Effect of radiotherapy on the levels of secretory immunoglobulin A against indigenous and virulent streptococci.

It is well known that the frequency of upper respiratory infection is clinically increased after radiotherapy of the head and neck region. This study found higher antibacterial secretory immunoglobulin A (S-IgA) activity against three indigenous streptococci (Streptococcus mitis, S. salivarius, and S. sanguis I) and S. pneumoniae in patients who had undergone radiation therapy of the head and neck region than in control subjects. This showed no relation to the extent of the radiation field. Compared with before radiotherapy, the S-IgA titer against S. pneumoniae and its ratio to the activities against the indigenous streptococci were significantly higher in patients with fully irradiated major salivary glands. These results indicated that the radiotherapy promoted the antigen-specific S-IgA production of virulent streptococci in most patients with head and neck cancer, even more than 6 months after radiotherapy. The resulting altered balance in the S-IgA system of normal indigenous streptococci may also impair the ability to maintain the stable bacterial interference between normal indigenous and virulent streptococci in the oropharyngeal cavity.

Cytokine production by tonsillar lymphocytes stimulated with alpha-streptococci in patients with pustulosis palmaris et plantaris.

To clarify the cellular immune response to alpha-streptococci in tonsillar lymphocytes from patients with pustulosis palmaris et plantaris (PPP) we have investigated cytokine production of tonsillar lymphocytes from patients with PPP recurrent tonsillitis (RT). Interleukin (IL)-1 alpha, IL-2, IL-4, IL-5, IL-6, interferon (IFN)-gamma and tumor necrotizing factor (TNF)-alpha were measured. The stimulation index of IFN-gamma production was significantly higher in tonsillar lymphocytes from PPP than that from RT when cultured with alpha-streptococci (stimulation index: the ratio of cytokine level produced by tonsillar lymphocytes with bacterial antigens to that without antigens). The same results were seen in the case of TNF-alpha, but IL-4 and IL-5 were not detected in any supernatants. These data suggest that increased production of IFN-gamma and TNF-alpha in tonsillar lymphocytes may play a key role in this kind of immunologic abnormalities.

[Relationship between birch pollen allergy and oral and pharyngeal hypersensitivity to fruit].

We evaluated the relationship between birch pollen allergy and oral and pharyngeal hypersensitivities to certain fruits. 1. Of 171 birch pollen CAP positive (score > or = 2) patients, twenty two (13%) were revealed to be hypersensitive to apples, eleven (6%) to be hypersensitive to peaches, both rates being higher than those found in patients with other CAP positive reactions (orchard grass pollen CAP, mugwort pollen CAP or Dermatophagoides pteronyssius CAP positive). 2. Among the birch pollen CAP positive patients, the higher the CAP score for birch pollen, the higher the prevalences of hypersensitivity to apples and peaches were found to be. 3. Of 171 birch pollen CAP positive patients, six (3.5%) were revealed to be hypersensitive to kiwi fruit. Of 253 patients with other CAP positive reactions, three (1%) were revealed to be hypersensitive to kiwi fruit.

[Superoxide production by neutrophils in patients with recurrent tonsillitis].

