INITIAL EVENTS IN THE PATHOGENESIS OF ACUTE TONSILLITIS CAUSED BY STREPTOCOCCUS-PYOGENES

Bacterial and epithelial cell samples were obtained, within 24 h of on set of pharyngeal symptoms, from the palatine tonsils of nine patients (four female and five male; age range 10-40 years, median age 23) wit h acute tonsillitis, culture-positive for Streptococcus pyogenes. The specimens were examined using fluorescein isothiocyanate- (FITC) and g old-labelled antiserum to S. pyogenes and fluorescence, scanning elect ron and transmission electron microscopy. S. pyogenes could be identif ied both in the mucous layer covering the tonsils and attached to the surface epithelial cells. Long chains of coccus-shaped bacteria could be seen encroaching on the epithelial cell borders. S. pyogenes can ap parently penetrate the mucous barrier, attach to the epithelial cells, spread from cell to cell and possibly penetrate into the outermost la yer of the epithelial cells. These events in turn provoke cytokine pro duction and/or complement activation, which induce inflammatory reacti on in the tonsillar tissue. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.