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Multi-species bacterial biofilm and intracellular infection in otitis media

Ruth B Thornton1, Paul J Rigby, Selma P Wiertsema

  • 1School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia. rthornton@meddent.uwa.edu.au

BMC Pediatrics
|October 25, 2011
PubMed
Abstract

Insights

Bacteria form biofilms and hide inside cells in children with chronic or recurrent ear infections, explaining why treatments often fail. This study found evidence of these hidden bacterial infections in middle ear tissues.

Area of Science:

  • Microbiology
  • Otolaryngology
  • Pediatric Infectious Diseases

Background:

  • Bacteria in middle ear effusion of children with chronic otitis media with effusion (COME) and recurrent acute otitis media (rAOM) are difficult to culture and eradicate.
  • These persistent bacteria may exist in biofilms or intracellularly, potentially contributing to otitis media (OM) pathogenesis.

Purpose of the Study:

  • To provide evidence for intracellular or biofilm-associated otopathogenic bacteria in the middle ear mucosa of children diagnosed with COME or rAOM.

Main Methods:

  • Middle ear mucosal biopsies from 20 children with COME or rAOM were analyzed.
  • Techniques included transmission electron microscopy (TEM), fluorescent in situ hybridization (FISH), and confocal laser scanning microscopy (CLSM).
  • A healthy control biopsy was also examined.

Main Results:

  • No bacteria were detected in the healthy control.
  • TEM revealed intracellular bacteria in 2 of 3 COME/rAOM biopsies, but biofilm was not observed.
  • FISH/CLSM detected bacteria in 15 of 17 COME/rAOM biopsies.
  • Bacterial biofilm was present in 11 (65%) and intracellular bacteria in 12 (71%) of the 17 biopsies.
  • 52% of biopsies showed both biofilm and intracellular bacteria.
  • Otopathogens were identified in 13 of 15 positive samples.

Conclusions:

  • Bacterial biofilm and intracellular infections by otopathogens are present in the middle ear mucosa of children with COME and/or rAOM.
  • This infection pattern, previously undescribed, may explain the limited efficacy of current treatment strategies for COME and rAOM.
  • Further research is needed to determine the precise role of these findings in disease pathogenesis.

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