Superoxide anion (O2-) production by peripheral blood polymorphonuclear leukocytes (PMNs) stimulated with phorbol myristate acetate (PMA) was measured by the cytochrome C method in 57 patients with recurrent tonsillitis. There was no significant correlation between superoxide production and episodes of acute tonsillitis, serum C-reactive protein levels, or peripheral white blood cell count. However, the superoxide production by PMNs was inversely correlated with serum anti-streptolysin-O titers (r = -.38, p = .008). Furthermore, the mean +/- SD superoxide levels produced by PMNs from patients with high serum ASO titers (> 71 U/ml), 69.58 +/- 30.56 nM/10(6) cells, was significantly lower than that of patients with low serum ASO titers (< 71 U/ml), 89.83 +/- 38.90 nM/10(6) cells (p = 0.037), and that of healthy adult controls, 102.27 +/- 44.67 nM/10(6) cells (p = 0.012). In addition, the effect of Streptococcus pyogenes on superoxide production by PMNs was studied in vitro. Superoxide production by PMNs preincubated with 600 micrograms/ml culture supernatant of Streptococcus pyogenes T4 (not detected) and T12 (34.82 +/- 31.40 nM/10(6) cells) was significantly lower than that of PMNs preincubated with culture medium (136.09 +/- 70.41 nM/10(6) cells; p < 0.05, each). Inhibition of superoxide production by PMNs by preincubation with culture supernatant of Streptococcus was increased by the protein in the culture supernatant in a concentration-dependent manner. These findings suggest that frequent and/or persistent streptococcal infections may reduce the superoxide production by PMNs, leading to recurrent episodes of tonsillitis.

[Tonsillectomy and osteoarthritic disease].

We investigated the clinical outcome of tonsillectomy in 89 cases out of 100 cases of sternocostoclavicular hyperosteosis (SCCH) and 18 cases of rheumatoid arthritis (RA) who went through the operation more than 3 months before in our hospital between April 1984 and May 1993. The effect of tonsillectomy was associated with a decrease in the degree of pain. The symptom improvement was defined as a degree of pain less than 50% of the pre-operative level. The rates of improvement were 80.9% (72/89) in SCCH and 66.7% (12/18) in RA, whole 79% of SCCH patients had pustulosis palmaris et plantaris, a known focal infection of the tonsil. Eight of nine (88.9%) patients and eleven of 13 (84.6%) patients who were positive for the tonsillar provocation test and the annulation test, respectively, showed improved SCCH postoperatively. These results suggest that focal infection of the tonsil may be one of the etiologies of SCCH and RA.

[Efficacy of tonsillectomy for improving skin lesions of Pustulosis palmaris et plantaris--evaluation of 289 cases at the Department of Otolaryngology of Sapporo Medical University].

In recent years, Pustulosis palmaris et plantaris (PPP) has been described as one of the representative second lesions of focal tonsillitis in Japan. We selected 289 cases of PPP, treated with bilateral tonsillectomy at our department over the past 12 years for this clinical evaluation. In 211 of those 289 tonsillectomy cases, follow-up was done for more than 3 months after operation. Prior to tonsillectomy, 196 cases suffered from PPP only, 90 cases had the complication of osteo-arthral lesions such as sterno-costa-clavicular hyperosteosis (SCCH), rheumatoid arthritis, and soon, whereas only 3 cases showed simultaneous lesions of Psoriasis vulgaris. The efficacy of tonsillectomy for improving the skin lesions was classified into 6 grades, mainly based upon individual evaluation by each patient as follows; disappeared, remarkably improved, improved, slightly improved, unchanged, and worsened. According to our 211 cases, post tonsillectomy improvement of skin lesions was very obvious, with disappearance occurring in 54.3% of cases and remarkable improvement in 21.4%. Age of onset and the duration from onset to tonsillectomy showed no association with effectiveness. However, the shorter the duration from onset to tonsillectomy, the fewer days were required for improvement of the skin lesions. The rate of improvement of PPP rose in conjunction with the number of days after tonsillectomy. We conclude that it requires 12 months, at minimum, to determine the efficacy of tonsillectomy as a treatment for PPP.

Role of serum antibodies to streptococci in patients with IgA nephropathy.

Serum antibodies to whole cells of streptococci and serum immune complexes were investigated in patients with IgA nephropathy accompanied by tonsillitis and in healthy adult controls by enzyme-linked immunosorbent assay (ELISA). Serum IgA levels to Streptococcus salivarius, S. sanguis I and S. pneumoniae were higher in patients with IgA nephropathy than in healthy controls. The levels of IgG to S. pyogenes T12, S. gordonii and S. sanguis II in patients with IgA nephropathy were also higher than in healthy controls. Serum immune complexes of IgG and IgA were higher in patients with IgA nephropathy than in healthy controls. Serum levels of IgA to some strains of streptococci tended to correlate with the level of IgA immune complex in both patients and healthy controls. These results suggest that antibodies to some strains of streptococci play a role in the pathogenesis of IgA nephropathy.

