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Immunoglobulin- and complement-coated bacteria in pus from peritonsillar abscesses

Published online by Cambridge University Press:  29 June 2007

Markus Lilja
Department of Otolaryngology, University of Tromsø, Tromsø, Norway
Simo Räisänen
Department of Clinical Laboratory, Central Hospital of Keski-Pohjanmaa, Kokkola, Finland.
Lars-Eric Stenfors*
Department of Otolaryngology, University of Tromsø, Tromsø, Norway
Address for correspondence: Lars-Eric Stenfors, M.D., Department of Otolaryngology, University of Tromsø, N-9038 Tromsø, Norway.


Fifty-five samples of pus were collected from 51 acute, non-perforated, two spontaneously ruptured and two recurrent peritonsillar abscesses (35 males and 18 females; median age 18 years) and analysed regarding (i) aerobic and anaerobic bacteria (standard culturing), (ii) morphology of bacteria and inflammatory cells (direct microscopy of acridine orange-stained material), and (iii) the percentage of bacteria coated with immunoglobulins IgG, secretory IgA (SIgA) andIgM and complement cleavage product C3b (immunofluorescence assay). Seventy-one per cent of the abscesses harboured a mixed bacterial flora of various aerobes and anaerobes. In none of the cases with a single bacterial species (27 per cent) could immunoglobulin- or complement-coated bacteria be found. In abscesses with a mixed flora, 18 per cent harboured IgG-coated, 15 per cent SIgA-coated, five per cent IgM-coated and five per cent C3b-coated bacteria, respectively. All pus samples contained inflammatory cells in abundance but they were mostly deformed and only occasionally could intracellular bacteria be recognized. Insufficient immunoglobulin-coating of bacteria might be an important aetiopathogenic factor in the development of a peritonsillar abscess. Bactericide in the abscesses is accomplished chiefly by protective mechanisms not dependent on antigen recognition by antibodies.

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