[Investigation of the bacterial flora in the tonsillar lacunae and serum levels of streptococcal antigen-specific antibodies in patients with pustulosis palmaris et plantaris].

The purpose of this study was to clarify the relationship between bacterial flora in tonsillar lacunae and antistreptococcal antibody in sera of the patients with pustulosis palmaris et plantaris (PPP). Since the pustules develops or worsens after tonsillitis in many patients with PPP, a pathogenic role of tonsillar bacteria is suggested, but no significant association has been proven so far. In this study, the aerobes in the tonsillar lacunae were identified and quantitated in 15 adult patients with PPP and 9 adult patients with chronic tonsillitis (CT). In addition, serum streptococcal antigen-specific antibody levels in 40 adult patients with PPP, 18 adult patients with chronic tonsillitis, and 11 healthy volunteers (controls) were examined by enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. A total of 53 strains (17 species) of aerobes were isolated and identified from the tonsillar lacunae in patients with PPP, while 35 strains (12 species) of aerobes were found in the patients with CT. 2. S. salivarius and S. pneumoniae were the dominant aerobes isolated from patients with PPP or CT. 3. Although the rates of isolation for Staphylococcus and S. pneumoniae were lower in PPP patients than in CT patients, the rate for S. sanguis I was higher in PPP patients than in CT patients. 4. The percentage of alpha, gamma-streptococci to total aerobes in PPP patients was higher than in CT patients. 5. The IgG antibody titers against S. sanguis and S. mitis, and the IgM antibody titers against all streptococci investigated in PPP patients were higher than those in both CT patients and controls. 6. Moreover, both the IgG antibody titers against S. pyogenes T4 and S. sanguis I and the IgM antibody titers against S. sanguis I and S. sanguis II of the patients in which PPP markedly improved after tonsillectomy were higher than those in which PPP showed less improvement postoperatively.