title: Microbes of the tonsils in PFAPA (Periodic Fever, Aphtous stomatitis, Pharyngitis and Adenitis) syndrome - a possible trigger of febrile episodes.
abstract: 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.
authors.affiliation: Department of Otorhinolaryngology, Oulu University Hospital and Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Lantto
authors.affiliation: Department of Otorhinolaryngology, Oulu University Hospital and Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Koivunen
authors.affiliation: Department of Pediatrics, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Tapiainen
authors.affiliation: Institute of Diagnostics, Department of Medical Microbiology and Immunology, University of Oulu, Oulu, Finland.
authors.forename: Virpi
authors.initials: V
authors.lastname: Glumoff
authors.affiliation: Department of Pathology, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Hirvikoski
authors.affiliation: Department of Pediatrics, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Uhari
authors.affiliation: Department of Pediatrics, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Renko
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000494:pharmacology; D018441:Biofilms / Q000187:drug effects; D002176:Candida albicans / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000382:microbiology* / Q000601:surgery; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008199:Lymphadenitis / Q000382:microbiology* / Q000601:surgery; D008297:Male; D008855:Microscopy, Electron, Scanning; D014066:Palatine Tonsil / Q000382:microbiology* / Q000601:surgery; D010612:Pharyngitis / Q000382:microbiology* / Q000601:surgery; D011446:Prospective Studies; D018139:Simplexvirus / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013280:Stomatitis / Q000382:microbiology* / Q000601:surgery; D013577:Syndrome; D014068:Tonsillectomy
chemical_list: D000890:Anti-Infective Agents
keywords: Recurrent fever; childhood; colonization; inflammasome; tonsillectomy