Bacterial adherence to the surface and isolated cell epithelium of the palatine tonsils

Bacterial adherence to mucosal epithelium in the upper airways has less significance than believed

BACKGROUND

Bacterial adherence to the upper airway epithelium is considered to be an important phenomenon in the pathogenesis of infections. However, the evidence for the hypothesis that bacterial adherence to mucosal epithelial cells has significance for pathogenesis of mucosal infections is based on studies using indirect techniques. We could find no biopsy studies with direct ocular observations of significant numbers of bacteria adhering to upper airway mucosal epithelial cells either in health or during disease.

RESULTS

We studied specimens from healthy and infected tonsillar epithelium and specimens from the soft palate epithelium obtained by surgery. The specimens were examined by TEM. In the vast majority of specimens, we found no bacteria adhering to the epithelial cells in the mucosal line regardless of whether the patient was infected or not. Bacteria adhering to shed epithelial cells were seen in higher numbers. Furthermore, as bacteria are small compared to epithelial cells, we calculated the risk of overlooking every adhered bacteria in a section if bacterial adherence was such a significant phenomenon as earlier suggested. We found this risk to be very small.

CONCLUSION

We conclude that bacterial adherence to mucosal surface epithelial cells is not a significant phenomenon, either in healthy mucosa in the upper airways or during infection. This is also in line with our earlier results, where we have shown that the site for the infectious process in pharyngotonsillitis is in the secretion on the tonsillar mucosal surface.

Bacterial adherence to pharyngeal cells: in vitro studies with alpha-haemolytic streptococci and Haemophilus influenzae

We examined the adherence to pharyngeal cells of alpha-haemolytic Streptococci (AHS) and Haemophilus influenzae, representing normal flora and otitis media (OM) pathogens, respectively. The bacteria were incubated with epithelial cells brushed from the tonsils, adenoid or tubal orifice of children and adults. Adherence varied among the clinical isolates of AHS and H. influenzae. AHS adhered better to epithelial cells from a child compared with those sampled from an adult. The bacteria adhered better to cells from the tubal orifice compared with those sampled from the adenoid. The selective attachment of AHS to certain cells but not to others could not be correlated to apoptotic/necrotic cells versus viable cells. Incubation of epithelial cells with an isolate of AHS with good inhibitory activity against OM pathogens showed almost no adherence of bacteria to the epithelial cells after 12 and 24 h of incubation. If, however, an isolate of AHS with weak inhibitory activity was incubated with the cells, the bacteria that were attached to the epithelial cells from the beginning showed overgrowth in the broth and increasing attachment to the cells after 12 and 24 h. Thus the inhibitory activity of AHS could also affect the adherence of potential pathogens to the mucosal surfaces. The adherence pattern may at least partially explain the difference in susceptibility to OM between children and adults.

Causes for massive bacterial colonization on mucosal membranes during infectious mononucleosis: implications for acute otitis media

OBJECTIVE

A common complication of virus-induced upper respiratory tract infections is acute otitis media caused by bacterial pathogens. Simultaneously, increased bacterial colonization in the nasopharynx occurs. Our intention in this study was to identify the causes of this increased colonization of bacteria by evaluating their coating with the antibacterial substances lysozyme, lactoferrin and immunoglobulins IgG, S-IgA and IgM and their ability to penetrate epithelial cells during infectious mononucleosis (IM) caused by Epstein-Barr virus.

METHODS

Cellular samples were collected from the oropharynx of 21 patients (16 males, five females; age range 10-21 years) with current IM. An immunocytochemical assay using gold-labelled antiserum to human lysozyme, lactoferrin, IgG, S-IgA and IgM followed by gold particle and epithelial cell tracing in the transmission electron microscope.

RESULTS

A significant reduction in bacterial coating with IgG (P<0.05) and S-IgA (P<0.01) was noted, whereas there was a significant increase in coating with lactoferrin (P<0.01) and IgM (P<0.01). No significant change in lysozyme coating of the bacteria was noted, compared with healthy controls. Bacterial penetration into epithelial cells was seen particularly in patients culture-positive for beta-haemolytic streptococci.

