Infected Tonsils Research Articles

Qualitative and quantitative immunoglobulin production by specific bacteria in chronic tonsillar disease.

Tonsillar tissue lymphocyte (TTL) function as measured by immunoglobulin production was assessed in vitro in 60 tonsils, 51 diseased and 9 normal controls. The diseased specimens were from children (aged 3 to 10 years) clinically classified as having recurrent tonsillitis (RT), idiopathic tonsillar hyperplasia (ITH), or recurrent tonsillitis with hyperplasia (RT/H). TTLs were challenged with intact, heat-inactivated bacteria found in the core of diseased tonsils--Streptococcus pyogenes (SP) and Haemophilus influenzae type B (HIB) as well as the dominant bacterium (DB) grown from that particular tonsillar core. The phytomitogen, leukoagglutinin (LA), was used as a nonspecific activator. Qualitative immunoglobulin production was assessed for the immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) classes. Immunoglobulin-specific production was quantified at the basal level, and at 2, 4, and 6 days following stimulation. Stimulation with HIB produced the greatest amount of IgG and IgM in TTLs from control tonsils. The DB was a relatively weak stimulator of normal (control) TTLs, yet produced relatively brisk IgG responses in the RT and ITH categories. It did, however, yield only marginal IgM secretion in these groups. IgA was consistently produced after stimulation in diseased TTLs, yet was not elicited from normal TTLs. The aforementioned findings suggest a differential qualitative and quantitative immunoglobulin response for healthy, recurrently infected, and hyperplastic tonsils. Lymphocyte hypofunction along with structural changes associated with hyperplasia may be central to the etiology of chronic tonsillar disease. The tonsillar immunologic response in disease and health is discussed.

Alterations to the oropharyngeal and nasopharyngeal microbial flora of children after tonsillectomy and adenoidectomy

The oropharyngeal and nasopharyngeal microbial flora of 40 children with chronically hypertrophied and infected tonsils or adenoids, was studied. Twenty of the children were treated by tonsillectomy and 20 by adenoidectomy. Swabs were taken from the surgical field pre-operatively and from the oropharynx or the nasopharynx 10 and 30 days-post-operatively. The swabs were cultured on suitable culture media and identification as well as quantitative estimation of the isolated bacteria, was carried out. Most of the potentially pathogenic bacteria exhibited beta-lactamase production. Interestingly, after surgical treatment, the respective microorganisms were quantitatively reduced and it was observed that their isolation rate was also lower. Furthermore, bacteria considered as normal inhabitants regularly showed an increase in their frequency of isolation despite the fact that a quantitative decrease was in some instances observed. These findings suggest that tonsillectomy and adenoidectomy result in an alteration to the abnormal oropharyngeal and nasopharyngeal microbial flora producing an almost normal one. It appears that, in cases of the failure of antimicrobial treatment, surgical procedures should be seriously considered.

A histofluorescent study of sympathetic innervation of human palatine tonsils.

The glyoxylic catecholaminergic histofluorescence method was employed on human palatine tonsil specimens in order to study the sympathetic innervation present. One percent neutral red was used as a counterstain. Abundant sympathetic fibers were demonstrable around the blood vessels of the medulla and capsule. However, few sympathetic fibers were found around the vessels of the subepithelial connective tissue and interfollicular septa. In the areas of the follicle and extrafollicle where B and T lymphocytes were located, sympathetic fibers were not found. These findings indicate that if sympathetic innervation can affect T and B cells, it will do so indirectly. Results also show that there is a higher norepinephrine content in focally infected tonsils that is not due to hyperactivity of the sympathetic nerve, but may be due to other mechanisms. Finally surgical dissection at the capsule during tonsillectomy will reduce bleeding, perhaps because vessels there have an abundant sympathetic innervation that leads to good vessel contraction.

The concept of focal infection of tonsil.

The concept of focal infection of tonsil.

Pharyngeal and tonsil infections caused by non-group A Streptococcus

Non-group A streptococci are members of the genus Streptococcus but do not share the notoriety of their cousin from group A. Most physicians, including otolaryngologists and head and neck surgeons, do not associate them with upper respiratory tract and head and neck infections. Some laboratories do not bother to report their presence on culture. At the University of California, Los Angeles they have been shown to cause (1) tonsillitis, painful tonsils lacking exudate and erythema (group C, one case; group F, one case), (2) acute nonexudative tonsillitis (group B, two cases; group C, one case; group F, one case), and (3) acute exudative tonsillitis (group C, one case). It should be remembered when there is a report of their presence that they are usually vulnerable to penicillin and its analogs. By judicious use of these drugs, morbidity can be diminished.

