Characteristics of systemic and local immunity in patients with chronic tonsillitis

Abstract

Palatine tonsils are the most significant cluster of lymphadenoid tissue of throat. Performing a protective function they are very prone to acute and chronic inflammation and thus they are a source of chronic infection in the body. Therefore the problem of chronic tonsillitis (CT) requires a serious attention. Rheumatoid arthritis (RA) is one of the important factors that could significantly complicate the course of chronic tonsillitis.
RA is a chronic immune inflammatory disease that progressively affects connective tissue mostly of the peripheral joints and it has a wide range of extra-articular manifestations. The aim of our study was to explore the
dynamics of immunologic indicators during the active disease and convalescence in patients with various severity of chronic tonsillitis, including tonsillitis complicated with RA, and to define indicators of local
and systemic immunity for further improvement of tactics  of immune correction in the complex treatment. Material and methods. 41 patients with various forms of chronic tonsillitis in active period of disease observed during the study. Patients were divided into the following groups: 19 persons with the compensate form of CT, 15
persons with the decompensate form of CT, 9 persons with the decompensate form of CT complicated with RA in remission stage. The control group consisted of 15 apparently healthy persons. Average age of the observed persons was 34.4 ± 0.8 years. Concentrations of serum immunoglobulins sIgA, IgA, IgM, IgG were determined by the method of radial immunodiffusion by Manchini. Levels of Ig Е, IL-4 and IFN – γ in the blood serum of patients were evaluated using ELISA test systems of "Vector-best". The detection of circulating immune complexes (CIC) was performed by the method based on a selective precipitation of antigen complexes in 3.5% solution of polyethylene glycol (PEG) with subsequent photometric determination of density of the precipitate.
In peripheral blood the relative level of CD3+, CD4+, CD8+, CD16+, CD19+cells was determined with the help of monoclonal antibodies to the differential antigens of lymphocytes by indirect immunofluorescence method. Results and discussion. It is noted that there are marked
changes in the immune system from both humoral and cellular components under the influence of chronic infection persisting in palatine tonsils. The immunity indicators in different groups of patients with chronic tonsillitis were compared after undertaken conservative treatment. The fastest positive changes for the normalization of indcators occured in the group CT (the compensate form), except IFN – γ. Indicators sIg A, Ig A were significantly reduced in group CT+RA, indicators IgG, IgЕ, CIC, IFN – γ remained significantly high relatively to control group. The decompensate form of CT was characterized by the deficit of sIg A, IgA and IgG in the context of increased levels of IFN – γ and IL-4. Thus, the studied changes in the levels of all fractions of immunoglobulins, IFN – γ та IL-4 indicate that the
undertaken conservative treatment was insufficient and it requires further improvement with the immune correction usage in the complex therapy in all patient groups except of the group with the compensate form of CT. Decrease of level of sIg A relatively to control group, a significant increase of level of IFN -γ was observed in patients with the compensate form of CT before starting treatment. After treatment the normalization of all analyzed indicators was observed except of IFN -γ which level was decreasing but remaining above the control value. Thus,
the existence of adequate immunologic reactivity makes application of immunomodulators by simple form of CT inappropriate. Deficit of sIg A, IgA and IgG in contest of increased levels of IFN – γ and IL-4, a reliable increase of CD19+ content and increase of level of lymphocytotoxic
autoantibodies were observed in patients with the decompensate form of CT. After treatment in patients with the decompensate form of CT the indicators of subpopulations CD8+, CD16+ content were decreased, deficit of sIg A, IgA and IgG, increased levels of IFN – γ
and IL-4 was observed, also level of lymphocytotoxic autoantibodies were increased. The obtained data shows that conservative treatment of the decompensate form of CT is insufficient and application of immunomodulating remedies of systemic action is appropriate. A significant number of CD4+ cells with simultaneously low number of
CD16+ is a peculiarity of phenotype of white blood cells of peripheral blood in patients with the decompensate form of CT that develops in the context of RA. Also the hyper production of immunoglobulins IgM, IgG and IgЕ in contest of decreased levels of sIg A, IgA, the increase 
of level of the CIC, IFN–γ and also lymphocytotoxic autoantibodies was noted. After the conservative treatment of CT most of these indicators does not reach the control values, an imbalance of T-cell link remains
and that points to the expediency of application of immunomodulating remedies.