, sinusitis and atopic diseases.

In order to estimate the co-morbidity between ear infections and related childhood diseases, data about the occurrence of recurrent ear infections, tonsillitis, sinusitis and atopic diseases from a population based sample of 7992 Norwegian twins were analysed. Correlational results revealed two general clusters, one consisting of upper respiratory tract infections (URI), the other defined by the atopic diseases. Overall, associations between the diseases were greater in males. The sizes of the correlations within each subgroup of infections were moderate, but significant, ranging from 0.191 to 0.363. Similar results were found for the relationship within the subgroup of atopies, with correlations ranging from 0.134 to 0.466. The correlations between the infectious and atopic diseases were weak. Both ear infections and tonsillitis seemed to be predisposing factors for sinusitis. The relative risk of sinusitis among individuals with a history of ear infections was 3.4 (1.9-6.2) and 1.9 (1.2-3.0) for males and females, respectively. Ear infections conferred an increase in tonsillitis, estimated at 2.3 (1.6-3.0) and 2.0 (1.2-3.6) for males and females, respectively. In conclusion, the present study finds evidence for a common predisposition of upper respiratory infections as well as for atopic diseases, but only moderate correlation between the subgroups. Specifically, between ear infections and hay fever there was no covariation.

Adolescent↗
PubMed1996

Evaluation of a PCR for detection of Actinobacillus pleuropneumoniae in mixed bacterial cultures from tonsils.

A PCR for the detection of Actinobacillus pleuropneumoniae was evaluated. All of 102 field, isolates of A, pleuropneumoniae reacted in the PCR by amplification of a 985 bp product. No PCR amplification product was observed when examining strains of A. ureae, A. capsulatus, A. hominis, A. equuli, A, rossii, A. suis, Escherichia coli, Bordetella bronchiseptica. Streptococcus suis, Pasteurella haemolytica, Pasteurella multocida, Haemophilus parasuis, Haemophilus taxon Minor group, Haemophilus taxon D/E and haemophilus taxon F. Amplification of a 985 bp product was, however, observed when testing strains of A. lignieresii. The lower detection limit of the PCR test was 10(3) A. pleuropneumoniae CFU/PCR test tube and was not affected by addition of 10(6) E. coli CFU/PCR test tube. Mixed bacterial cultures from tonsils of 101 pigs from 9 different herds were tested by culture and by PCR using four different bacteriological media. While 65% reacted positive in the PCR only 23% were positive by culture, thereby suggesting a superior sensitivity of the PCR test to that of culture. The use of selective media, large inoculum and incubation for 48 h gave the highest number of positive PCR reactions from mixed bacterial cultures. Tonsil cultures from 50 pigs from an A. pleuropneumoniae-negative herd did not react in the PCR. The results show that PCR on mixed bacterial cultures from tonsils may be a highly sensitive method for the detection of A. pleuropneumoniae in pig herds.

Actinobacillus Infections↗
PubMed1991

The neuroimmune connection in human tonsils.

The present light microscopic immunohistochemical study evaluates the distribution of peptidergic nerve fibers in human tonsil and describes their spatial relationship with specific cells of the immune system. Further, using a panneural marker protein gene product (PGP) 9.5, a qualitative evaluation of the density of specific peptidergic innervation of the human tonsil was performed. Nerve fibers staining for tachykinins, calcitonin gene-related peptide, neuropeptide Y, or vasoactive intestinal polypeptide/peptide histidine isoleucine showed characteristic distribution patterns, but constituted only a minor subfraction of the PGP 9.5-stained fiber population. Both peptide- and PGP 9.5-immunopositive fibers predominantly supplied the vasculature; nonvascular areas were less densely innervated. Double staining for surface antigens thought to be associated with subsets of lymphoid cells, i.e., T-cells, B-cells, granulocytes, and macrophages, and for peptides or PGP 9.5 revealed close proximity of characteristic subpopulations of neurochemically defined nerve fibers and the various immune cells. The presence of peptidergic nerve fibers among T-cells was more prevalent than peptidergic nerve fibers adjacent to macrophages. Few positively stained nerve fibers resided in B-cell compartments. Neuro-B-cell interrelations were extremely infrequent. Neuroimmune connections were restricted to paravascular, subepithelial, and interfollicular regions, while germinal centers were devoid of nerve supply. The results are compatible with the view that peptides, being present in small-diameter nerve fibers, could exert an indirect immunoregulatory role by influencing vascular tone and/or permeability. In quantitative terms, a direct neuroimmunomodulatory action of endogenous neurally derived peptides appears to be of minor importance, because nonvascular neuroimmune circuits were found infrequently and were regionally restricted. However, we cannot be sure that all fibers were stained. The functional state of the peptidergic and nonpeptidergic innervation of the human palatine tonsil may be of physiological and pathophysiological significance within the psycho-neuro-immuno-endocrine network. The peptide-coded neuroimmune link may play a role in tonsillar pain.

