Bacteriology of the Tonsil Core in Recurrent Tonsillitis and Tonsillar Hyperplasia - a Short Review

Lindroos, Robert

doi:10.1080/000164800454404

Cited by 52 publications

(38 citation statements)

References 12 publications

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“…We chose to culture the tonsillar core rather than the surface because of higher recovery of anaerobes from the core and the ndings that the surface tonsillar ora may not always re ect the content of the deep tonsillar ora (15,16). Similar to previous studies (14-16), we found abundant mixed aerobic and anaerobic bacterial ora in the core tonsils of the study group patients.…”

Section: Discussionsupporting

confidence: 76%

“…In adults, we found that a-and b-hemolytic streptococci and Prevotella species were the most common blood culture isolates. An explanation why H. in uenzae was not found in the present material is that its prevalence is higher in children and consequently lower in adults (16,21). Of note was the frequent recovery of anaerobes (four of the nine) from the blood cultures in our series.…”

Section: Discussionmentioning

confidence: 44%

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Association between Tonsillar Core Microflora and Post-tonsillectomy Bacteremia

Kasenõmm

Kull

Mikelsaar³

2002

Microbial Ecology in Health and Disease

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The aim of the study was to determine whether the population levels of aerobic and anaerobic bacteria in the core tonsils of adults with recurrent acute tonsillitis in uence the developmen t of post-tonsillectomy bacteremia. F or that purpose we performed qualitative and quantitative bacteriology of 24 excised tonsillar core specimens, together with aerobic and anaerobic perioperative blood cultures. The blood cultures from ten non-surgica l patients with recurrent acute tonsillitis served as controls to determine the occurrence of baseline bacteremia . Post-tonsillectomy bacteremia was foun d in nine (38%) patients. Isolated bacteria were a-hemolytic streptococci (n ¾ 2), group C b-hemolytic streptococci (n ¾ 2), group A b-hemolytic streptococcus (GAS) (n ¾ 1), Peptostreptococcus sp. (n¾ 1), Bacteroides sp. (n ¾1) and Prevotella sp. (n ¾ 2). N one of the blood cultures from the controls were positive. M ixed aerobic and anaerobic bacterial ora was foun d in the tonsil cores from both the patients with blood culture positive or negative results. All blood culture isolates were also recovered in the correspondin g tonsillar core, excep t for the GAS. However , its presence was subsequently demonstrated by PCR . In further analysis, we found no correlation between the bacterial population levels and the developmen t of post-tonsillectomy bacteremia . The absence of G AS growth from the core tonsil of a patient with G AS bacteremia also suggest s that translocation of certain bacteria may occu r in spite of low counts. In conclusion , the occurrence of post-tonsillectomy bacteremia is quite frequent in adults and the spectrum of invading agent s is variable.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 44%

Association between Tonsillar Core Microflora and Post-tonsillectomy Bacteremia

Kasenõmm

Kull

Mikelsaar³

2002

Microbial Ecology in Health and Disease

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“…Positioned in the oropharynx, they are continuously exposed to bacteria, fungi, viruses, and other inhaled or ingested substances (33). The high antigenic burden is reflected in a comprehensive B cell activation with numerous germinal centers and only very few primary B cell follicles (data not shown).…”

