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1.
PLoS One ; 15(4): e0228122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243441

RESUMO

The present study aimed to specify diagnostics for peritonsillar abscesses (PTAs) and to clarify the role of minor salivary glands. This prospective cohort study included 112 patients with acute tonsillitis (AT) and PTA recruited at a tertiary hospital emergency department between February and October 2017. All patients completed a questionnaire concerning their current disease. Serum amylase (S-Amyl) and C-reactive protein (S-CRP) levels, tonsillar findings, and pus aspirate samples and throat cultures were analyzed. Eight of 58 PTA patients (13.8%) had no signs of tonsillar infection. The absence of tonsillar erythema and exudate was associated with low S-CRP (p<0.001) and older age (p<0.001). We also observed an inverse correlation between S-Amyl and S-CRP levels (AT, r = -0.519; PTA, r = -0.353). Therefore, we observed a group of PTA patients without signs of tonsillar infection who had significantly lower S-CRP levels than other PTA patients. These findings support that PTA may be caused by an etiology other than AT. Variations in the S-Amyl levels and a negative correlation between S-Amyl and S-CRP levels may indicate that minor salivary glands are involved in PTA development.


Assuntos
Abscesso Peritonsilar/epidemiologia , Glândulas Salivares Menores/microbiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Tonsilite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tonsila Palatina/microbiologia , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/microbiologia , Abscesso Peritonsilar/patologia , Prevalência , Estudos Prospectivos , Glândulas Salivares Menores/patologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia , Tonsilite/sangue , Tonsilite/epidemiologia , Tonsilite/microbiologia , Adulto Jovem
3.
Georgian Med News ; (298): 49-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141848

RESUMO

Chronic and recurrent tonsillitis associated with tonsillitis recurrence, which can greatly affect the quality of life of the patient. Among the causes of chronic infection and resistance to antibiotic treatment are the formation of biofilms in the respiratory tract in respiratory infections. The purpose of the study is to identify the ability to biofilm strains of streptococci on the surface of the epithelial tissue of the oropharynx isolated from patients with recurrent tonsillitis. Clinical strains of Streptococcus spp bacteria obtained from the oropharynx of 22 children with recurrent tonsillitis were investigated. The biofilm formation ability was studied by growing bacteria on 96-well plates. It was found that 9 (40.09%) strains out of 22 had film-forming ability, among which 1 (4.54%) strains showed strong film-forming, 4 (18.18%) strains-moderate, 4 strain (18.138%). - weak film formation and in 13strains (59.09%) this ability was absent. Studies of the intensity of biofilm formation over three days of cultivation showed a tendency to increase the rate of optical density (OD) in the line: 0,1691±0,019 on the first day (24 h); 0,2159±0,029 in the second (48 h) and in the third - 0,3156±0,055. The degree of severity of the film-forming ability of the studied strains of streptococci isolated from patients with recurrent tonsillitis showed an increase in the optical density (OD) over three days of cultivation, with it fluctuating within 0,1407

Assuntos
Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação , Tonsilite/microbiologia , Antibacterianos/uso terapêutico , Biofilmes , Criança , Humanos , Qualidade de Vida , Recidiva , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus/classificação , Streptococcus/patogenicidade , Tonsilectomia/métodos , Tonsilite/diagnóstico , Tonsilite/cirurgia
5.
J Med Microbiol ; 69(3): 443-450, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32011228

