Recurrent Streptococcal Tonsillitis Research Articles

Intranasal streptococcal infection exacerbates psoriasis-like dermatitis via the induction of skin tissue-resident memory T cells

Recurrent streptococcal tonsillitis exacerbates psoriasis. Studies have indicated that T cells responding to streptococcal antigens in the skin are involved in the pathogenesis of the disease. However, a direct link between streptococcal tonsillitis and psoriasis has not been evidenced. In the present study, the impact of intranasal (i.n.) streptococcal infection on psoriasis was investigated using the imiquimod (IMQ) psoriasis mouse model. The results showed that repeated i.n. infection with group A Streptococcus (GAS) induced a robust and persistent Th17 response in the nasal-associated lymphoid tissue (NALT) and exacerbated IMQ-mediated psoriatic skin lesions. ELISpot and flow cytometry analyses revealed that GAS-reactive tissue-resident memory T cells (TRM) were present in the skin of GAS-infected mice and produced IL-17/IL-23 axis cytokines in response to IMQ, compared to mice uninfected with GAS. In addition, i.n. infection with Streptococcus pneumoniae (Sp), a pathogen not associated with the development of psoriasis, also induced a persistent Th17 response in NALT but did not exacerbate IMQ-induced psoriatic inflammation nor elicited Sp-specific T cells in the skin. The results provide in vivo evidence that GAS-associated psoriasis is dependent on the skin GAS-specific TRM cells induced by GAS nasopharyngeal infection and can be later activated by environmental triggers, leading to psoriatic inflammation. Reducing the reservoir of Th17 cells, which are source of skin TRM cells, may constitute a promising treatment for psoriasis.

The Psoriasis Risk Allele HLA-C*06:02 Shows Evidence of Association with Chronic or Recurrent Streptococcal Tonsillitis

Pharyngeal tonsillitis is one of the most common upper respiratory tract infections, and group A streptococcus is the most important bacterial pathogen causing it. While most patients experience tonsillitis only rarely, a subset of patients suffers from recurrent or chronic tonsillitis or pharyngitis. The predisposing factors for recurring or chronic forms of this disease are not yet fully understood, but genetic predisposition has been suggested. A genetic association study using Illumina's Immunochip single-nucleotide polymorphism (SNP) array was performed to search for new genetic biomarkers in pharyngeal tonsillitis. More than 100,000 SNPs relevant to immune-mediated diseases were analyzed in a cohort of 95 patients subjected to tonsillectomy due to recurrent/chronic tonsillitis and 504 controls. Genetic association between the cases and controls showed strongest association with two peaks in the HLA locus (odds ratio [OR], 3.7 to 4.7; P = 4.9 × 10-6 to 5.7 × 10-6). Further analysis with imputed classical HLA alleles suggested the known psoriasis risk allele HLA-C*06:02 as a risk factor for tonsillitis (P = 4.8 × 10-4; OR, 2.3). In addition, the imputed HLA haplotype HLA-C*06:02/HLA-B*57:01, a reported risk haplotype in psoriasis, had the strongest risk for tonsillitis (P = 3.2 × 10-4; OR, 6.5). These findings further support the previously reported link between streptococcal throat infections and psoriasis.

Management of recurrent tonsillitis in children

ObjectiveTo compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. MethodsThe study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. ResultsBoth groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. ConclusionAZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

The association between pediatric general emergency department visits and post operative adenotonsillectomy hospital return

PurposeTo define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following adenotonsillectomy. MethodsRetrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. ResultsThere was a significant relationship between patients who visited the ED pre-operatively, 25% (N=96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit (χ2=53.6, df=1, p<0.001), female gender (female=56.9%; male=43.1%; χ2=4.2, df=1, p=0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST=18%; RST=17.5%; OSA=11.8%; χ2=12.8, p=0.002) and having a post-operative ED visit. ConclusionGeneralized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints.

HEV, PGS, GABA, Chronic Tonsilitis

To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children.The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000 IU for children ≤ 27 kg and 1,200,000 IU for ≥ 27 kg) every two weeks for six months. Group B children received single oral AZT (250 mg for children ≤ 25 kg and 500 mg for ≥ 25 kg) once weekly for six months.Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance.AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—an uncommon, but important indication for tonsillectomy

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, also know as “PANDAS,” is well described in the neurologic and psychiatric literature. PANDAS is associated with obsessive compulsive disorders (OCD) and tic disorders. The streptococcal infections may trigger an autoimmune reaction that exacerbates these conditions. Recurrent streptococcal tonsillitis is one of the recurrent infections associated with PANDAS. This paper reviews the case reports of two brothers, one with OCD and the other with a tic disorder, both of whom improved significantly after undergoing adenotonsillectomy for treatment of their recurrent tonsillitis. A review of the pathophysiology and current understanding of PANDAS is presented.