[Investigation of the immune response in tonsillar lymphocytes against streptococci in patients with pustulosis palmaris et plantaris].

The purpose of this study was to clarify the etiological role of immune responses in tonsillar lymphocytes of the patients with pustulosis palmaris et plantaris (PPP). In order to determine their immune response to S. pyogenes T4, S. pyogenes T12, S mitis, S. salivarius, S. sanguis I, S. sanguis II and S. pneumoniae, tonsillar lymphocytes from patients with PPP, CT, and sleep apnea syndrome (control) were cultured with formalinized streptococcal cellular antigens. Blastoid transformation was investigated by [3H] -thymidine uptake, while antistreptococcal antibody production were measured by an enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. Tonsillar lymphocytes from PPP patients underwent blastoid transformation and accelerated the production of immunoglobulin G following the addition of S. sanguis I, S. sanguis II S. mitis, S. pyogenes T4, and S. pyogenes T12, while those form CT patients and controls did so only with S. pyogenes T4 and S. pyogenes T12. 2. The spontaneous production of specific IgG against various streptococci, including S. sanguis I, S. sanguis II and S. mitis by tonsillar lymphocytes from patients with PPP was already higher than that from CT patients and controls. The specific IgM production was also increased above that in PPP patients without any antigens. 3. S. sanguis I, S. sanguis II and S. salivarius antigens stimulated antigen-specific IgM production in tonsillar lymphocytes from PPP patients. 4. The levels of specific IgG production against S. sanguis I and S. sanguis II by tonsillar lymphocytes from PPP patients showed a relationship with the serum levels of the PPP patients. These results suggested that the sensitization of alpha-streptococci, especially S. sanguis, in the tonsillar lacunae may lead to the specific production of anti-S. sanguis antibodies in patients with PPP, and these may be involved in the pathogenesis of PPP.

[Investigation of the bacterial flora in the tonsillar lacunae and serum levels of streptococcal antigen-specific antibodies in patients with pustulosis palmaris et plantaris].

The purpose of this study was to clarify the relationship between bacterial flora in tonsillar lacunae and antistreptococcal antibody in sera of the patients with pustulosis palmaris et plantaris (PPP). Since the pustules develops or worsens after tonsillitis in many patients with PPP, a pathogenic role of tonsillar bacteria is suggested, but no significant association has been proven so far. In this study, the aerobes in the tonsillar lacunae were identified and quantitated in 15 adult patients with PPP and 9 adult patients with chronic tonsillitis (CT). In addition, serum streptococcal antigen-specific antibody levels in 40 adult patients with PPP, 18 adult patients with chronic tonsillitis, and 11 healthy volunteers (controls) were examined by enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. A total of 53 strains (17 species) of aerobes were isolated and identified from the tonsillar lacunae in patients with PPP, while 35 strains (12 species) of aerobes were found in the patients with CT. 2. S. salivarius and S. pneumoniae were the dominant aerobes isolated from patients with PPP or CT. 3. Although the rates of isolation for Staphylococcus and S. pneumoniae were lower in PPP patients than in CT patients, the rate for S. sanguis I was higher in PPP patients than in CT patients. 4. The percentage of alpha, gamma-streptococci to total aerobes in PPP patients was higher than in CT patients. 5. The IgG antibody titers against S. sanguis and S. mitis, and the IgM antibody titers against all streptococci investigated in PPP patients were higher than those in both CT patients and controls. 6. Moreover, both the IgG antibody titers against S. pyogenes T4 and S. sanguis I and the IgM antibody titers against S. sanguis I and S. sanguis II of the patients in which PPP markedly improved after tonsillectomy were higher than those in which PPP showed less improvement postoperatively.