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Sleep Disordered Breathing and Recurrent Tonsillitis Are Associated With Polymicrobial Bacterial Biofilm Infections
Tulia Mateus1,2, Elke J Seppanen2, Camilla de Gier1,2
1School of Medicine, University of Western Australia, Perth, WA, Australia.
Insights
Pediatric obstructive sleep disordered breathing (SDB) and recurrent tonsillitis (RT) involve polymicrobial biofilms in tonsils. Anti-biofilm therapies may help manage SDB in children.
Area of Science:
- Microbiology
- Pediatric Otolaryngology
- Sleep Medicine
Background:
- The pathogenesis of pediatric obstructive sleep disordered breathing (SDB) and recurrent tonsillitis (RT) remains unclear.
- Understanding these conditions is crucial for developing less invasive treatments.
Purpose of the Study:
- To investigate the bacterial composition and biofilm presence in children with SDB, RT, or both.
- To compare bacterial loads in affected children versus healthy controls.
Main Methods:
- Quantitative PCR (qPCR) was used to measure bacterial loads in nasopharyngeal and oropharyngeal swabs, as well as adenoid and tonsillar tissue from children aged 1-16 years.
- Bacterial species analyzed included nontypeable *Haemophilus influenzae* (NTHi), *Staphylococcus aureus*, *Streptococcus pyogenes*, *Streptococcus pneumoniae*, and *Moraxella catarrhalis*.
- 16S rRNA Fluorescence In Situ Hybridization (FISH) was used to examine biofilms in tonsil biopsies.
Main Results:
- The five target bacterial species were detected in all children's naso- and oropharyngeal samples and frequently in adenotonsillar tissue of those with SDB, RT, or SDB+RT.
- NTHi and *S. aureus* were prevalent in tonsils, with similar bacterial densities observed across disease groups.
- Polymicrobial biofilms and intracellular bacteria were identified in tonsils of children with adenotonsillar disease.
Conclusions:
- Bacterial biofilms and intracellular bacteria are present in the tonsils of children with SDB and RT.
- Antimicrobial strategies, especially anti-biofilm therapies, show potential for managing pediatric SDB.
Background:
The underlying pathogenesis of pediatric obstructive sleep disordered breathing (SDB) and recurrent tonsillitis (RT) are poorly understood but need to be elucidated to develop less invasive treatment and prevention strategies.
Methods:
Children aged between 1- and 16-years undergoing adenoidectomy, tonsillectomy or adenotonsillectomy for SDB (n=40), RT alone (n=18), or both SDB and RT (SDB+RT) (n=17) were recruited with age-matched healthy controls (n=33). Total bacterial load and species-specific densities of nontypeable Haemophilus influenzae (NTHi), Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and Moraxella catarrhalis were measured by qPCR in nasopharyngeal swabs, oropharyngeal swabs, adenoid and tonsillar tissue from children with SDB, SDB+RT and RT, and in naso- and oro- pharyngeal swabs from healthy children. A subset of tonsil biopsies were examined for biofilms using 16S rRNA FISH (n=3/group).
Results:
The 5 bacterial species were detected in naso- and oro- pharyngeal samples from all children. These species were frequently detected in adenotonsillar tissue (except S. aureus, which was absent in adenoids) from children with SDB, SDB+RT and RT. NTHi and S. aureus were observed in tonsils from 66.7-88.2% and 33.3-58.8% of children respectively. Similar total and species-specific bacterial densities were observed in adenotonsillar tissue from children with SDB, SDB+RT or RT. Nasopharyngeal and oropharyngeal swabs were more likely to have multiple bacterial species co-detected than adenotonsillar tissue where one or two targeted species predominated. Polymicrobial biofilms and intracellular bacteria were observed in tonsils from children with adenotonsillar disease.
Conclusions:
Antimicrobials, particularly anti-biofilm therapies, may be a strategy for managing children with SDB.
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