Retrospective Microbiological Study of Atypical Recurrent Pharyngitis in Patients Presenting the White-line Clinical Sign

Abstract

Background: Chronic atypical oropharyngeal disease in adults, accompanied with chronic cough, can occur at any age manifesting itself with different grade evolutive diseases. Often their pathogenesis is attributed to gastroesophageal reflux, to virosis or to unspecified immune deficiencies but some clinical aspects, such as the simultaneous presence of urinary disorders, the temporal scanning of the recurrence and the reduced response to antibiotic therapy, suggests a different or a superimposed pathology. Methods: The present study was carried out to assess retrospectively biopsy and biological materials from a population afflicted by atypical recurrent pharyngitis, presenting a �??white line�?� clinical sign into the context of respiratory difficulties, manifesting chronic choking cough (CCC), laryngopharyngeal (LPR) and gastroesophageal (GERD) reflux diseases. This population, already clinically, endoscopically and histologically characterized, was newly studied following the microbial approach by cultural and molecular procedures. Results: We analyzed 14 biopsy, 60 biological pooled materials from lingual, pharyngeal, post nasal drip mucoid secretions and sputum (here initialled: LPNS) and 60 lingual cell and salivary secretions (LCSS) resulted positive to Chlamydiaceae [(Chlamydia pneumoniae (Cp) and Chlamydia trachomatis (Ct)], to urogenital Mycoplasmas [Mycoplasma hominis (Mh) and Ureaplasma urealyticum (Uu)], to Helicobacter pylori (Hp) into the context of a changeable overlapping with other typical bacteria, belonging to Corynebacteria, Enterobacteria, Streptococci and Staphylococci groups. Conclusions: Our data indicated that atypical infections [C. trachomatis and urogenital Mycoplasmas (Mh and Uu)], together with Cp, were the underhand pathogens of an initial chronic oropharyngeal scenery until now unrecognized, triggering, after decades, the respiratory problems in middle and old subjects genetically susceptible. The presence of white line clinical sign, endoscopically observed, together with an altered pH salivary secretion, into the scenario of CCC, LPR and GERD reflux manifestations, refractory to non-specific medical therapy, represents a pathognomonic triad to include routinely these valuations into the diagnostic protocol of an atypical recrudescent pharyngitis.