In response to our study, other investigators argue that, like GAS, Fn can be considered part of the normal flora and the simple presence of the organism should not be taken to represent infection.[16] We hypothesized that a bacterial tonsillitis could create a dysbiosis in the tonsillar microbial flora, although it might also be the case that an evolving dysbiosis associated with increasing predominance of Fn could play a role in the development of an inflammatory response. This evidence concerns the gene FN1 and infection.