Abstract
Chronic tonsillar diseases are an important health problem, leading to large numbers of surgical procedures worldwide. Little is known about pathogenesis of these diseases. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases, we developed a cross-sectional study to determine the rates of viral detections of common respiratory viruses detected by TaqMan real time PCR (qPCR) in nasopharyngeal secretions, tonsillar tissues and peripheral blood from 121 children with chronic tonsillar diseases, without symptoms of acute respiratory infections. At least one respiratory virus was detected in 97.5% of patients. The viral co-infection rate was 69.5%. The most frequently detected viruses were human adenovirus in 47.1%, human enterovirus in 40.5%, human rhinovirus in 38%, human bocavirus in 29.8%, human metapneumovirus in 17.4% and human respiratory syncytial virus in 15.7%. Results of qPCR varied widely between sample sites: human adenovirus, human bocavirus and human enterovirus were predominantly detected in tissues, while human rhinovirus was more frequently detected in secretions. Rates of virus detection were remarkably high in tonsil tissues: over 85% in adenoids and close to 70% in palatine tonsils. In addition, overall virus detection rates were higher in more hypertrophic than in smaller adenoids (p = 0.05), and in the particular case of human enteroviruses, they were detected more frequently (p = 0.05) in larger palatine tonsils than in smaller ones. While persistence/latency of DNA viruses in tonsillar tissues has been documented, such is not the case of RNA viruses. Respiratory viruses are highly prevalent in adenoids and palatine tonsils of patients with chronic tonsillar diseases, and persistence of these viruses in tonsils may stimulate chronic inflammation and play a role in the pathogenesis of these diseases.
Highlights
Palatine tonsils and adenoids are prominent secondary lymphoepithelial organs associated with the upper respiratory tract, where inhaled antigens first come in contact with host defense cells [1]
In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases we have performed a cross-sectional study in surgical tissue samples and cavity washes from patients with recurrent tonsillitis and chronic adenotonsillar hyperplasia
The study was based on sensitive molecular assays to detect respiratory viruses in sets of samples prospectively collected from children with a full spectrum of chronic adenotonsillar diseases requiring tonsillectomy
Summary
Palatine tonsils and adenoids are prominent secondary lymphoepithelial organs associated with the upper respiratory tract, where inhaled antigens first come in contact with host defense cells [1]. Tonsillar hyperplasia and recurrent tonsillitis are common chronic diseases that often lead to complications that include nasal obstruction, recurrent sinusitis, snoring, auditory tube dysfunction, otitis media, obstructive sleep apnea and changes in facial growth and behavioral development [2]. These complications frequently lead to patients undergoing tonsillectomy, which still is one of the most commonly performed pediatric surgical procedures worldwide [3]. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases we have performed a cross-sectional study in surgical tissue samples and cavity washes from patients with recurrent tonsillitis and chronic adenotonsillar hyperplasia. The high rates of detection of respiratory viruses in adenoids and palatine tonsils of patients with chronic adenotonsillar disease bring new insights about the transmission of respiratory viruses and their role in pathogenesis of chronic adenotonsillar diseases
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