RESUMO

Introduction. Pharyngotonsillitis caused by Streptococcus pyogenes (group A streptococci, or GAS) is among the most common infections treated with antibiotics in pediatric patients.Aim. This study aimed to analyse changes in molecular epidemiology and antibiotic susceptibility among GAS isolates in three study periods spanning 10 years.Methodology. GAS isolated from paediatric patients with pharyngotonsillitis during Period I (mid-2007 to 2008, n=235), Period II (2012, n=210), and Period III (2018, n=189) were analysed for emm type, multilocus sequence type (MLST), antibiotic susceptibility, and macrolide (ML)- and quinolone (QL)-resistance genes.Results. Over 20 % of isolates represented emm1 and emm12 types, remaining common in all three periods. Among other emm types, emm4 was common in Period I, emm28 and emm89 in Period II, and emm3 and emm89 in Period III. All isolates remained highly susceptible to penicillins and cephalosporins. Isolates possessing mefA, ermA, or ermB genes mediating ML resistance increased from 34.9 % in Period I to 60.9 % in Period II, but fell to 27.5 % in Period III. QL-resistant isolates with amino acid substitutions affecting ParC and/or GyrA gradually increased from 11.5 to 14.3 %. Specific sequence types identified by MLST and emm typing were associated closely with ML or QL resistance.Conclusion. Our findings indicate that even in ambulatory care, antibiotic choice for these infections should be based on rapid identification and characterization of causative pathogens.


Assuntos
Antibacterianos/farmacologia , Antígenos de Bactérias/genética , Farmacorresistência Bacteriana/genética , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/genética , Tonsilite/epidemiologia , Proteínas da Membrana Bacteriana Externa/genética , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Genótipo , Humanos , Japão/epidemiologia , Macrolídeos/farmacologia , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Nasofaringe/microbiologia , Filogenia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/classificação , Streptococcus pyogenes/efeitos dos fármacos , Tonsilite/tratamento farmacológico , Tonsilite/microbiologia
7.
APMIS ; 128(3): 211-219, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31692060

RESUMO

The aim of this study was to analyze the prevalence of Staphylococcus aureus in the tonsils of children subjected tonsillectomy due to recurrent tonsilitis and to determine the spa types of the pathogens, carriage of virulence genes and antimicrobial resistance profiles. The study included 73 tonsillectomized children. Bacteria, including S. aureus were isolated from tonsillar surface prior to tonsillectomy, recovered from tonsillar core at the time of the surgery, and from posterior pharynx 2-4 weeks after the procedure. Staphylococcus aureus isolates were compared by spa typing, tested for antimicrobial susceptibility and for the presence of superantigenic toxin genes (sea-seu, eta, etb, tst, lukS/lukF-PV) by multiplex polymerase chain reaction. Seventy-three patients (mean 7.1 ± 4.1 years, 61.6% male) were assessed. The most commonly isolated bacteria were S. aureus. The largest proportion of staphylococcal isolates originated from tonsillar core (63%), followed by tonsillar surface (45.1%) and posterior pharynx in tonsillectomized children (18.2%, p = 0.007). Five (6.3%) isolates were identified as MRSA (mecA-positive). Up to 67.5% of the isolates synthesized penicillinases (blaZ-positive isolates), and 8.8% displayed MLSB resistance. The superantigenic toxin genes were detected in more than half of examined isolates (56.3%). spa types t091, t084, and t002, and clonal complexes (CCs) CC7, CC45, and CC30 turned out to be most common. Staphylococcus aureus associated with RT in children showed pathogenicity potential and considerable genetic diversity, and no clones were found to be specific for this condition although further studies are needed.


Assuntos
Farmacorresistência Bacteriana/genética , Variação Genética/genética , Staphylococcus aureus/genética , Tonsilite/microbiologia , Adolescente , Anti-Infecciosos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Tonsila Palatina/microbiologia , Prevalência , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Tonsilectomia/métodos , Tonsilite/tratamento farmacológico , Virulência/genética , Fatores de Virulência/genética
8.
BMC Oral Health ; 19(1): 275, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31806002

