Abstract
BackgroundGroup A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of this population are chronic carriers of GAS. Antibacterial therapy has previously been shown to be insufficient at clearing GAS carriage. Bacterial biofilms are a surface-attached bacterial community that is encased in a matrix of extracellular polymeric substances. Biofilms have been shown to provide a protective niche against the immune response and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. The objective of this study was to test the hypothesis that GAS is present within tonsil tissue at the time of tonsillectomy.MethodsBlinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from children undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.ResultsImmunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had tonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS pharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was localized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of cocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms from in vivo animal models.ConclusionOur study revealed the presence of GAS within the tonsillar reticulated crypts of approximately one-third of children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis at the Wake Forest School of Medicine.Trial RegistrationThe tissue collected was normally discarded tissue and no patient identifiers were collected. Thus, no subjects were formally enrolled.
Highlights
Group A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of this population are chronic carriers of GAS
Children undergoing tonsillectomy for recurrent GAS tonsillopharyngitis were more likely to have had a diagnosis of streptococcal pharyngitis in the prior year and history of ear tube placement than those with adenotonsillar hypertrophy (ATH)
The proportion of tonsil samples that had GAS detected by immunofluorescence with or without acute symptoms of streptococcal pharyngitis was similar for children undergoing surgery for ATH (11 (37%) of 30 samples) and for those with recurrent GAS infection (10 (33%) of 30 samples, P = 0.79)
Summary
Group A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of this population are chronic carriers of GAS. Biofilms have been shown to provide a protective niche against the immune response and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. Tonsillopharyngitis is an acute infection of the palatine tonsils and pharynx often presenting symptomatically with a sore throat, fever and cervical lymphadenopathy [7]. A common clinical problem occurs when patients frequently present with episodes of acute viral pharyngitis, but GAS is repeatedly detected by throat culture or antigen detection methods because some of these children may be chronic carriers of GAS. 20% of school-age children are estimated to be chronic carriers of GAS, defined as prolonged persistence of GAS without evidence of infection or an immune response [9]. Chronic carriage is well known and widespread, it is poorly understood and its clinical relevance is unclear
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