Cellular defence in surface secretion in acute pharyngotonsillitis

As acute pharyngotonsillitis is contagious the offensive organisms are supposed to enter mostly from the outside of the diseased person into the tonsillar secretion and tissues. To elucidate the function and the pathophysiological importance of the cellular defence system in the surface secretion of the tonsils, the cellular kinetics and spatial relations between the cellular elements in the secretion were followed during the course of acute pharyngotonsillitis in 16 patients using a newly invented imprint technique. The most prominent findings in the secretions at the start of the infections, irrespective of positive or negative bacterial culture for beta-haemolytic streptococci, were huge numbers of bacteria, great numbers of granulocytes, many of which showed signs of exhaustion and death, and extensive intracellular and frustrated phagocytosis, features highly consistent with an infectious process. During healing there were rapid and profound changes in cellular content and spatial relations towards those in secretions of healthy volunteers. However, even in the surface secretions of these subjects, bacteria, granulocytes and in some areas phagocytosis were present, albeit to a significantly lesser extent. It is concluded that a cellular defence system is constantly active in the surface secretions of the tonsils. During disease, this system is strongly activated and stressed. Based on our recent and present results it is speculated that acute pharyngotonsillitis is primarily and often only due to the emergence of an overload on the cellular defence system of the surface secretion.