Lantto Ulla, Koivunen Petri, Tapiainen Terhi, Glumoff Virpi, Hirvikoski Pasi, Uhari Matti, Renko Marjo
Department of Otorhinolaryngology, Oulu University Hospital and Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
Department of Pediatrics, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland.
APMIS. 2015 Jun;123(6):523-9. doi: 10.1111/apm.12383. Epub 2015 Apr 23.
Periodic Fever, Aphtous stomatitis, Pharyngitis, and Adenitis (PFAPA) is a childhood febrile syndrome that is often cured by tonsillectomy (TE). We hypothesized that microbes present in the tonsils may act as a trigger for the activation of inflammasomes and investigated the microbiology of the tonsils in PFAPA patients and controls. We recruited 31 consecutive children who underwent TE due to PFAPA; 24 children who underwent TE due to other reasons served as controls. We cultured all the samples for bacteria, mycobacteria, yeasts, and viruses and used PCR for 15 viruses. Also biofilm formation and histologic findings were identified. The samples of the patients yielded Candida albicans more often than did the controls (16 vs 0%, p = 0.003). Staphylococcus aureus occurred in only 10% of the patients, but in 38% of the controls (p = 0.01). Varicella zoster and Herpes simplex viruses occurred less often in patients than in controls. Biofilm was present in 55% of PFAPA tonsils, but in only 24% of the controls (p = 0.03). The microbes found in the tonsils of PFAPA patients showed significant differences from those of controls. This may in part explain the efficacy of TE in PFAPA.
周期性发热、口疮性口炎、咽炎和腺炎（PFAPA）是一种儿童发热综合征，通常通过扁桃体切除术（TE）治愈。我们推测扁桃体中存在的微生物可能作为炎性小体激活的触发因素，并研究了PFAPA患者和对照组扁桃体的微生物学。我们招募了31名因PFAPA接受TE的连续儿童；24名因其他原因接受TE的儿童作为对照。我们对所有样本进行细菌、分枝杆菌、酵母菌和病毒培养，并对15种病毒进行聚合酶链反应（PCR）检测。同时还确定了生物膜形成和组织学结果。患者样本中白色念珠菌的检出率高于对照组（16%对0%，p = 0.003）。金黄色葡萄球菌仅在10%的患者中出现，但在38%的对照组中出现（p = 0.01）。水痘带状疱疹病毒和单纯疱疹病毒在患者中的出现频率低于对照组。55%的PFAPA扁桃体存在生物膜，而对照组仅为24%（p = 0.03）。PFAPA患者扁桃体中发现的微生物与对照组有显著差异。这可能部分解释了TE在PFAPA中的疗效。
