Swidsinski A, Göktas O, Bessler C, Loening-Baucke V, Hale L P, Andree H, Weizenegger M, Hölzl M, Scherer H, Lochs H
Medizinische Klinik, Charité Humboldt Universität, CCM, Molekular-genetisches Labor für polymikrobielle Infektionen und bakterielle Biofilme, Berlin, Germany.
J Clin Pathol. 2007 Mar;60(3):253-60. doi: 10.1136/jcp.2006.037309. Epub 2006 May 12.
The reasons for recurrent adenotonsillitis are poorly understood.
The in situ composition of microbiota of nasal (5 children, 25 adults) and of hypertrophied adenoid and tonsillar tissue (50 children, 20 adults) was investigated using a broad range of fluorescent oligonucleotide probes targeted to bacterial rRNA. None of the patients had clinical signs of infection at the time of surgery.
Multiple foci of ongoing purulent infections were found within hypertrophied adenoid and tonsillar tissue in 83% of patients, including islands and lawns of bacteria adherent to the epithelium, with concomitant marked inflammatory response, fissures filled with bacteria and pus, and diffuse infiltration of the tonsils by bacteria, microabscesses, and macrophages containing phagocytosed microorganisms. Haemophilusinfluenzae mainly diffusely infiltrated the tissue, Streptococcus and Bacteroides were typically found in fissures, and Fusobacteria,Pseudomonas and Burkholderia were exclusively located within adherent bacterial layers and infiltrates. The microbiota were always polymicrobial.
Purulent processes persist during asymptomatic periods of adenotonsillitis. Most bacteria involved in this process are covered by a thick inflammatory infiltrate, are deeply invading, or are located within macrophages. The distribution of the bacteria within tonsils may be responsible for the failure of antibiotic treatment.
复发性腺扁桃体炎的病因尚不清楚。
使用多种靶向细菌rRNA的荧光寡核苷酸探针，研究了鼻腔（5名儿童，25名成人）以及肥大的腺样体和扁桃体组织（50名儿童，20名成人）的微生物群原位组成。手术时所有患者均无感染的临床症状。
83%的患者肥大的腺样体和扁桃体组织内发现多个正在进行的化脓性感染灶，包括附着在上皮上的细菌岛和菌苔，伴有明显的炎症反应、充满细菌和脓液的裂隙，以及细菌、微脓肿和含有吞噬微生物的巨噬细胞对扁桃体的弥漫性浸润。流感嗜血杆菌主要弥漫性浸润组织，链球菌和拟杆菌通常见于裂隙中，梭杆菌、假单胞菌和伯克霍尔德菌仅存在于附着的细菌层和浸润灶内。微生物群总是多菌的。
在腺扁桃体炎的无症状期，化脓性过程持续存在。参与此过程的大多数细菌被厚厚的炎症浸润所覆盖，侵入较深，或位于巨噬细胞内。扁桃体内细菌的分布可能是抗生素治疗失败的原因。