RESUMO

BACKGROUND: Microbial culture-based investigations of inflamed tonsil tissues have previously indicated enrichment of several microorganisms such as Streptococcus, Staphylococcus and Prevotella. These taxa were also largely reflected in DNA sequencing studies performed using tissue material. In comparison, less is known about the response of the overall oral cavity microbiota to acute tonsillitis despite their role in human health and evidence showing that their compositions are correlated with diseases such as oral cancers. In addition, the influence of subject-specific circumstances including consumption of prescription antibiotics and smoking habits on the microbiology of acute tonsillitis is unknown. METHODS: We collected oral rinse samples from 43 individuals admitted into hospital for acute tonsillitis and 165 non-disease volunteers recruited from the public, and compared their microbial community compositions using 16S rRNA gene sequencing. We assessed the impact of tonsillitis, whether subjects were prescribed antibiotics, the presence of oral abscesses and their smoking habits on community composition, and identified specific microbial taxa associated with tonsillitis and smoking. RESULTS: Oral rinse community composition was primarily associated with disease state (tonsillitis vs non-tonsillitis) although its effect was subtle, followed by smoking habit. Multiple Prevotella taxa were enriched in tonsillitis subjects compared to the non-tonsillitis cohort, whereas the non-tonsillitis cohort primarily showed associations with several Neisseria sequence variants. The presence of oral abscesses did not significantly influence community composition. Antibiotics were prescribed to a subset of individuals in the tonsillitis cohort but we did not observe differences in community composition associated with antibiotics consumption. In both tonsillitis and non-tonsillitis cohorts, smoking habit was associated with enrichment of several Fusobacterium variants. CONCLUSIONS: These findings show that the oral cavity microbial community is altered during acute tonsillitis, with a consistent enrichment of Prevotella during tonsillitis raising the possibility of targeted interventions. It also supports the possible link between smoking, Fusobacteria and oral cancers.


Assuntos
Bactérias/genética , Metagenoma/genética , Microbiota , Boca/microbiologia , RNA Ribossômico 16S/genética , Tonsilite/microbiologia , Bactérias/classificação , Bactérias/isolamento & purificação , Estudos de Casos e Controles , Estudos Transversais , Feminino , Genoma Bacteriano/genética , Humanos , Masculino , RNA Bacteriano/genética , Análise de Sequência de RNA , Inquéritos e Questionários , Tonsilite/diagnóstico
9.
Sci Rep ; 9(1): 20130, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882880

RESUMO

Streptococcus mutans is known to be a major causative agent of dental caries, and strains expressing the cell surface collagen-binding Cnm protein contribute to the development of several systemic diseases. A relationship between tonsillar immunity and glomerulonephritis has been recognized in IgA nephropathy (IgAN), and specific pathogens may have effects on tonsillar immunity (mucosal immunity). Here, we present findings showing a relationship between the presence of Cnm-positive S. mutans strains in the tonsils of IgAN patients and IgAN condition/pathogenesis. Analyses of tonsillar specimens obtained from patients with IgAN (n = 61) and chronic tonsillitis (controls; n = 40) showed that the Cnm protein-positive rate was significantly higher in IgAN patients. Among IgAN patients, the tonsillar Cnm-positive group (n = 15) had a significantly higher proportion of patients with high urinary protein (>1.5 g/gCr) and lower serum albumin level than the Cnm-negative group (n = 46). Additionally, Cnm protein and CD68, a common human macrophage marker, were shown to be merged in the tonsils of IgAN patients. These findings suggest that Cnm-positive S. mutans strains in the tonsils may be associated with severe IgAN.


Assuntos
Suscetibilidade a Doenças , Glomerulonefrite por IGA/etiologia , Tonsila Palatina/imunologia , Tonsila Palatina/microbiologia , Streptococcus mutans/imunologia , Adulto , Biomarcadores , Biópsia , Suscetibilidade a Doenças/imunologia , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Tonsila Palatina/patologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/microbiologia , Tonsilite/complicações , Tonsilite/imunologia , Tonsilite/microbiologia , Tonsilite/patologia
10.
Can J Physiol Pharmacol ; 97(10): 939-944, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31365280