Branhamella catarrhalis and croup: Toxicity in the upper respiratory tract

Branhamella catarrhalis has gained increasing recognition as a pathogen in the respiratory tract. During the past 18 years, since its transfer from the genus Neisseria, it has been associated with infection in cavities of the respiratory tract (sinuses and middle ear). It has been recognized as playing a role in laryngitis. Its isolation in large numbers from the surface and core of acutely and chronically infected tonsils indicates a possible role in these infections. Croup (two patients reported here) can now be added to this list. The toxic potential of B catarrhalis, its movement from commensal to pathogen for the upper respiratory tract, and the pathogenic mechanisms by which this has occurred are reviewed.

扁桃と感染

We reviewed the reports on the mechanisms of focal infection of tonsil and our recent research.Recent reports suggested that the focal infection of tonsil may relate to the viral or bacterial products.In the case of viral infection, Epstein-Barr (EB) virus transformes not only B lymphocyte to produce immuno-globulins, but also infects the epithelium.The serological data of EB virus were related to the various types of tonsillar disease with focal infection.

Recurrent tonsillitis and growth in children

Anecdotal observations suggest an association between tonsil disease and growth retardation. This study compared height, weight and skinfold thickness measurements between a group of children (44) suffering from recurrent tonsillitis for a mean duration of 4 years, and a control group (34). No important differences were observed between the groups. Recurrent tonsil infection does not appear to retard the growth of children.

Estrogen and progesterone receptors in some human myeloma cell lines and murine hybridomas

The control of immune responses by sex hormones is well documented but the effect of sex hormones on lymphoid cell subsets is poorly understood. We have investigated the expression of receptors for androgens (AR), estradiol (ER) and progesterone (PR) by human cell lines of the B lymphocyte lineage and by murine myeloma or hybridomas. AR, ER and PR were determined by cytosol and nuclear binding assays. Eleven human lymphoblastoid cell lines obtained by in virto infection of blood or tonsil B cells with Epstein-Barr Virus (EBV) B95, did not express AR or ER. Similarly, 10 Burkitt's lymphoma cell lines were AR, ER and PR negative with the exception of the pre-B RAJI cells which bear AR. Among 13 cell lines derived from patients with multiple myeloma none expressed AR but five were found to bear ER (20–164 fmol/mg DNA or 5–10 fmol/mg protein). Four of the latter group also bear PR (86–450 fmol/mg DNA). Two mouse hybridomas out of seven tested were ER and PR positive. The MOPC 315 myeloma expressed ER but not PR. The possible functional role of these sex hormone binding sites in cell proliferation and immunoglobulin secretion deserves further investigation.

The role of natural killer cells in human tonsillar tissue focussing on the change of tonsillar tissue with aging.

The natural killer (NK) activity of tonsillar lymphocytes is low and NK-cells are small in number. In tonsillar tissue, NK-cells were present in the germinal center, which is where B-cells are located. This suggests that B-cells are related to NK-cells. Judging from the rates of augmentation of NK-activity of INF-alpha, INF-beta, and from the fact that there is no difference in the rate of NK-activity augmentation between tonsillar and peripheral blood lymphocytes with IFN added, it is highly unlikely that there is much difference between the ratios of pre-NK cells and NK-cells. The fact that the NK-activity augmentation in the tonsil rose to approximately double that of peripheral blood on the addition of IL-2 suggests that the percentage of immature NK-cells is high in the tonsil. This supposition is in agreement with the morphological findings. In the infected and child tonsil, it is probable that NK-cells are at an immature stage, that NK-activity is low, that B-cells are active, and that immunoglobulin production is in progress.

Participation of autonomic nerve in tonsillar focal infection.

Participation of the autonomic nerve in tonsillar focal infection was investigated by measuring neurotransmitters, receptors and microvibration. In focal infection patients, the volume of norepinephrine in the tonsil increased significantly and the number of a-adrenergic receptors decreased. These findings suggest that the focally infected tonsil exhibits a high degree of sympathetic nerve activity. The ratio of N-type in microvibration decreased systematically, which indicates some imbalance or immaturity of the autonomic nervous system in focal infection patients. Based on this data, the production mechanism of tonsillar focal infection was speculated from the point of view of the autonomic nerve.

Boonste Lugweg Infeksies (deel 2)

In Part 2 the causes, symptoms, complications and treatment of infections of the tonsils, the ear and mastoid are discussed. Practical guidelines are given for the family physician.

Detection of adenovirus nucleic acid sequences in human tonsils in the absence of infectious virus

Human tonsillar and adenoid tissues from surgical specimens and cell cultures established therefrom were screened for adenovirus type 2 (Ad2) sequences by in situ hybridization. For labeling we have utilized biotinylated DNA probes. We report detection of adenoviral sequences after hybridization with adenovirus type 2 DNA probes in tissues as well as in cell cultures from specimens without any signs of infectious virus even after long-term cultivation. In the infected tonsils only some of the cells appear to carry viral sequences. In conclusion, truly latent adenovirus infections in man seem to occur.