Biomarkers↗
PubMed2003

Immunology of tonsils and adenoids: everything the ENT surgeon needs to know.

The lymphoid tissue of Waldeyer's ring, and particularly the nasopharyngeal tonsil (adenoids), appears to be functionally comparable to nasal-associated lymphoid tissue in rodents. Antigen-stimulated lymphoid follicles give rise to: (a) clonal B-cell expansion; (b) B-cell receptor affinity maturation; (c) positive selection of B cells according to receptor affinity for antigen; (d) differentiation to B memory cells and plasma cells; and (e) variable induction of the joining (J)-chain gene. B-cell differentiation is also important to promote downstream isotype switching of the immunoglobulin (Ig) heavy chain constant genes. For tonsillar B cells, this process gives mainly rise to IgG and IgA plasma cells, partially associated with J-chain expression. Because the J chain is a key peptide in the polymer structure of secretory IgA, tonsils and adenoids may provide B cells for mucosal effector sites. Thus, several observations suggest that these lymphoid organs generate polymeric IgA (pIgA)-expressing B cells that migrate to the upper airway mucosa, lacrimal glands and salivary glands. Accordingly, the nasal route of vaccination induces secretory IgA-dependent regional mucosal immunity and will also enhance systemic immunity. Although the pIgA-producing capacity of tonsillar B cells is considerably decreased in children with recurrent tonsillitis, a conservative attitude towards adenotonsillectomy appears immunologically desirable, particularly in the young age group.

Adenoidectomy↗
PubMed2005

Treatment of non-streptococcal tonsillitis with metronidazole.

The potential role of anaerobic bacteria in acute tonsillitis was investigated in a retrospective study that evaluated the efficacy of antimicrobial therapy with metronidazole on the management of acute episodes of non-beta-hemolytic streptococcal tonsillitis (NST). Forty children suffering from NST were included, 20 that were treated with metronidazole 250 mg b.i.d. for 10 day, and 20 that had received no therapy. The efficacy of therapy was evaluated by the ability to alleviate the symptoms of acute infection. As compared with the untreated group, the group that received metronidazole, had a significant reduction in fever and sore throat one day after initiation of therapy, a significant reduction in the presence of fever, pharyngeal injection and sore throat within 2 days, and reduction in pharyngeal injection and tonsillar size at day 3. These findings illustrated that metronidazole therapy was more efficacious than no therapy in relieving the signs and symptoms of acute episodes of NST. These findings should encourage further studies that are prospective and blinded that are needed to evaluate the use of antimicrobials effective against anaerobic bacteria in the treatment of non-GABHS (group A-beta-hemolytic streptococcus) tonsillitis.

Adolescent↗
PubMed2005

Ectopic salivary tissue of the tonsil: a case report.

To report one patient with an ectopic salivary tissue tag on the tonsil, and review the embryology, management, and implications of this benign disorder. Case report with literature review. Ectopic salivary tissue presented on the tonsil of a child as a painless, growing, unilateral pale exophytic mass. Tonsillectomy was performed to provide diagnosis, and was curative. Ectopic salivary tissue of the tonsil is a rare finding. Tonsillectomy allows for definitive diagnosis and treatment.

Adolescent↗
PubMed2005

The influence of tonsillitis on oral and throat muscles in children.

