Why some children with strep throat suffer from repeated tonsil infections

A new study reveals why certain children are prone to repeated tonsil infections during bouts with strep throat, answering a question that has long baffled scientists. Strep throat, which causes approximately 600 million cases a year, occurs when group A Streptococcus (GAS) bacteria infect the throat and cause fever, swelling of the tonsils and enlarged lymph nodes. Most cases can be treated with antibiotics, but some infected children develop recurrent tonsillitis (RT), a condition characterized by repeated tonsil infections. RT results in hundreds of thousands of school absences each year, and often leads to tonsillectomies, an invasive procedure in which the afflicted tonsils are removed. Seeking to better understand vulnerability to RT in some children, Jennifer Dan and colleagues obtained tonsil samples from a total of 146 children aged five to 18 years old, who underwent tonsillectomies for either GAS-associated RT or sleep apnea. They observed that the GAS-RT tonsils had smaller germinal centers - sites where B cells and T cells interact - and GAS-RT blood samples displayed lower amounts of antibodies against a GAS bacterial toxin named SpeA. These tonsils also harbored fewer germinal center T follicular helper cells, which orchestrate the immune response to GAS infection. Interestingly, the authors identified two variations in human leukocyte antigen genes that were associated with a higher risk of RT, indicating that some children may be genetically predisposed to the disease. Although further research is necessary, Dan et al. say their findings could facilitate the development of new vaccines for RT and strep throat that target SpeA - potentially reducing childhood strep throat disease burden by avoiding costly RT antibiotics treatments and surgeries.

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