CONCLUSIONS

Reduced bacterial coating with IgG and S-IgA immunoglobulins, combined with bacterial penetration into epithelial cells, may exacerbate the bacterial colonization on oropharyngeal mucosal membranes observed during IM.

Where are the receptors for Streptococcus pyogenes located on the tonsillar surface epithelium?

Streptococcus pyogenes is the most frequent causative agent of acute pharyngotonsillitis (AT). The first events in the etiopathogenesis of an AT infection caused by these bacterial pathogens are their penetration through the mucus film covering the oropharyngeal mucosa, and their attachment to the surface epithelium. Adherence of S. pyogenes to tonsillar epithelial cells is a precondition for bacterial colonisation, for triggering off cell activation, internalising of bacteria into the epithelial cells and cytokine release from the epithelial cells with subsequent induction of an inflammatory reaction in underlying tissues. Scanning and transmission electron microscopic studies revealed that the surface epithelium of the human palatine tonsils consisted of a weakly keratinized, stratified squamous epithelium built up of pentangular cells where the apical cell surface formed an irregular pattern of microridges. The distance between two adjacent microridges was roughly one-third of the diameter of a S. pyogenes bacterium. By using gold-labelled antiserum to S. pyogenes, we showed that the target region for these pathogens on the epithelial cells during an on-going AT infection was located on the crests of the microridges where bacterial pili made adhesin-receptor contact with the tonsillar surface epithelium.

Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes

Bacterial and epithelial cell samples were obtained, within 24 h of onset of pharyngeal symptoms, from the palatine tonsils of nine patients (four female and five male; age range 10-40 years, median age 23) with acute tonsillitis, culture-positive for Streptococcus pyogenes. The specimens were examined using fluorescein isothiocyanate- (FITC) and gold-labelled antiserum to S. pyogenes and fluorescence, scanning electron and transmission electron microscopy. S. pyogenes could be identified both in the mucous layer covering the tonsils and attached to the surface epithelial cells. Long chains of coccus-shaped bacteria could be seen encroaching on the epithelial cell borders. S. pyogenes can apparently penetrate the mucous barrier, attach to the epithelial cells, spread from cell to cell and possibly penetrate into the outermost layer of the epithelial cells. These events in turn provoke cytokine production and/or complement activation, which induce inflammatory reaction in the tonsillar tissue.

Acute pharyngotonsillitis is an infection restricted to the crypt and surface secretion

A commonly accepted hypothesis is that acute pharyngotonsillitis is caused by bacteria which first adhere to the epithelial surface and then invade the tonsillar parenchyma; however, evidence directly supporting this hypothesis is not available. In previous studies on acute pharyngotonsillitis, we found that the secretion in crypts and at the surface was infected in acute pharyngotonsillitis while no bacteria were detected in the parenchyma. Based on these results, we have proposed a new hypothesis stating that the infection is restricted to the crypt and surface secretions in acute pharyngotonsillitis. To evaluate this hypothesis further, in the present study we examined tonsillar tissue and secretion from patients with acute pharyngotonsillitis, recurrent pharyngotonsillitis and healthy tonsils. Surface secretion was studied after sampling by an imprint technique followed by routine histological preparation. Tonsillar tissue was examined by fluorescence microscopy after staining with acridine orange and by transmission electron microscopy. There were high numbers of bacteria and moderate or extensive ongoing phagocytosis in the crypt and surface secretion from patients with acute pharyngotonsillitis. Bacteria, leucocytes and phagocytosis were also present, but to less extent in the secretion from patients with recurrent pharyngotonsillitis and to even less extent in the healthy controls. In none of all the investigated tonsils were bacteria present in the parenchyma. Bacterial adherence to the epithelial surface was only very rarely observed. This study supports the hypothesis that acute pharyngotonsillitis is an infection restricted to the crypt and surface secretion and that bacterial adherence is not of significant importance in the pathogenesis of acute pharyngotonsillitis.