Research ArticlePEDIATRICS

Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells

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Science Translational Medicine  06 Feb 2019:
Vol. 11, Issue 478, eaau3776
DOI: 10.1126/scitranslmed.aau3776

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Teasing apart tonsillitis

Although exposure to group A Streptococcus is prevalent, only some children develop recurrent tonsillitis, which can lead to tonsillectomy. To discern why some children are susceptible and others are resistant, Dan et al. examined tonsil samples from two cohorts. They found that children with a history of recurrent tonsillitis had smaller germinal centers and reduced antibacterial antibodies. Moreover, the T follicular helper cells from those subjects may actually have been cytotoxic toward B cells. Class II HLA analysis also identified protective and risk alleles. Together, these results reveal that altered adaptive immune responses to group A Streptococcus may differentiate those at risk of recurrent infection.