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Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis

BACKGROUND: The two major indications for tonsillectomy are recurrent tonsillitis (RT) and peritonsillar abscess (PTA). Unlike PTAs, which are primarily treated surgically, RT is often cured by tonsillectomy only after a series of failed drug therapy attempts. Although the bacteriological background...

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Autores principales: Zautner, Andreas E., Krause, Merit, Stropahl, Gerhard, Holtfreter, Silva, Frickmann, Hagen, Maletzki, Claudia, Kreikemeyer, Bernd, Pau, Hans Wilhelm, Podbielski, Andreas
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830486/
https://www.ncbi.nlm.nih.gov/pubmed/20209109
http://dx.doi.org/10.1371/journal.pone.0009452
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author Zautner, Andreas E.
Krause, Merit
Stropahl, Gerhard
Holtfreter, Silva
Frickmann, Hagen
Maletzki, Claudia
Kreikemeyer, Bernd
Pau, Hans Wilhelm
Podbielski, Andreas
author_facet Zautner, Andreas E.
Krause, Merit
Stropahl, Gerhard
Holtfreter, Silva
Frickmann, Hagen
Maletzki, Claudia
Kreikemeyer, Bernd
Pau, Hans Wilhelm
Podbielski, Andreas
author_sort Zautner, Andreas E.
collection PubMed
description BACKGROUND: The two major indications for tonsillectomy are recurrent tonsillitis (RT) and peritonsillar abscess (PTA). Unlike PTAs, which are primarily treated surgically, RT is often cured by tonsillectomy only after a series of failed drug therapy attempts. Although the bacteriological background of RT has been studied, the reason for the lack of success of conservative therapeutic approaches is not well understood. METHODS: In a prospective study, tonsil specimens from 130 RT patients and 124 PTA patients were examined for the presence of extra- and intracellular bacteria using antibiotic protection assays. Staphylococcus aureus isolates from RT patients were characterized by pulsed-field gel electrophoresis (PFGE), spa-typing and MSCRAMM-gene-PCR. Their ability for biofilm formation was tested and their cell invasiveness was confirmed by a flow cytometric invasion assay (FACS), fluorescent in situ hybridization (FISH) and immunohistochemistry. FINDINGS: S. aureus was the predominant species (57.7%) in RT patients, whereas Streptococcus pyogenes was most prevalent (20.2%) in PTA patients. Three different assays (FACS, FISH, antibiotic protection assay) showed that nearly all RT-associated S. aureus strains were located inside tonsillar cells. Correspondingly, the results of the MSCRAMM-gene-PCRs confirmed that 87% of these S. aureus isolates were invasive strains and not mere colonizers. Based upon PFGE analyses of genomic DNA and on spa-gene typing the vast majority of the S. aureus isolates belonged to different clonal lineages. CONCLUSIONS: Our results demonstrate that intracellular residing S. aureus is the most common cause of RT and indicate that S. aureus uses this location to survive the effects of antibiotics and the host immune response. A German translation of the Abstract is provided as supplementary material (Abstract S1).
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spelling pubmed-28304862010-03-05 Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis Zautner, Andreas E. Krause, Merit Stropahl, Gerhard Holtfreter, Silva Frickmann, Hagen Maletzki, Claudia Kreikemeyer, Bernd Pau, Hans Wilhelm Podbielski, Andreas PLoS One Research Article BACKGROUND: The two major indications for tonsillectomy are recurrent tonsillitis (RT) and peritonsillar abscess (PTA). Unlike PTAs, which are primarily treated surgically, RT is often cured by tonsillectomy only after a series of failed drug therapy attempts. Although the bacteriological background of RT has been studied, the reason for the lack of success of conservative therapeutic approaches is not well understood. METHODS: In a prospective study, tonsil specimens from 130 RT patients and 124 PTA patients were examined for the presence of extra- and intracellular bacteria using antibiotic protection assays. Staphylococcus aureus isolates from RT patients were characterized by pulsed-field gel electrophoresis (PFGE), spa-typing and MSCRAMM-gene-PCR. Their ability for biofilm formation was tested and their cell invasiveness was confirmed by a flow cytometric invasion assay (FACS), fluorescent in situ hybridization (FISH) and immunohistochemistry. FINDINGS: S. aureus was the predominant species (57.7%) in RT patients, whereas Streptococcus pyogenes was most prevalent (20.2%) in PTA patients. Three different assays (FACS, FISH, antibiotic protection assay) showed that nearly all RT-associated S. aureus strains were located inside tonsillar cells. Correspondingly, the results of the MSCRAMM-gene-PCRs confirmed that 87% of these S. aureus isolates were invasive strains and not mere colonizers. Based upon PFGE analyses of genomic DNA and on spa-gene typing the vast majority of the S. aureus isolates belonged to different clonal lineages. CONCLUSIONS: Our results demonstrate that intracellular residing S. aureus is the most common cause of RT and indicate that S. aureus uses this location to survive the effects of antibiotics and the host immune response. A German translation of the Abstract is provided as supplementary material (Abstract S1). Public Library of Science 2010-03-01 /pmc/articles/PMC2830486/ /pubmed/20209109 http://dx.doi.org/10.1371/journal.pone.0009452 Text en Zautner et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Zautner, Andreas E.
Krause, Merit
Stropahl, Gerhard
Holtfreter, Silva
Frickmann, Hagen
Maletzki, Claudia
Kreikemeyer, Bernd
Pau, Hans Wilhelm
Podbielski, Andreas
Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title_full Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title_fullStr Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title_full_unstemmed Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title_short Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis
title_sort intracellular persisting staphylococcus aureus is the major pathogen in recurrent tonsillitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830486/
https://www.ncbi.nlm.nih.gov/pubmed/20209109
http://dx.doi.org/10.1371/journal.pone.0009452
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