Perianal streptococcal dermatitis. The possible protective role of alpha-streptococci against spread and recurrence of group A streptococcal throat infection

Objective - To follow the spread of beta-haemolytic streptococci group A (GAS) within a family and examine the protective activity of normally occurring alpha-streptococci against GAS tonsillitis. Design - Follow up of recurrent GAS throat infection within a family. Setting - Intra familial spread of GAS. Patients - A family of four, the mother suffering from recurrent streptococcal tonsillitis and a son with perianal streptococcal dermatitis. Results - The strain of the GAS found in the perianal region of the boy was identical with that found in the throat of his mother. She had recurrent streptococcal tonsillitis, while the boy remained healthy in the throat. She lacked interfering alpha-streptococci in the throat, while the boy had a massive growth of alpha-streptococci in his throat with capacity to inhibit the growth of the streptococcal isolate. Main outcome measures - Infection with GAS within a family correlated with the growth-inhibiting activity of the alpha-streptococci in vitro. Conclusions - The study demonstrated the spread of GAS from a patient with streptococcal dermatitis to the throat of another person within the family, and the hindrance of induction of infection in patients carrying interfering alpha-streptococci.

Alpha-streptococci as supplementary treatment of recurrent streptococcal tonsillitis: A randomized placebo-controlled study : Roos K.; Holm S.E.; Grahn E.; Lind L.SCAND. J. INFECT. DIS. (SWE) (1993) 25/1 (31-5)

Alpha-streptococci as supplementary treatment of recurrent streptococcal tonsillitis: A randomized placebo-controlled study : Roos K.; Holm S.E.; Grahn E.; Lind L.SCAND. J. INFECT. DIS. (SWE) (1993) 25/1 (31-5)

Interfering α-streptococci as a protection against recurrent streptococcal tonsillitis in children

Recurrent streptococcal tonsillitis/ pharyngitis is a great problem, especially in certain epidemiological situations. Patients treated with antibiotics often have a disturbed normal throat flora and may lack, e.g., a-streptococci known in vitro to have an interfering activity against group A streptococci. Thirty-one patients with recurrent streptococcal tonsillitis were given antibiotics for 10 days. At the end of this treatment they were sprayed in their mouths with four selected a-streptococcal strains known to have strong growth inhibiting activity in vitro against most /β-streptococci group A. The follow-up period after this colonization was 3 months. After α-streptococcal treatment, none of the patients attracted a new tonsillitis during the follow-up period while 8% of the controls had a second tonsillitis. Treatment of streptococcal tonsillitis/ pharyngitis with antibiotics followed by recolonization with α-streptococci seems to hinder further recurrences.

Alpha-Streptococci as Supplementary Treatment of Recurrent Streptococcal Tonsillitis: A randomized Placebo-controlled Study

Recurrences are a common finding after antibiotic treatment of acute group A streptococcal tonsillitis. This has been attributed to several factors, among others a disturbed normal throat flora and especially a lack of alpha-streptococci. It thus seems logical in patients with recurrent streptococcal tonsillitis, to restore the normal alpha-streptococcal flora by reimplantation of alpha-streptococci. This was performed in a double blinded, randomized, placebo-controlled study. 36 patients with recurrent streptococcal group A tonsillitis were treated with antibiotics followed by either placebo (19 patients) or a pool of 4 selected alpha-streptococcal strains (17 patients) with good interfering activity against clinical isolates of beta-streptococci. No patient recurred during the first 2 months of follow-up in the alpha-treated group, but 7 in those treated with antibiotics and placebo. After 3 months 1 in the patient group treated with antibiotics and alpha-streptococci and 11 in the placebo-treated group recurred. These results are statistically highly significant and show that recolonisation with alpha-streptococci seems to offer a new way to lower the rate of recurrence in streptococcal throat infections.

Alpha-Streptococci as Supplementary Treatment of Recurrent Streptococcal Tonsillitis: A randomized Placebo-controlled Study

Recurrences are a common finding after antibiotic treatment of acute group A streptococcal tonsillitis. This has been attributed to several factors, among others a disturbed normal throat flora and especially a lack of alpha-streptococci. It thus seems logical in patients with recurrent streptococcal tonsillitis, to restore the normal alpha-streptococcal flora by reimplantation of alpha-streptococci. This was performed in a double blinded, randomized, placebo-controlled study. 36 patients with recurrent streptococcal group A tonsillitis were treated with antibiotics followed by either placebo (19 patients) or a pool of 4 selected alpha-streptococcal strains (17 patients) with good interfering activity against clinical isolates of beta-streptococci. No patient recurred during the first 2 months of follow-up in the alpha-treated group, but 7 in those treated with antibiotics and placebo. After 3 months 1 in the patient group treated with antibiotics and alpha-streptococci and 11 in the placebo-treated group recurred. These results are statistically highly significant and show that recolonisation with alpha-streptococci seems to offer a new way to lower the rate of recurrence in streptococcal throat infections.

Alpha-streptococci-inhibiting beta-streptococci group A in treatment of recurrent streptococcal tonsillitis.

Alpha-streptococci-inhibiting beta-streptococci group A in treatment of recurrent streptococcal tonsillitis.

Treatment of recurrent streptococcal tonsillitis by recolonization with alpha-streptococci

Treatment of recurrent streptococcal tonsillitis by recolonization with alpha-streptococci