Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis

• DOI: 10.1371/journal.pone.0009452
• Publication Date: 2010-03-03T00:12:02Z
• Authors: Andreas E. Zautner; Merit Krause; Gerhard Stropahl; Silva Holtfreter; Hagen Frickmann; Claudia Maletzki; Bernd Kreikemeyer; Hans Wilhelm Pau; Andreas Podbielski
• Keywords: Peritonsillar Abscess

Background The two major indications for tonsillectomy are recurrent tonsillitis (RT) and peritonsillar abscess (PTA). Unlike PTAs, which primarily treated surgically, RT is often cured by only after a series of failed drug therapy attempts. Although the bacteriological background has been studied, reason lack success conservative therapeutic approaches not well understood. Methods In prospective study, tonsil specimens from 130 patients 124 PTA were examined presence extra- intracellular bacteria using antibiotic protection assays. Staphylococcus aureus isolates characterized pulsed-field gel electrophoresis (PFGE), spa-typing MSCRAMM-gene-PCR. Their ability biofilm formation was tested their cell invasiveness confirmed flow cytometric invasion assay (FACS), fluorescent in situ hybridization (FISH) immunohistochemistry. Findings S. predominant species (57.7%) patients, whereas Streptococcus pyogenes most prevalent (20.2%) patients. Three different assays (FACS, FISH, assay) showed that nearly all RT-associated strains located inside tonsillar cells. Correspondingly, results MSCRAMM-gene-PCRs 87% these invasive mere colonizers. Based upon PFGE analyses genomic DNA on spa-gene typing vast majority belonged to clonal lineages. Conclusions Our demonstrate residing common cause indicate uses this location survive effects antibiotics host immune response. A German translation Abstract provided as supplementary material (Abstract S1).