RESUMO

To evaluate the clinical efficacy of azithromycin, cefaclor, and amoxicillin in treatment of pediatric tonsillitis, a total of 256 children with Group A ß-hemolytic streptococcus (GAS) tonsillitis were randomly divided into 3 groups. Only patients assessed with streptococcus-positive tonsillitis, considered to be compliant with treatment and complete clinical and microbiological evaluations at the end of therapy (day 14) and follow-up (day 30) were included in the efficacy analysis. Our study demonstrated that 96.4% of patients in the azithromycin group, 92.4% of patients in the cefaclor group, and 91.0% of patients in the amoxicillin group were recorded as clinical success at the end of therapy. Bacteriological eradication rates of the 3 groups at the end of therapy were 94.0%, 89.9%, and 88.5%, respectively. A pathogen recurrence rate was evaluated as 2.6%, 7.0%, and 5.9% at the follow-up. Treatment-stimulated adverse events occurred in 2.4% of patients in the azithromycin group, 11.3% in the cefaclor group, and 11.4% in the amoxicillin group. In summary, azithromycin showed an effective tendency for the treatment of pediatric tonsillitis with lower occurrence rate of adverse reactions, although there is no statistical significance for the clinical and bacteriological eradication efficacy between these 3 groups.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Cefaclor/administração & dosagem , Infecções Estreptocócicas/tratamento farmacológico , Tonsilite/tratamento farmacológico , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Cefaclor/efeitos adversos , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Humanos , Masculino , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/isolamento & purificação , Tonsilite/microbiologia , Resultado do Tratamento
11.
BMC Pediatr ; 19(1): 205, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226961

RESUMO

BACKGROUND: Culture tests have demonstrated that once-daily administration of amoxicillin may be effective in the treatment of group A streptococcal (GAS) pharyngitis. However, culture methods do not allow accurate assessments of bacterial load changes because of the suppressive effect of the antibiotic on bacterial growth. In this study, we used real-time PCR to compare the effectiveness of once-daily and multiple-daily amoxicillin treatment for pediatric patients with GAS pharyngitis. METHODS: The subjects were children (≧3 years of age) diagnosed with GAS pharyngitis. Amoxicillin was administered at a dose of 40-50 mg/kg/day, divided into one (QD), two (BID), or three (TID) daily doses, for 10 days. Throat swabs were collected before treatment (visit 1), 1 to 3 days after treatment (visit 2), and 9 to 11 days after treatment (visit 3), and GAS copies were quantified by real-time PCR. The main compared parameters were the rate of negative PCR results and the number of GAS determined by PCR in throat swabs between each regimen. RESULTS: Samples were collected from 34 patients (QD, 12; BID, 15; TID, 7) at visit 1, 32 patients (QD, 11; BID, 14; TID, 7) at visit 2, and 25 patients (QD, 7; BID, 11; TID, 7) at visit 3. The rates of negative PCR result for QD, BID, and TID regimens were 18.2, 0, and 14.3% at visit 2, and 85.7, 72.7, and 85.7% at visit 3, respectively. The median values of bacterial load for QD, BID, and TID groups at visit 1 were 1.4 × 106, 8.2 × 105, and 5.4 × 105 copies/µL. At visit 2, they comprised 3.8 × 103, 1.1 × 103, and 2.8 × 103 copies/µL, respectively, whereas at visit 3, GAS copies were mostly undetectable. There was no statistical difference in the negative results and median value of GAS copies between regimens at any stage. CONCLUSIONS: Our results obtained by a molecular biology approach indicated that the QD regimen was as effective in eradicating GAS infection as BID or TID. TRIAL REGISTRATION: UMIN000036083 / March 12, 2019.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Faringite/tratamento farmacológico , Faringite/microbiologia , Streptococcus pyogenes/efeitos dos fármacos , Doença Aguda , Amoxicilina/farmacologia , Antibacterianos/farmacologia , Criança , Pré-Escolar , Intervalos de Confiança , DNA Bacteriano/isolamento & purificação , Esquema de Medicação , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Estatísticas não Paramétricas , Streptococcus pyogenes/isolamento & purificação , Tonsilite/tratamento farmacológico , Tonsilite/microbiologia
13.
J Exp Med ; 216(7): 1615-1629, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31092533

