Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage

Blinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from children undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.Immunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had tonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS pharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was localized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of cocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms from in vivo animal models.Our study revealed the presence of GAS within the tonsillar reticulated crypts of approximately one-third of children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis at the Wake Forest School of Medicine.The tissue collected was normally discarded tissue and no patient identifiers were collected. Thus, no subjects were formally enrolled.Group A Streptococcus (GAS) is a β-hemolytic, Gram-positive human pathogen capable of causing a wide variety of human disease. GAS is one of the predominant causes of acute bacterial tonsillopharyngitis [1-6]. Tonsillopharyngitis is an acute infection of the palatine tonsils and pharynx often presenting symptomatically with a sore throat, fever and cervical lymphadenopathy [7]. Patients diagnosed with GAS tonsillopharyngitis are prescribed antibiotic therapy to avoid the potential development of post-infectious sequelae such as acute rheumatic fever and acute rheumatic heart disease [1-6].Prevention of rheumatic fever with antibacterial therapy can be life-saving, so it is important to identify patients with GAS pharyngitis. Because accurate clinical differentiation between viral and GAS pharyngitis is not possib