Certain genetic characteristics increase the risk of developing chronic sore throat. A ScienceTranslationalMedicine study associates recurring local infections with immunodeficiency.
What function do tonsils perform and why do they play an important role in the development of infection?
Tonsils form in the mouth and throat the first line of defense against pathogens. Bacteria, viruses or fungi linger in the tonsils, where they are destroyed by local and systemic immunity.
Most people have no noticeable inflammation. There are a number of children who have a sore throat with infections that ultimately requires tonsillectomy.
The main causative agents of infectious diseases of the throat are Lansfield group A streptococci.
A team led by the La Jolla Institute of Immunology in San Diego examined tissue samples from 146 children aged 5 to 18 years. All children had tonsils removed due to infections or sleep apnea. In the second group, children previously suffered sore throat less often.
The first differences were visible by immunohistochemical examination of the tonsils. Tonsils, which are nothing more than specialized lymph nodes, had smaller germinal centers.
Germ centers are the place where T helper cells and B cells exchange information. Simply put, T cells inform B cells of new pathogens. B cells then form antibodies that are capable of fighting pathogens in different places.
Children suffering from recurring infections have local immunodeficiency.
Researchers found fewer supporting T cells and B cells in the germinal centers. According to scientists, tonsils, which should protect against infections, become a breeding ground for bacteria in sick children.
Antibody concentration also decreases
Antibody formation is also significantly reduced in children at risk. The immune response to SpeA was weakened in children with recurring bouts of sore throat. SpeA is a pyrogenic streptococcal toxin - a relatively new component of bacteria.
SpeA increases the chances of survival in the fight against the immune system, which is why SpeA-positive bacteria has spread throughout the world in recent decades. SpeA appears to "interfere" with the immune response in the tonsils. T helper cells turn into killer cells that attack B cells instead of supporting them against bacteria.
The immune response to SpeA depends on the genes of the immune system. Researchers found that susceptibility to recurring infections was found in children with certain genetic characteristics. This may explain the possibility of a "hereditary" transmission of immunity to bacteria.
The lack of an immune response to SpeA is a key problem with persistent sore throat. According to scientists, a vaccine that “educates” the immune system in advance and builds a protective immune response is most likely to protect children from frequent inflammation. It will also help avoid unnecessary tonsil removal.
When should tonsils be removed?
Tonsil removal is one of the 20 most common inpatient cases in Russia. Every child suffers from numerous infections of the throat and tonsils during the first years of life.
Acute sore throat in 74-92% of cases is caused by viruses. However, the doctor cannot diagnose viral diseases by examining the throat. In addition to swelling of the tonsils, the specialist also evaluates a fever or cough.
With regard to surgery, it is recommended to follow a “restrained strategy”: not every sore throat requires surgical intervention. The basis for the decision is the number of episodes of angina in the last twelve months.
Only in especially severe cases should the operation be performed quickly. In moderate and mild forms, it makes sense to wait six months. If further inflammation occurs during this waiting time, almond removal is the best preventative method.