RESUMO

Streptococcus pyogenes (Group A streptococcus; GAS) is a human pathogen causing diseases from uncomplicated tonsillitis to life-threatening invasive infections. GAS secretes EndoS, an endoglycosidase that specifically cleaves the conserved N-glycan on IgG antibodies. In vitro, removal of this glycan impairs IgG effector functions, but its relevance to GAS infection in vivo is unclear. Using targeted mass spectrometry, we characterized the effects of EndoS on host IgG glycosylation during the course of infections in humans. Substantial IgG glycan hydrolysis occurred at the site of infection and systemically in the severe cases. We demonstrated decreased resistance to phagocytic killing of GAS lacking EndoS in vitro and decreased virulence in a mouse model of invasive infection. This is the first described example of specific bacterial IgG glycan hydrolysis during infection and thereby verifies the hypothesis that EndoS modifies antibodies in vivo. This mechanisms of immune evasion could have implications for treatment of severe GAS infections and for future efforts at vaccine development.


Assuntos
Imunidade Adaptativa/imunologia , Proteínas de Bactérias/metabolismo , Glicosídeo Hidrolases/metabolismo , Imunoglobulina G/imunologia , Infecções Estreptocócicas/imunologia , Streptococcus pyogenes/imunologia , Animais , Modelos Animais de Doenças , Eletroforese em Gel de Poliacrilamida , Feminino , Glicosilação , Humanos , Hidrólise , Imunoglobulina G/metabolismo , Imunoglobulina G/farmacologia , Limite de Detecção , Espectrometria de Massas , Camundongos , Camundongos Endogâmicos C57BL , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/enzimologia , Tonsilite/imunologia , Tonsilite/microbiologia
14.
Braz J Infect Dis ; 23(1): 8-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30849330

RESUMO

INTRODUCTION: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. MATERIAL AND METHODS: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. RESULTS: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. CONCLUSIONS: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.


Assuntos
Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Tonsilite/microbiologia , Adolescente , Adulto , Antibacterianos/farmacologia , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Eletroforese em Gel de Campo Pulsado , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Staphylococcus aureus/efeitos dos fármacos , Tonsilectomia/métodos , Tonsilite/cirurgia , Adulto Jovem
15.
Eur Arch Otorhinolaryngol ; 276(3): 879-887, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30767047

RESUMO

PURPOSE: Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT. METHODS: Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up. RESULTS: We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment. CONCLUSIONS: We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.


Assuntos
Terapia Biológica/métodos , Probióticos/uso terapêutico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae , Streptococcus oralis , Streptococcus salivarius , Tonsilite/terapia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Sprays Orais , Faringite/microbiologia , Faringite/terapia , Probióticos/administração & dosagem , Recidiva , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Tonsilite/microbiologia
16.
Sci Transl Med ; 11(478)2019 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728285

RESUMO

"Strep throat" is highly prevalent among children, yet it is unknown why only some children develop recurrent tonsillitis (RT), a common indication for tonsillectomy. To gain insights into this classic childhood disease, we performed phenotypic, genotypic, and functional studies on pediatric group A Streptococcus (GAS) RT and non-RT tonsils from two independent cohorts. GAS RT tonsils had smaller germinal centers, with an underrepresentation of GAS-specific CD4+ germinal center T follicular helper (GC-TFH) cells. RT children exhibited reduced antibody responses to an important GAS virulence factor, streptococcal pyrogenic exotoxin A (SpeA). Risk and protective human leukocyte antigen (HLA) class II alleles for RT were identified. Lastly, SpeA induced granzyme B production in GC-TFH cells from RT tonsils with the capacity to kill B cells and the potential to hobble the germinal center response. These observations suggest that RT is a multifactorial disease and that contributors to RT susceptibility include HLA class II differences, aberrant SpeA-activated GC-TFH cells, and lower SpeA antibody titers.