Section: Cd4 ϩ Tonsil T Cells Are Activated But Fail To Produce Cytokmentioning

confidence: 99%

Germinal Centers Regulate Human Th2 Development

Johansson‐Lindbom

Ingvarsson

Borrebaeck

2003

The Journal of Immunology

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In the present study we demonstrate that all CD4+ T cells in human tonsil expressing the Th2-selective receptor chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) also 1) express high levels of CXCR5, and 2) display a transitional CD45RA/RO phenotype and consistently do not produce significant amounts of cytokines when immediately analyzed ex vivo. Hence, they represent precursors of Th2 effector cells, a conclusion confirmed by their robust production of IL-4, IL-5, and IL-13, but not IFN-γ, after in vitro activation. CD4+ T cells, which express only intermediate levels of CXCR5, instead develop into IFN-γ-producing cells under identical culture conditions, thus establishing a correlation between relative levels of CXCR5 expression and the acquired cytokine profile. Because CXCR5 is critically involved in follicular localization, the results suggest that these CRTH2+ Th2 cells preferentially develop their cytokine-producing phenotype within germinal centers (GCs), whereas extrafollicular differentiation instead promotes Th1 development. In support for this proposal, we show that T cells with an intermediate expression of CXCR5 can be forced to also produce IL-4 and IL-13 if cultured with allogenic GC B cells. Finally, we demonstrate that the previously described CD57+ GC T cells also express high levels of CXCR5 but instead of comprising a Th2 precursor, they represent anergized T cells. Taken together, these data suggest that GCs and B cells regulate CD4+ T cell differentiation in a finely tuned fashion, either by promoting differentiation of Th2 cells, which apparently leave the lymphoid tissue before evolving a cytokine-producing phenotype, or by furnishing T cell unresponsiveness.

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“…), and it represents one of the most frequent operations performed, especially in children (10,34). Several studies have demonstrated that Streptococcus pyogenes (group A beta-hemolytic streptococci [GAS]) and Haemophilus influenzae, isolated in 14 to 37% and 16 to 32% of the patients, respectively, are the most common bacteria causing tonsillar disease (10,15,19,30,34). The same bacteria, however, have also been isolated from the tonsils of healthy individuals (34).…”

mentioning

confidence: 99%

Toll-Like Receptor 4 Gene ( TLR4 ), but Not TLR2 , Polymorphisms Modify the Risk of Tonsillar Disease Due to Streptococcus pyogenes and Haemophilus influenzae

Liadaki

Petinaki

Skoulakis

et al. 2011

Clin Vaccine Immunol

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Tonsillar disease (recurrent tonsillitis and/or tonsillar hypertrophy) is one of the most common human disorders, with Streptococcus pyogenes (group A beta-hemolytic streptococcus [GAS]) and Haemophilus influenzae representing the most common pathogens. Until now, no study has investigated why some individuals are more susceptible to tonsillar infections caused by specific bacteria than others. The aim of this study was to uncover possible associations between common Toll-like receptor gene (TLR) polymorphisms and tonsillar disease. The TLR2-R753Q, TLR4-D299G, and TLR4-T399I polymorphisms were determined in a cohort of 327 patients subjected to tonsillectomy due to recurrent tonsillitis (n ‫؍‬ 245) and tonsillar hypertrophy (n ‫؍‬ 82) and 245 healthy bone marrow donors. Associations of the aforementioned polymorphisms with the isolated bacterial strains after tonsillectomy were also investigated. Interestingly, carriers of the TLR4 polymorphisms displayed an approximately 3-fold increased risk for GAS infections (for TLR4-D299G, odds ratio [OR] ‫؍‬ 2.81, 95% confidence interval [CI] ‫؍‬ 1.16 to 6.79, P ‫؍‬ 0.038; for TLR4-T399I, OR ‫؍‬ 3.01, 95% CI ‫؍‬ 1.29 to 7.02, P ‫؍‬ 0.023), and this association was more profound in patients with recurrent tonsillitis. On the contrary, the presence of the TLR4-T399I polymorphism was associated with a 2-fold decreased risk of Haemophilus influenzae carriage (OR ‫؍‬ 0.38, 95% CI ‫؍‬ 0.15 to 0.96, P ‫؍‬ 0.038). In the end, no significant differences were observed, considering the genotype and allele frequencies of the above-mentioned polymorphisms, between patients and controls. Our findings indicate that, regarding tonsillar infections, TLR4 polymorphisms predispose individuals to GAS infection, while they are protective against Haemophilus influenzae infection. This result further elucidates the role that host immune genetic variations might play in the susceptibility to common infections and tonsillar disease.

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Bacteriology of the Tonsil Core in Recurrent Tonsillitis and Tonsillar Hyperplasia - a Short Review

Cited by 52 publications

References 12 publications

Association between Tonsillar Core Microflora and Post-tonsillectomy Bacteremia

Association between Tonsillar Core Microflora and Post-tonsillectomy Bacteremia

Germinal Centers Regulate Human Th2 Development

Toll-Like Receptor 4 Gene ( TLR4 ), but Not TLR2 , Polymorphisms Modify the Risk of Tonsillar Disease Due to Streptococcus pyogenes and Haemophilus influenzae

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