Expression of TLRs and CD14 Does Not Necessarily Correlate with the Type of Pathogenic Bacteria in the Tonsils of Tonsillectomy Patients

Aims: It has been revealed that in patients with chronic tonsillitis there is an increase in the expression of various types of toll-like receptors (TLRs) in the tonsils. The TLRs in question, especially TLR2 and 4, require Cluster of Differentiation 14 (CD14) in recognising the cellular component of the pathogenic agents. This study aimed to evaluate whether the expression of TLRs and CD14 are associated with the types of bacteria of tonsillar surface swabs of tonsillectomy patients.

Study Design: Cross-sectional.

Place and Duration of Study: Dustira Hospital, Cimahi, West Java, Indonesia, between May and September 2017.

Methodology: Children aged 4-15 years (n = 34) with chronic tonsillitis showing indications for tonsillectomy in Dustira Hospital, Cimahi, West Java, Indonesia were included in the study. Tonsilar surface swabs were taken by rotating a sterile-cotton tip fine needle on the surface of the tonsils and inoculated into sheep blood and MacConkey agar plates. After tonsillar swabbing then tonsillectomy performed, tonsil specimens were transported to the laboratory in an hour or less for TLRs expression examination using immunohistochemical techniques. To assess CD14+ leukocytes, the venous blood sample (1 ml) of each subject was collected and analyzed using the whole-blood flow cytometry-based method.

Results: Tonsillar surface swabs culture resulted in 18 (52,9%) cultures that were not overgrown with pathogenic bacteria and 16 (47,1%) cultures were overgrown with Staphylococcus aureus (n = 12) and Klebsiella pneumoniae+Streptococcus non-group A (N = 4). All statistical analysis performed regarding the role of bacterial types in TLRs and CD14 expression, as well as the association between variables, showed no significant results.

Conclusion: The present study suggests that in chronic tonsillitis, the expression of TLR2 and TLR4, as well as their CD14-coreceptors, do not necessarily correlate with the type of pathogenic bacteria on the surface of the tonsils.