Abstract
Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis and a prevalent cause for acute admission to otorhinolaryngology departments. Our aim was to examine the role of viruses in the pathogenesis of PTA, as this has not previously been considered. We examined both palatine tonsils from 25 patients undergoing acute tonsillectomy for PTA, using PCR-based assays for herpes simplex virus-1 and -2 (HSV-1 and -2), adenovirus, Epstein-Barr virus (EBV), influenza A and B, and respiratory syncytial virus (RSV) A and B. We similarly examined tonsils from 55 patients undergoing elective tonsillectomy due to chronic tonsillar conditions. These patients served as a control group, as they did not have a clinically apparent infection at the time of surgery. Only HSV-1 (5/80, 6.3%), adenovirus (11/80, 13.8%), and EBV (71/80, 88.8%) were detected in our study population. There was no statistically significant difference in the frequency of these viruses across different diagnostic groups. Quantification of EBV load demonstrated no differences between the PTA and the elective tonsillectomy group, nor between the abscessed and non-abscessed tonsil of PTA patients. In summary, our data do not support a significant role for the examined viruses in the pathogenesis of PTA.
Similar content being viewed by others
References
Rusan M, Klug TE, Ovesen T (2009) An overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. Eur J Clin Microbiol Infect Dis 28(3):243–251. doi:10.1007/s10096-008-0619-y
Klug TE, Henriksen JJ, Fuursted K, Ovesen T (2011) Significant pathogens in peritonsillar abscesses. Eur J Clin Microbiol Infect Dis 30(5):619–627. doi:10.1007/s10096-010-1130-9
Ryan C, Dutta C, Simo R (2004) Role of screening for infectious mononucleosis in patients admitted with isolated, unilateral peritonsillar abscess. J Laryngol Otol 118(5):362–365. doi:10.1258/002221504323086552
Arkkila E, Sipila J, Laurikainen E, Suonpaa J (1998) Peritonsillar abscess associated with infectious mononucleosis. ORL J Otorhinolaryngol Relat Spec 60(3):159–163
Hanna BC, McMullan R, Gallagher G, Hedderwick S (2006) The epidemiology of peritonsillar abscess disease in Northern Ireland. J Infect 52(4):247–253. doi:10.1016/j.jinf.2005.07.002
Stenfors LE, Bye HM, Raisanen S (2003) Noticeable differences in bacterial defence on tonsillar surfaces between bacteria-induced and virus-induced acute tonsillitis. Int J Pediatr Otorhinolaryngol 67(10):1075–1082
Stenfors LE, Bye HM, Raisanen S (2001) Bacterial coating with immunoglobulins on the palatine tonsils during infectious mononucleosis: immunocytochemical study with gold markers. J Laryngol Otol 115(2):101–105
Stenfors LE, Bye HM, Raisanen S (2002) Causes for massive bacterial colonization on mucosal membranes during infectious mononucleosis: implications for acute otitis media. Int J Pediatr Otorhinolaryngol 65(3):233–240
Patel J, Faden H, Sharma S, Ogra PL (1992) Effect of respiratory syncytial virus on adherence, colonization and immunity of non-typable Haemophilus influenzae: implications for otitis media. Int J Pediatr Otorhinolaryngol 23(1):15–23
Bakaletz LO (1995) Viral potentiation of bacterial superinfection of the respiratory tract. Trends in Microbiology 3(3):110–114
Wald ER (2011) Acute otitis media and acute bacterial sinusitis. Clin Infect Dis 52(Suppl 4):S277–S283. doi:10.1093/cid/cir042
Rothberg MB, Haessler SD, Brown RB (2008) Complications of viral influenza. Am J Med 121(4):258–264. doi:10.1016/j.amjmed.2007.10.040
van Elden LJ, Nijhuis M, Schipper P, Schuurman R, van Loon AM (2001) Simultaneous detection of influenza viruses A and B using real-time quantitative PCR. J Clin Microbiol 39(1):196–200. doi:10.1128/JCM.39.1.196-200.2001
Pevenstein SR, Williams RK, McChesney D, Mont EK, Smialek JE, Straus SE (1999) Quantitation of latent varicella-zoster virus and herpes simplex virus genomes in human trigeminal ganglia. J Virol 73(12):10514–10518
Ebner K, Suda M, Watzinger F, Lion T (2005) Molecular detection and quantitative analysis of the entire spectrum of human adenoviruses by a two-reaction real-time PCR assay. J Clin Microbiol 43(7):3049–3053. doi:10.1128/JCM.43.7.3049-3053.2005
Hu A, Colella M, Tam JS, Rappaport R, Cheng SM (2003) Simultaneous detection, subgrouping, and quantitation of respiratory syncytial virus A and B by real-time PCR. J Clin Microbiol 41(1):149–154
