Background: Group A Streptococcus (GAS) causes acute tonsillopharyngitis in children, and approximately 20% of\r\nthis population are chronic carriers of GAS. Antibacterial therapy has previously been shown to be insufficient at\r\nclearing GAS carriage. Bacterial biofilms are a surface-attached bacterial community that is encased in a matrix of\r\nextracellular polymeric substances. Biofilms have been shown to provide a protective niche against the immune\r\nresponse and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. The\r\nobjective of this study was to test the hypothesis that GAS is present within tonsil tissue at the time of\r\ntonsillectomy.\r\nMethods: Blinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from\r\nchildren undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.\r\nResults: Immunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had\r\ntonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS\r\npharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was\r\nlocalized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of\r\ncocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms\r\nfrom in vivo animal models.\r\nConclusion: Our study revealed the presence of GAS within the tonsillar reticulated crypts of approximately onethird\r\nof children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS\r\ntonsillopharyngitis at the Wake Forest School of Medicine.
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