AUTHOR=Mateus Tulia , Seppanen Elke J. , de Gier Camilla , Clark Sharon , Coates Harvey , Vijayasekaran Shyan , Prosser Karen , Wiertsema Selma P. , Fuery Angela , Kirkham Lea-Ann S. , Richmond Peter C. , Thornton Ruth B. 

TITLE=Sleep Disordered Breathing and Recurrent Tonsillitis Are Associated With Polymicrobial Bacterial Biofilm Infections Suggesting a Role for Anti-Biofilm Therapies

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.831887

DOI=10.3389/fcimb.2022.831887

ISSN=2235-2988

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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 <italic>Haemophilus influenzae</italic> (NTHi)<italic>, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae</italic> and <italic>Moraxella catarrhalis</italic> 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).</p></sec><sec><title>Results</title><p>The 5 bacterial species were detected in naso- and oro- pharyngeal samples from all children. These species were frequently detected in adenotonsillar tissue (except <italic>S. aureus</italic>, which was absent in adenoids) from children with SDB, SDB+RT and RT. NTHi and <italic>S. aureus</italic> 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.</p></sec><sec><title>Conclusions</title><p>Antimicrobials, particularly anti-biofilm therapies, may be a strategy for managing children with SDB.</p></sec>