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. 2012 Jan 9:12:3.
doi: 10.1186/1471-2431-12-3.

Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage

Amity L Roberts  1 , Kristie L Connolly, Daniel J Kirse, Adele K Evans, Katherine A Poehling, Timothy R Peters, Sean D Reid
Affiliations

Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage

Amity L Roberts et al. BMC Pediatr. .

Abstract

Background: Group A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of this population are chronic carriers of GAS. Antibacterial therapy has previously been shown to be insufficient at clearing GAS carriage. Bacterial biofilms are a surface-attached bacterial community that is encased in a matrix of extracellular polymeric substances. Biofilms have been shown to provide a protective niche against the immune response and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. The objective of this study was to test the hypothesis that GAS is present within tonsil tissue at the time of tonsillectomy.

Methods: Blinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from children undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.

Results: Immunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had tonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS pharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was localized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of cocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms from in vivo animal models.

Conclusion: Our study revealed the presence of GAS within the tonsillar reticulated crypts of approximately one-third of children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis at the Wake Forest School of Medicine.

Trial registration: The tissue collected was normally discarded tissue and no patient identifiers were collected. Thus, no subjects were formally enrolled.

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Figures

Figure 1
Figure 1
Fluorescent antibody staining (10 μm sections) of Cytokeratin 8 & 18 (white) allows visualization of the tonsillar crypt epithelium. Representative images of tonsils removed due to ATH (left) or recurrent GAS infection (right) are shown at 4 × magnification.
Figure 2
Figure 2
Fluorescent antibody staining of GAS (red) within the crypts (green) of pediatric tonsils removed due to recurrent GAS tonsillopharyngitis. (A) GAS within in vivo biofilm from a chinchilla. (B and C) GAS within the tonsillar crypts.
Figure 3
Figure 3
Fluorescent antibody staining of GAS (red) within the crypts (green) of pediatric tonsils removed due to ATH. (A) GAS within in vivo biofilm from a chinchilla. (B, C, D) GAS within the tonsillar crypts.
Figure 4
Figure 4
SEM showing chains of adherent cocci organized into biofilms attached to the surface of pig skin epithelium (A and B) and to the surface of a tonsil removed due to recurrent GAS infection (C and D) or ATH (E and F).
Figure 5
Figure 5
Gram-stain showing the positive detection of GAS biofilm (b) in a chinchilla sample (A). Detection of a Gram-positive biofilm (b) in a tonsil removed due to recurrent GAS infection (B) or ATH (C and D).
See this image and copyright information in PMC

References

    1. Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis. 2002;35(2):113–125. - PubMed
    1. Casey JR, Pichichero ME. Higher dosages of azithromycin are more effective in treatment of group A streptococcal tonsillopharyngitis. Clin Infect Dis. 2005;40(12):1748–1755. - PubMed
    1. Pichichero ME, Green JL, Francis AB, Marsocci SM, Murphy AM, Hoeger W, Noriega C, Sorrento A, Gootnick J. Recurrent group A streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 1998;17(9):809–815. - PubMed
    1. Pichichero ME, Marsocci SM, Murphy ML, Hoeger W, Green JL, Sorrento A. Incidence of streptococcal carriers in private pediatric practice. Arch Pediatr Adolesc Med. 1999;153(6):624–628. - PubMed
    1. Tarlow MJ. Macrolides in the management of streptococcal pharyngitis/tonsillitis. Pediatr Infect Dis J. 1997;16(4):444–448. - PubMed

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