Assuntos
Anticorpos Antibacterianos/imunologia , Streptococcus/fisiologia , Tonsilite/imunologia , Tonsilite/microbiologia , Adolescente , Alelos , Linfócitos B/imunologia , Diferenciação Celular , Criança , Suscetibilidade a Doenças , Feminino , Centro Germinativo/imunologia , Granzimas/metabolismo , Antígenos de Histocompatibilidade Classe II/metabolismo , Humanos , Imunoglobulina G/metabolismo , Masculino , Recidiva , Superantígenos/metabolismo , Linfócitos T Auxiliares-Indutores/imunologia
17.
Clin Exp Rheumatol ; 37(4): 546-551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30620277

RESUMO

OBJECTIVES: Group A streptococcal (GAS) tonsillitis is reported as an uncommon cause of acute non-rheumatic fever (non-RF) myocarditis. The aim of this research was to study the occurrence, diagnosis, management and prognosis of this condition. METHODS: We conducted a retrospective computerised search through medical records of patients admitted to our tertiary medical center between 1998-2016 with the diagnosis of either acute rheumatic fever or non-RF streptococcal myocarditis based on criteria we developed and review the relevant literature from 1973-2016. RESULTS: We identified 283 cases diagnosed with acute myocarditis. Eight patients with non-RF GAS-myocarditis were identified, 7 of whom were men. Average age was 28.5 (22-35) years, and average latency period between onset of sore throat and chest pain 4.8 (3-10) days. Most patients presented with ST-segment elevations on the ECG and 2 underwent coronary catheterisation with presumed diagnosis of myocardial infarction. Three patients had heart failure, as documented by echocardiogram. All patients were treated with antibiotics and 6 patients received non-steroidal anti-inflammatory drugs (NSAIDs). All patients recovered with no evidence of heart failure a few months after the initial infection. One patient had a recurrent episode. CONCLUSIONS: Non-RF GAS myocarditis typically affects healthy young males and represents about 3% of all hospitalised patients with myocarditis. These patients may be mistakenly diagnosed with an acute rheumatic fever or myocardial infarction. The prognosis in generally good following treatment with antibiotics and possibly NSAIDs.


Assuntos
Miocardite , Infecções Estreptocócicas , Tonsilite/complicações , Adulto , Eletrocardiografia , Feminino , Humanos , Masculino , Miocardite/etiologia , Estudos Retrospectivos , Febre Reumática , Infecções Estreptocócicas/complicações , Tonsilite/microbiologia
19.
Braz. j. infect. dis ; 23(1): 8-14, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1001504

RESUMO

ABSTRACT Introduction: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. Material and methods: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. Results: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. Conclusions: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/genética , Tonsilite/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Tonsilectomia/métodos , Tonsilite/cirurgia , Reação em Cadeia da Polimerase , Estudos Transversais , Eletroforese em Gel de Campo Pulsado , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Antibacterianos/farmacologia
20.
Med Clin North Am ; 102(6): 1109-1120, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30342612

RESUMO

Infections of the head and neck are common and appropriately managed by primary care providers in most cases. However, some infections are associated with significant morbidity and require urgent recognition and management by specialty services. These include deep neck space infections originating in the oral cavity, pharynx, and salivary glands, as well as complicated otologic and sinonasal infection. This article provides a review of these conditions, including the pathophysiology, presenting features, and initial management strategy.


Assuntos
Infecções Bacterianas/diagnóstico , Cabeça/microbiologia , Pescoço/microbiologia , Atenção Primária à Saúde/métodos , Humanos , Doenças Faríngeas/microbiologia , Infecções Respiratórias/microbiologia , Sinusite/microbiologia , Tonsilite/microbiologia
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