Investigation of Helicobacter pylori in tonsillary tissue with Pronto Dry ® test and pathologic examination

Abstract

Objective The objectives of this clinical study were to identify, by means of the Pronto Dry ® test and pathologic examination, Helicobacter pylori (HP) in tonsillary tissue and to establish the role of HP in tonsillary microbiology by identifying that bacterium in the tonsillary mucosa or within the tonsil core. Methods The subjects consisted of 52 patients (25 men and 27 women; age range, 3–65 years; mean age, 15.1 ± 14.5 years) who were scheduled to undergo tonsillectomy for the treatment of chronic tonsillitis and who had not been treated with an antibiotic or a bismuth-containing compound for 6 months before the initiation of the study. In each patient, two specimens (one 4 mm × 4 mm tissue sample from the nonmucosal tonsil core and one 4 mm × 4 mm sample of mucosal tissue) were excised from both tonsils immediately after tonsillectomy. The specimens were placed in the Pronto Dry ® test kit, and the test results were obtained 1 h later. The remaining tonsillary tissues were submitted for pathologic analysis via hematoxylin–eosin stain, Giemsa stain, Warthin-Starry silver stain, and staining for inducible nitric oxide synthase (iNOS). Results The results of the Pronto Dry ® test were positive for HP in 42% ( n = 22) of the excised mucosal tissue and in 47% ( n = 24) of the excised core tissue. In 27% ( n = 14) of the patients, both the core and the mucosal tissues tested positive for HP. There was no significant difference between the positive Pronto Dry ® test ratios of the biopsies obtained from the mucosa and those obtained from the core ( P = 0.693). iNOS staining showed that macrophage iNOS activity was significantly higher ( P = 0.025) in biopsied mucosal tissues with a positive Pronto Dry ® test result than in those with a negative result. Light microscopy revealed no HP in samples stained with hematoxylin–eosin stain, Giemsa stain, or Warthin-Starry silver stain. Conclusion Positive Pronto Dry ® test results and the results of iNOS staining showed that HP contributes to chronic tonsillitis, especially at the mucosal layer. Although HP does not colonize, it contributes to the chronic tonsillary inflammatory process as a triggering agent by affecting macrophages in the tonsil and thus increasing iNOS expression.