Identification and characterization of the Epstein-Barr virus receptor on human B lymphocytes and its relationship to the C3d complement receptor (CR2)

In pursuing studies on the early events in the infection of human B cells by Epstein-Barr virus (EBV), we examined the host cell attachment phase with a panel of B-cell-specific monoclonal antibodies. One of the monoclonal antibodies, OKB7, directly blocked the attachment of purified EBV to B lymphocytes in the absence of a second anti-immunoglobulin antibody and thereby prevented EBV infection of tonsil and peripheral blood B cells. Although earlier studies have shown a close association of the EBV and complement receptor (CR2), an anti-CR2 monoclonal antibody, anti-B2, did not directly block the binding of EBV to B cells. A comparison of the structures recognized by these monoclonal antibodies on various cell types and their functional and physiochemical properties was undertaken. Flow cytometric analysis revealed that the molecules detected by OKB7 and anti-B2 were coexpressed to the same extent on B cells but were not expressed on T-cell lines. OKB7 and anti-B2 both immunoprecipitated a 145,000-molecular-weight membrane protein with an isoelectric point of 8.2 from membrane extracts of Raji lymphoblastoid cells. OKB7 and, to a lesser extent, anti-B2 directly blocked the attachment of C3d,g-coated fluorescent microspheres and sheep erythrocytes bearing C3d to B cells, indicating that these antibodies also react with CR2. These studies indicate that the EBV-CR2 receptor is a single membrane glycoprotein which possesses multiple antigenic and functional epitopes.

Pathological and virological studies of experimental parvoviral enteritis in calves

Calves held in isolation showed a progressive decline in maternally derived antibody titres to bovine parvovirus but low concentrations of inhibitors resistant to heat and kaolin treatment persisted as the animals matured. These inhibitors had both haemagglutination inhibition and plaque neutralising activity and were considered to be of non-specific origin. Following oral challenge with bovine parvovirus, calves developed mild to moderate diarrhoea, with lymphopenia and viraemia. Sequential virological and immunofluorescent studies showed that the virus initially infected tonsils and intestinal tract, subsequently spreading to systemic lymphoid tissues. Histological and scanning electron microscopic examinations revealed moderate small intestinal villus atrophy and fusion due to crypt damage, together with lymphoid necrosis predominantly associated with the intestinal tract and thymus. Although the disease was not very severe, this may have been because the low parasite burden in the animals reduced mitotic activity in susceptible tissues.

The Attack on the Tympanic Membrane

Fluid in the ear, glue ear, and conductive hearing loss have replaced the "infected, large, or hypertrophied tonsils" and "enlarged adenoids" as a major concern of primary physicians caring for children and the special domain of ear, nose, and throat physicians. Having myringotomy tubes put into the ears has become a favorite topic of discussion for parents marveling at the positive effects. Indeed, these devices must be something of a fashion or status symbol, because it is estimated that tubes of various configurations and materials are placed into the tympanic membrane of at least 1 million children per year in this country.

In vitro protection of group A beta-hemolytic streptococci from penicillin and cephalothin by Bacteroides fragilis.

beta-Lactamase produced by Bacteroides fragilis could protect from antibiotics group A beta-hemolytic streptococci (GABHS), penicillin-susceptible pathogens frequently isolated from acute tonsillitis in children. To test this hypothesis we determined the minimal bactericidal concentration (MBC) to penicillin and cephalothin of GABHS alone and in mixed culture with eleven beta-lactamase-producing strains of B. fragilis. B. fragilis strains with MBC values less than or equal to 32 micrograms/ml to penicillin and less than or equal to 64 micrograms/ml to cephalothin did not provide any protection for GABHS. However, strains with MBC greater than or equal to 128 micrograms/ml to penicillin and greater than or equal to 256 micrograms/ml to cephalothin provided protection by increasing the MBC of GABHS at least 8,534 times for penicillin and 2,048 times for cephalothin. This phenomenon was most marked in 5% CO2. B. fragilis provided no protection against clindamycin. These results may explain the inability of penicillin therapy to completely eradicate GABHS from cases of recurrently infected tonsils.