OBJECTIVES: Surface electromyography (sEMG) studies were performed on 80 children with acute tonsillitis (AT) and 110 children with recurrent tonsillitis (RT), age 4-12 years, to trace sEMG changes of duration and amplitude of muscle activity during swallowing and continuous drinking. STUDY DESIGN: Prospective observational study of randomly chosen patients compared to normative database. METHODS: Timing and amplitude (in muV) of activity of masseter, submental and infrahyoid muscles were evaluated during voluntary single swallows of saliva ("dry" swallow), water swallows, swallows of excessive amount of water (up to 15 ml), and continuous drinking of 50 ml of water. These parameters were measured for two age groups for both conditions: 4-8 and 9-12 years old. The previously established normative database was taken for control. RESULTS: AT presents prolonged duration of swallowing and electric hyperactivity of infrahyoid muscles but this activity returns to normal after recovery. RT affects masseter and infrahyoid muscles even during periods of remission but do not affect duration of swallowing activity. CONCLUSION: AT and RT in children age 4-12 years affects muscle activity during swallowing significantly by involving additional muscles (mainly infrahyoid) in this process. AT presents temporary electric hyperactivity of infrahyoid muscles. RT affects masseter and infrahyoid muscles even during periods of remission (pathologic changes are fixed). Abnormally high electric activity of masseter and infrahyoid muscles in patients with RT might serve as an additional indicator for tonsillectomy. Surface EMG of swallowing is a simple, non-invasive and reliable method for diagnostic and preoperative evaluation of dysphagia complaints associated with tonsillitis.

Child↗
PubMed2004

Liquid chromatographic-tandem mass spectrometric assay for the simultaneous determination of didanosine and stavudine in human plasma, bronchoalveolar lavage fluid, alveolar cells, peripheral blood mononuclear cells, seminal plasma, cerebrospinal fluid and tonsil tissue.

We have developed a sensitive, high-pressure liquid chromatographic-tandem mass spectrometric (LC/MS/MS) method for the simultaneous determination of didanosine (ddI) and stavudine (d4T) in human plasma, bronchoalveolar lavage fluid (BALF), alveolar cells (AC), peripheral blood mononuclear cells (PBMC), seminal plasma, cerebrospinal fluid (CSF), and tonsil tissue. Plasma, AC, PBMC and CSF were run with an isocratic HPLC method, while BALF supernatant, semen, and tonsil tissue utilized a gradient elution. Samples were prepared by solid phase extraction. Detection was by electrospray positive ionization with multiple reaction monitoring mode. The lower limits of quantitation for both ddI and d4T were 2.0 ng/ml in plasma; 0.5 ng/ml in CSF; 0.4 ng/ml in AC, PBMC, and BALF; 1.0 ng/ml in seminal plasma; and 0.01 ng/mg in tonsil tissue.

Bronchoalveolar Lavage Fluid↗
PubMed2005

[Treatment of tonsillitis].

Tonsillitis is a frequent infection. Most of cases are viral and require only symptomatic treatment. Tonsillitis due to Corynebacterium diphteriae, Neisseria gonorrhoeae and Fusospirochetosis require specific treatment. Antibiotic treatment of streptococcal tonsillitis is needed to avoid suppurative and non suppurative complications such as rhumatoid fever.

Humans↗
PubMed1999

Expression of endothelin-1 in macrophages and mast cells in hyperplastic human tonsils.

In situ hybridization and immunohistochemical examinations of surgically resected specimens of human hyperplastic tonsils showed that macrophages in the germinal center and mast cells in the parafollicular and interfollicular areas expressed the transcript and protein of endothelin (ET)-1, but not ET-2 and ET-3. The macrophages appeared to be activated, since they possessed significant amounts of inducible nitric oxide synthase. None of these expressions was observed in normal tonsil. Our results suggest that the over-production of ET-1 by macrophages and mast cells may be involved in the pathogenesis of hyperplastic tonsils.

Adult↗
PubMed1991

The potential role of the ovine pharyngeal tonsil in respiratory tract immunity: a scanning and transmission electron microscopy study of its epithelium.

