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What’s behind frequent strep throat? Consult the tonsils

Immune problems may be one source — stowaway germs may give faulty diagnoses

The germs that cause strep throat infections can hide out in the tonsils

For kids, getting strep throat over and over is a pain. It’s also a problem that has puzzled scientists. Now a study of kids’ tonsils suggests what’s up. Some kids have a faulty immune response to strep bacteria. Others are misdiagnosed with the disease when strep germs hide out in their tonsils. That’s the finding of a study published online February 6 in Science Translational Medicine.

Each year, strep throat sickens some 600 million people across the globe. Bacteria called group-A Streptococcus are to blame. The sickness can cause a sore throat, fever and more. Kids who get the disease are at risk of heart problems and rheumatic fever (a non-infectious but very serious disease). Doctors treat strep throat with antibiotics. Still, some treated kids keep getting strep throat again and again. These children and teens tend to have smaller immune structures in their tonsils than kids who hadn’t had repeated infections, a new study finds. Those immune structures help make antibodies — proteins that fight off bacteria and viruses.

Tonsils may be key

Shane Crotty studies the immune system at the La Jolla Institute for Immunology. It’s in Southern California. For a new study, he and his colleagues examined tonsils from kids 5- to 18-years old. Some had their tonsils taken out because of frequent strep throat. Others had theirs removed to fix breathing problems caused by big tonsils. This second group was a stand-in for kids who don’t get recurring strep throat. The team looked at pieces of the tonsils under a microscope. Kids with recurring strep had smaller immune structures called germinal (GER-mih-nul) centers. And these centers made fewer immune cells known as T cells. T cells help other immune cells known as B cells make antibodies.

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