QUALITATIVE AND QUANTITATIVE IMMUNOGLOBULIN PRODUCTION BY SPECIFIC BACTERIA IN CHRONIC TONSILLAR DISEASE

Tonsillar tissue lymphocyte (TTL) function as measured by immunoglobul in production was assessed in vitro in 60 tonsils, 51 diseased and 9 n ormal controls. The diseased specimens were from children (aged 3 to 1 0 years) clinically classified as having recurrent tonsillitis (RT), i diopathic tonsillar hyperplasia (ITH), or recurrent tonsillitis with h yperplasia (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 b acterium (DB) grown from that particular tonsillar core. The phytomito gen, leukoagglutinin (LA), was used as a nonspecific activator. Qualit ative immunoglobulin production was assessed for the immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) classes. Imm unoglobulin-specific production was quantified at the basal level, and at 2, 4, and 6 days following stimulation. Stimulation with HIB produ ced the greatest amount of IgG and IgM in TTLs from control tonsils. T he DB was a relatively weak stimulator of normal (control) TTLs, yet p roduced relatively brisk IgG responses in the RT and ITH categories. I t 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 hy pofunction along with structural changes associated with hyperplasia m ay be central to the etiology of chronic tonsillar disease. The tonsil lar immunologic response in disease and health is discussed.