The mucosal epithelium of the pharyngeal tonsil was studied in 10 conventionally raised sheep by scanning and transmission electron microscopy. The surface of the tonsil was covered by two types of topographically and ultrastructurally distinct epithelium. The epithelium overlying the lymphoid follicle region (follicle-associated epithelium) was compressed by adjacent ciliated epithelium and consisted of predominantly non-ciliated cells of varying height. The majority of these cells possessed microvilli or microfolds of varying number, height and density on their surface. Small numbers of squamous cells and, occasionally, intermediate cells were also present in these areas. Ultrastructurally, the microvillous cells showed features similar to M cells which occur in other mucosal sites. They contained cytoplasmic vesicles and vacuoles and formed intercellular digital junctions. Between these cells was a heavy infiltration of lymphoid cells. Focal disintegration of the mucosal epithelium was occasionally seen. The epithelium covering non-follicle areas consisted of mainly ciliated cells interspersed with some goblet cells and squamous cells, morphologically resembling those elsewhere in the respiratory tract. These findings have provided evidence which confirms that the ovine pharyngeal tonsil is part of the respiratory tract-associated lymphoid tissue.

Animals↗
PubMed2002

Decreased serum and pharyngeal antibody levels specific to streptococcal lipoteichoic acid in children with recurrent tonsillitis.

OBJECTIVE: Streptococcus (S.) pyogenes is a common cause of primary as well as recurrent tonsillitis (RT). Lipoteichoic acid (LTA) has been proposed as a possible candidate for vaccine formulation against streptococcal infections, because LTA is a common constituent of streptococci and the antibody to LTA inhibits bacterial attachment to epithelial cells in vitro. Streptolysin-O and streptococcal whole cell body are highly immunogenic and the antibodies to these antigens are reported to be better parameters for streptococcal infections The objective of the present study is to investigate how systemic and local immune activities against S. pyogenes may be associated with RT. METHODS: Sera from 178 children with or without RT aged 1-15 years with a median age of 5 years were investigated for the levels of total immunoglobulins and antibodies specific to streptococcal antigens such as whole cell body, LTA, and streptolysin-O. Pharyngeal secretions from 67 children with or without RT aged 2-14 years with a median age of 6 years were subjects to secretory IgA (SIgA) antibody levels to streptococcal LTA. The antibodies to whole cell body and LTA were measured by enzyme-linked immunosorbent assay. Total immunoglobins and the anti-streptolysin-O antibody were assayed by nephelometry. RESULTS: An age-matched comparison revealed that either levels of serum IgG antibody or pharyngeal SIgA antibody to streptococcal LTA at 2-5 years of age were significantly lower in RT children than in non-RT children (1.39 vs. 5.14 microg/ml, P=0.001; 10.6 vs. 29.9 units/ng/ml total SIgA, P=0.015; respectively) and correlated inversely to episodes of tonsillitis (r=-0.242, P=0.024; r=-0.3, P=0.024; respectively). Either serum total immunoglobulin levels of IgG or IgA correlated positively to episodes of tonsillitis in children aged 2-5 years (r=0.293, P=0.011; r=0.361, P=0.002; respectively). No difference was found on either serum levels of IgG antibody to streptococcal whole cell body or antibody to streptolysin-O between RT and non-RT children in any age-matched comparisons. High serum antibody levels to whole cell body was associated with high antibody levels to streptococcal LTA in non-RT children (r=0.198, P<0.05), but no association was found between these antibody levels in RT children. CONCLUSIONS: Selective immunologic failure in systemic and pharyngeal antibody response to streptococcal LTA may be a potential cause of RT in young children.

Adolescent↗
PubMed1983

T cell subsets in the tonsil in relation to age analyzed with monoclonal antibodies (anti-leu antibodies) and fluorescence activated cell sorter (FACS).

The ratio of the cells reacting to anti-leu 1, 3a and 4 antibodies is as low as that of T cells in the tonsil to those in the peripheral blood. The number of the tonsillar cells reacting to anti-leu 2a and 7 antibodies is still smaller. Fluorescence intensity of tonsillar lymphocytes reacting to leu (1, 2a, 3a, and 4) antibodies is lower than that of peripheral blood lymphocytes. Adult tonsillar lymphocytes have higher ratios of the cells reacting to anti-leu 1, 2a, 3a, 4 and 7 antibodies than child tonsillar lymphocytes and fluorescence intensity of the cells reacting to these anti-leu antibodies tended to be higher in adult tonsillar lymphocytes. These findings suggest less cytotoxic/suppressor T and NK/K function cells in the tonsil than in the peripheral blood. From these, it is conceivable that the tonsillar lymphocyte constitution becomes closer to that of peripheral blood as the child grows up. Further, immature T cells are present in the tonsil, though in a small number. This tendency is stronger in children than in adults.