Surface vs Core-Tonsillar Aerobic and Anaerobic Flora in Recurrent Tonsillitis

Specimens from both the surface and the core of tonsils from 23 children with recurrent tonsillitis were cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all patients. The predominant anaerobic isolates were Bacteroides sp,<i>Fusobacterium nucleatum</i>, anaerobic Gram-positive cocci, and<i>Eubacterium</i>sp. The predominant aerobic isolates were α-hemolytic streptococci,<i>Staphylococcus aureus</i>, β-hemolytic streptococci, and<i>Haemophilus</i>sp. β-Lactamase production was noted in 49 isolates from 19 patients (83%). Seventy percent of the aerobic isolates were recovered in both core and surface specimens, compared with 57% of the anaerobic isolates. Ten percent of aerobes were recovered only in the core, compared with 33% of the anaerobes, and 20% of the aerobes in the surface only, compared with 10% of the anaerobes. These data demonstrate the discrepancies between surface and core cultures in the isolation of anaerobic bacteria, and raise the question whether surface cultures can accurately predict the presence of β-lactamase-producing organisms or other pathogens in the recurrently infected tonsil. (<i>JAMA</i>244:1696-1698, 1980)

Analysis of human tonsil and cancer DNAs and RNAs for DNA sequences of group C (serotypes 1, 2, 5, and 6) human adenoviruses

Group C human adenoviruses (Ads) of serotypes 1, 2, 5, and 6 infect most children and commonly cause latent infections of lymphoid tissues. Ads transform cells into a malignant-like phenotype; the oncogenic genetic information is in the left 8% of the viral genome, in the HindIII-G DNA fragment. We have investigated the molecular basis for group C Ad latent infections in human tonsils as well as whether these viruses are linked to human cancer. Tonsil or cancer DNAs and RNAs were assayed for Ad sequences by liquid-phase saturation-hybridization with in vitro-labeled Ad5 HindIII-G fragment. About 25% of the 52 tonsils analyzed contained DNA or RNA sequences specific to HindIII-G, indicating that Ad transforming sequences are expressed as RNA in tonsils. Southern blotting analysis of four tonsil DNAs revealed multiple copies of the complete Ad genome in a free state and provided evidence for an unusual form of the Ad genome, possibly Ad DNA integrated into cellular DNA. In assays of human cancers, no Ad sequences were detected in DNAs from 26 squamous cell carcinomas (Cas), 3 adenocarcinomas, 4 oat cell Cas, 5 stomach Cas, 5 small intestine Cas, 15 colon Cas, 6 rectum Cas, 5 Hodgkin and 6 non-Hodgkin lymphomas, and 2 breast Cas. Reconstruction experiments indicated that the HindIII-G probe could detect 1 copy per cell of 0.2-0.3% of the viral genome. No HindIII-G-specific sequences were detected in RNAs from 21 squamous cell Cas, 3 oat cell Cas, 2 stomach Cas, or 18 colon Cas. In six other experiments using the complete Ad2 genome as probe, no Ad sequences were found in DNAs from 6 lung Cas, 12 normal lung tissues, 33 gastrointestinal Cas, 19 normal gastrointestinal tissues, 6 Hodgkin lymphomas, 3 breast Cas, or 4 kidney Cas, at a sensitivity of about 1 copy per tumor cell of 5-10% of the Ad2 genome. All Ad-induced cancer cells should contain at least 1 copy of 1-6% of the viral genome, the minimal size of the transforming region, and probably should contain multiple copies of more of the genome. Therefore, our data are definitive evidence against group C Ads being the cause of the cancers tested, which represent about 50% of the cancer incidence in the United States. Of additional interest, we did not detect Ad2 sequences in RNAs from 7 human placentas, 12 normal lungs, or 19 normal gastrointestinal tissues (nor in 44 cancer or 23 tonsil RNAs). Thus, we did not confirm a recent report of the presence of Ad2 RNA in RNAs from human placentas; the possibility that a small population of cells in placenta expresses group C "related" sequences is not ruled out.

Transfer of Ciclacillin to Tissues of Upper Respiratory Tract

We carried out studies to determine tissue levels of drugs administered for infections of the upper repiratory tract. Twenty-one patients examined in the Dept. of Otorhinolaryngology of Osaka University Medical School served as subjects for the present study.Ciclacillin (AC-PC) was administered one hour before surgery under local anesthesia in oral doses of 500mg and 250mg to adults and children, respectively. Tissue levels of the antibiotic were determined by the cylinder-plate method using S. aureus as test organism and the serum levels by the Agar well method using B. subutilis.We found that Ciclacillin concentration in lymphatic tissues such as the adenoids and tonsils to the serum was significantly lower than that in the mucous membranes of nasal polyp and paranasal cavity, and inferior turbinates.In consideration of the factors concerning differences in Ciclacillin levels in various tissues of the upper respiratory tract, we concluded that Ciclacillin should be administered to children as well as adults with acute tonsil and/or adenoid infections at a higher dose than that required for infections in the nasal or paranasal cavities.