Niesters HG, van Esser J, Fries E, Wolthers KC, Cornelissen J, Osterhaus AD (2000) Development of a real-time quantitative assay for detection of Epstein-Barr virus. J Clin Microbiol 38(2):712–715
Yoda K, Sata T, Kurata T, Aramaki H (2000) Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection. Arch Otolaryngol Head Neck Surg 126(2):185–193
Wat PJ, Strickler JG, Myers JL, Nordstrom MR (1994) Herpes simplex infection causing acute necrotizing tonsillitis. Mayo Clin Proc 69(3):269–271
Grady D, McClung JE, Veltri RW, Sprinkle PM, Veach JS (1982) Association of Epstein-Barr virus with acute exudative tonsillitis. Otolaryngol Head Neck Surg 90(1):11–15
Kohdera U, Kino M, Ito M (2006) Detection of adenovirus DNA in throat swabs and blood by SYBR green real-time PCR assay in patients with adenovirus-associated tonsillitis. Jpn J Infect Dis 59(6):394–396
Piacentini GL, Peroni DG, Blasi F, Pescollderungg L, Goller P, Gallmetzer L, Drago L, Bodini A, Boner AL (2010) Atypical bacteria in adenoids and tonsils of children requiring adenotonsillectomy. Acta Oto-Laryngologica 130(5):620–625. doi:10.3109/00016480903359921
Drago L, Esposito S, De Vecchi E, Marchisio P, Blasi F, Baggi E, Capaccio P, Pignataro L (2008) Detection of respiratory viruses and atypical bacteria in children's tonsils and adenoids. J Clin Microbiol 46(1):369–370. doi:10.1128/JCM.01819-07
Hug M, Dorner M, Frohlich FZ, Gysin C, Neuhaus D, Nadal D, Berger C (2010) Pediatric Epstein-Barr virus carriers with or without tonsillar enlargement may substantially contribute to spreading of the virus. J Infect Dis 202(8):1192–1199. doi:10.1086/656335
Sahin F, Gerceker D, Karasartova D, Ozsan TM (2007) Detection of herpes simplex virus type 1 in addition to Epstein-Bar virus in tonsils using a new multiplex polymerase chain reaction assay. Diagn Microbiol Infect Dis 57(1):47–51. doi:10.1016/j.diagmicrobio.2006.09.013
Vassallo J, Camargo LA, Chagas CA, Pinto GA, Endo LH (2005) Search for Herpesvirus 1 and 2 by in situ hybridization in tonsils and adenoids. Int J Pediatr Otorhinolaryngol 69(3):345–349. doi:10.1016/j.ijporl.2004.10.006
Hudnall SD, Ge Y, Wei L, Yang NP, Wang HQ, Chen T (2005) Distribution and phenotype of Epstein-Barr virus-infected cells in human pharyngeal tonsils. Mod Pathol 18(4):519–527. doi:10.1038/modpathol.3800369
Ikeda T, Kobayashi R, Horiuchi M, Nagata Y, Hasegawa M, Mizuno F, Hirai K (2000) Detection of lymphocytes productively infected with Epstein-Barr virus in non-neoplastic tonsils. J Gen Virol 81(Pt 5):1211–1216
Berger C, Hug M, Gysin C, Molinari L, Frei M, Bossart W, Nadal D (2007) Distribution patterns of beta- and gamma-herpesviruses within Waldeyer's ring organs. J Med Virol 79(8):1147–1152. doi:10.1002/jmv.20899
Pai PC, Tsang NM, Tseng CK, Hao SP, Kuo TT, Wei KC, Hsueh C, Chuang CC (2004) Prevalence of LMP-1 gene in tonsils and non-neoplastic nasopharynxes by nest-polymerase chain reaction in Taiwan. Head Neck 26(7):619–624. doi:10.1002/hed.20057
Dias EP, Rocha ML, Carvalho MO, Amorim LM (2009) Detection of Epstein-Barr virus in recurrent tonsillitis. Braz J Otorhinolaryngol 75(1):30–34
Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE Jr, Vassallo J (2001) Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 58(1):9–15
Hesse J, Ibsen KK, Krabbe S, Uldall P (1983) Prevalence of antibodies to Epstein-Barr virus (EBV) in childhood and adolescence in Denmark. Scand J Infect Dis 15(4):335–338
Kvestad E, Kvaerner KJ, Roysamb E, Tambs K, Harris JR, Magnus P (2005) Heritability of recurrent tonsillitis. Arch Otolaryngol Head Neck Surg 131(5):383–387. doi:10.1001/archotol.131.5.383
Marom T, Cinamon U, Itskoviz D, Roth Y (2010) Changing trends of peritonsillar abscess. Am J Otolaryngol 31(3):162–167. doi:10.1016/j.amjoto.2008.12.003
Acknowledgements
The authors wish to thank Marianne Lund, Kurt Handberg, and Søren E. Degn for technical guidance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rusan, M., Klug, T.E., Henriksen, J.J. et al. The role of viruses in the pathogenesis of peritonsillar abscess. Eur J Clin Microbiol Infect Dis 31, 2335–2343 (2012). https://doi.org/10.1007/s10096-012-1573-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-012-1573-2