Adult↗
PubMed1997

Trace elements in children with chronic and recurrent tonsillitis.

Trace elements are indispensable for life and play a very important role in the essential functions. According to some reports in the literature lower trace element levels increase the susceptibility to recurrent infections. Since there are no reports available in the English literature about the effects of trace elements on recurrent and chronic tonsillitis, 37 children with recurrent and chronic tonsillitis were evaluated for Zn, Cu and Mg levels. Serum levels of Zn in 6 patients were slightly lower than the normal limit. All the other serum levels of Zn, Cu and Mg were within the normal range. On the other hand, the mean serum level of Zn in the 37 patients was significantly lower than in a control group of 28 age and sex matched children. In contrast, the mean serum levels of Cu and Mg in the patients were significantly higher than in the control group. Whether this alteration in the trace element status causes or fosters recurrent and chronic tonsillitis is not clear.

Adolescent↗
PubMed1998

Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes.

Bacterial and epithelial cell samples were obtained, within 24 h of onset of pharyngeal symptoms, from the palatine tonsils of nine patients (four female and five male; age range 10-40 years, median age 23) with acute tonsillitis, culture-positive for Streptococcus pyogenes. The specimens were examined using fluorescein isothiocyanate- (FITC) and gold-labelled antiserum to S. pyogenes and fluorescence, scanning electron and transmission electron microscopy. S. pyogenes could be identified both in the mucous layer covering the tonsils and attached to the surface epithelial cells. Long chains of coccus-shaped bacteria could be seen encroaching on the epithelial cell borders. S. pyogenes can apparently penetrate the mucous barrier, attach to the epithelial cells, spread from cell to cell and possibly penetrate into the outermost layer of the epithelial cells. These events in turn provoke cytokine production and/or complement activation, which induce inflammatory reaction in the tonsillar tissue.

Acute Disease↗
PubMed1988

Recurrent tonsillitis and growth in children.

Anecdotal observations suggest an association between tonsil disease and growth retardation. This study compared height, weight and skinfold thickness measurements between a group of children (44) suffering from recurrent tonsillitis for a mean duration of 4 years, and a control group (34). No important differences were observed between the groups. Recurrent tonsil infection does not appear to retard the growth of children.

Body Height↗
PubMed1996

Outpatient biopsies of the palatine tonsil: access to lymphoid tissue for assessment of human immunodeficiency virus RNA titers.

OBJECTIVES: Our objective was to assess the feasibility of using tonsillar lymphoid biopsy specimens obtained on an outpatient basis to quantitate a patient's lymphoid human immunodeficiency virus (HIV) RNA titers. DESIGN: A pilot cohort study was performed. PATIENTS: We evaluated ten HIV-seropositive patients who ranged in age from 26 to 48 years and had CD4+ cell counts ranging from 110 to 833 at enrollment. MAIN OUTCOME MEASURES: The main outcome measures were tolerance and safety of outpatient tonsil biopsies and quantitation of HIV RNA titers in tonsillar lymphoid biopsy specimens, plasma, and peripheral blood mononuclear cells determined by a new method of HIV RNA signal amplification with branched DNA probes. RESULTS: Outpatient tonsil biopsies were well tolerated and were performed without complications. Nine of 10 tonsil biopsies from the HIV-seropositive patients examined were positive for significant concentrations of HIV RNA, ranging from 106 to 101 HIV RNA equivalents per gram of tissue. All of the HIV RNA-positive tonsillar lymphoid specimens had HIV RNA titers that were 101 to 104 times greater than those recovered from plasma (per milliliter) of the same patient obtained at the time of biopsy. CONCLUSIONS: Sufficient tonsillar tissue can be obtained in an outpatient clinic setting to quantitate lymphoid HIV titers by the new branched-DNA signal amplification method with relative ease and without complication. The biopsy method described here affords ready access to the lymphoreticular system, which may help to advance our understanding of the pathogenesis of myriad immune diseases without the need for excisional node biopsies.

Adult↗