Are penicillin treatment failures in Arcanobacterium haemolyticum pharyngotonsillitis caused by intracellularly residing bacteria?

Arcanobacterium haemolyticum is an infrequent agent of pharyngotonsillitis in children and young adults. Despite the fact that A. haemolyticum is fully sensitive to penicillin in vitro, penicillin treatment failures are frequent. The ability of A. haemolyticum to invade HEp-2 cells and survive intracellulary was investigated. All 12 strains tested, of which 10 were isolated from patients with pharyngotonsillitis, and 2 were reference strains, were internalized by the HEp-2 cells. Four strains tested further, one of the reference strains and 3 of the clinical isolates, proved able to survive intracellularly for 4 days, thus creating intracellular reservoirs of bacteria. It was also shown that erythromycin, an antibiotic known to penetrate well intracellularly, efficiently killed these bacteria.