Polio and Tonsillectomies - Literature
[back] Polio and Tonsillectomies
|Medicine (Baltimore) 1992 Sep;71(5):311-5; discussion 324-5
Tonsillectomy and poliomyelitis. I. Epidemiologic
- Classical Article
- Historical Article
Personal Name as Subject:
From the article: "In
the data given by Top and Vaughan, a history of tonsillectomy is more
frequent in all cases of poliomyelitis than in the several sets of controls
in the same area. These figures, barring any unseen selection - for
example, in making up the control groups - would indicate that the absence
of tonsils predisposes to poliomyelitis......Data concerning the comparative
frequency of the bulbar and spinal forms of poliomyelitis in
tonsillectomized and non-tonsillectomized individuals (excluding cases
occurring within 30 days after the operation)..........all show a higher
percentage of the bulbar form of the disease in individuals with a history
of tonsillectomy than in those with tonsils present. Non-paralystic
poliomyelitis occurs in both groups of individuals with the same frequency
as the bulbar and spinal forms combined. These data, therefore, suggest
that removal of tonsils is not a determinant between non-paralytic and
paralytic poliomyelitis, but rather between the bulbar and spinal forms of
the paralytic disease."
PMID: 1522807 [PubMed - indexed for MEDLINE]
Incubation of poliomyelitis as calculated from the time
of entry into the central nervous system via the peripheral nerve pathways.
University of Leeds, United Kingdom.
A new theory of how poliovirus reaches the central nervous system
(CNS)--that it enters at many peripheral nerve endings with passage along
nerve pathways to the CNS, with limited dispersal in the CNS--is used in
making predictions of incubation periods, and these are compared with data
from the literature and with predictions from other theories. The virus
transit speed along the nerve of 2.4 mm/h has been used in calculating the
incubation time. The calculated incubation time for Cutter vaccinees is
similar to the actual times reported, and the calculated minimal and maximal
incubation times in humans are similar to the published ranges. Incubation
times in different animals and for different paralyses are explained. The
pathology of lesions in humans and the consequent paralyses are compatible
with the model.
Tonsillectomy-associated poliomyelitis is reviewed and discussed in relation
to possible entry of virus from peripheral nerve endings in muscle.
Increased lymphocyte concentrations in the muscle may account for continuing
susceptibility after tonsillectomy. Severe paralysis following exercise is
explained as an effect of increased blood supply to nerves in the CNS that
has already been invaded by virus. In developing countries, the phenomenon
of paralysis in the injected muscle a few hours after injection in febrile
children may occur in a similar fashion. The entry of poliovirus from many
sites at nerve endings in muscles is consistent with clinical, experimental,
and pathologic data and provides an explanation of the incubation times and
related phenomena of poliomyelitis.
PMID: 2163095 [PubMed - indexed for MEDLINE]
The immunologic substrate: role of local and systemic
immunity in the head and neck.
From the article: "Two
diseases have been reported to occur with increased frequency following
tonsillectomy: poliomyelitis and Hodgkin's disease. The association between
polio and tonsillectomy was first suggested in 1938, and subsequently a
number of epidemiologic and experimental studies have verified that such a
relationship exists, at least when a child is infected with wild poliovirus
shortly before or following tonsillectomy. There is also some evidence that
tonsillectomy performed in the remote past increases later susceptibility to
paralytic poliomyelitis. In more recent studies by Ogra and coworkers,
vaccine induced antipolio SIgA levels dropped sharply in nasopharyngeal
secretions following tonsillectomy and adenoidectomy. Antipolio IgG levels
transiently increased in the secretions following surgery and the depression
in SIgA levels, but later the levels of this immunoglobulin also decreased.
Additionally, immunization following tonsillectomy produced lower antipolio
SIgA levels than immunization in children with intact tonsils. It is
difficult to translate this information into advice regarding the hazards of
tonsillectomy, especially since poliomyelitis has now become a relatively
- PMID: 980496 [PubMed - indexed for MEDLINE]
[Tonsils and immunology (author's transl)]
[Article in German]
Tonsils are lymphatic organs carrying out functions of humoral and cellular
immunity. They form a local immunologic barrier; they are also involved in
general immunologic defence mechanisms. Tonsillectomy or the destruction of
tonsils by infections does not reduce the immunoglobulin concentration and
antibody titres in peripheral blood.
Only the local formation of IgA antibodies against poliomyelitis antigen
seems to be impaired at least for a short time. The clinical
relevance of this finding is unknown. Signs of defects in immunosurveillance,
which were found in some study groups resulting from an increase of the
morbidity rates of Hodgkin's disease and thyroid carcinoma, must be
considered seriously although there is no statistic evidence for an increase
of tumor frequency after tonsillectomy. The indication for tonsillectomy
must be decided on clinical findings. Signs for a reduction of local
antibody synthesis or for a possible diminuation of immunosurveillance
should serve to critical indication.
PMID: 1104543 [PubMed - indexed for MEDLINE]
Tonsillectomy and adenoidectomy: are too many being done?
- From the article:
When poliomyelitis was common in the
United States, it was observed by several that of the children who had
developed bulbar poliomyelitis, a considerable number had had
tonsillectomies in the past month and some in the past six months. This
resulted in a recommendation by the health department of New York that
tonsillectomies should not be done during the period when poliomyelitis is
likely to be present, unless these children have previously been immunized
against all three types of the poliovirus at least a month before surgery."
PMID: 1059022 [PubMed - indexed for MEDLINE]
in childhood. Dangers and complications]
[Article in German]
PMID: 4547107 [PubMed - indexed for MEDLINE]
Effect of tonsillectomy and adenoidectomy on
nasopharyngeal antibody response to poliovirus.
- From the article: "These
observations suggest that complete removal of tonsils and adenoids,
particularly in young male children, who have recently been immunized
with poliovaccine, may deprive them of a valuable source of
immunocompetent tissue, which may be actively involved in the
replication of poliovirus and the synthesis of specific antibody.
Although direct evidence of local antibody production to polio virus in
the tonsils and adenoids is not available, it is known that extensive
replication of poliovirus takes place in the tonsillar tissues after
natural or induced infection with poliovirus."
PMID: 4321186 [PubMed - indexed for MEDLINE]
Med J Austr 1953 Aug 22; II(8): 281-298
Studies on a long rage
association between bulbar poliomyelitis and previous tonsillectomy.
article: "In 1952 the writer stated
in a paper read at the Eighth Session of the Australasian Medical Congress
(British Medical Association) in Melbourne, that the patients who contracted
bulbar poliomyelitis during the 1947-1948 poliomyelitis epidemic in South
Australia had nearly all undergone tonsillectomy at some time prior to the
onset of poliomyelitis, and that in only a few cases was the tonsillectomy
recent......The preliminary studies suggested that the association between
prior tonsillectomy and bulbar poliomyelitis lasted for five to ten years.
In the present paper the completed studies of the 1947-1948 bulbar cases are
given, and the association and duration are confirmed."