International Journal of Pediatric Otorhinolaryngology
Recurrences in chronic tonsillitis substained by tonsillar biofilm-producing bacteria in children. Relationship with the grade of tonsillar hyperplasy
Introduction
It is known that bacterial biofilms are involved in the chronicity of infections and resistance to antibiotic treatments, and therefore have a considerable negative impact on the patients’ quality of life and a significant effect on public health [1], [2]. Bacterial biofilms may play a role in various recurrent/chronic upper respiratory tract infections, including acute and chronic middle ear diseases [3], [4], chronic adenoiditis [5], and rhinosinusitis [6], and a few studies of limited case-series of patients have recently suggested that they are also involved in chronic tonsillar disease [7], [8], [9]. They have been found in the tonsillar tissue of children with chronic infections [7], [8], [9] and children with chronic tonsillar hyperplasia [7], but are more prevalent in the former. In 2009, Stoodley et al. [10] suggested that the tonsilloliths often associated with tonsillar inflammation [11] were actually polymicrobial biofilms that are structurally heterogeneous at confocal microscopy.
However, there are few published studies of biofilm formation on tonsillar surfaces, and a lack of any strong evidence concerning the etiopathogenic role of tonsillar biofilm in childhood chronic tonsillar infections. The aim of this study was to assess the presence of biofilm-producing bacteria (BPB) in tonsillar bioptic specimens taken from children with recurrent exacerbations of chronic hyperplastic tonsillitis during tonsillectomy between episodes of tonsillar infections, and evaluate the possible relationship between their presence and the patients’ demographic and clinical characteristics.
Section snippets
Study design
A longitudinal study at a tertiary hospital.
Study setting
The study was carried out at the Department of Clinical Sciences and Community Health and at the Department of Pathophysiology and Transplantation of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Milan, Italy). The protocol was approved by our local Ethics Committee, and written informed consent was obtained from the children's parents or legal guardians.
Study subjects
Between March 2008 and February 2009, we recruited outpatients aged 3–13 years who
Results
BPB were detected in 50.0% of the 44 tonsillar specimens taken from the 22 enrolled children (68.2% males; median age 6.5 years, range 3–13 months). The main pathogen was Staphylococcus aureus, which was detected in 18 samples (81.8%). Table 1 shows the main demographic and clinical data.
Table 2 shows the microbiological results by GTH. The presence of tonsillar BPB did not correlated with gender, age, or the number of reported tonsillar infections in the previous 12 months, but there was a
Discussion
Our findings documented the presence of BPB in 50% of tonsillar bioptic specimens taken during tonsillectomy from children with recurrent exacerbations of chronic hyperplastic tonsillar infections. This confirms previous findings [7], [8], [9] and seems to be in line with the reported prevalence of tonsillar biofilm (41–85%) in limited case-series of patients with recurrent or chronic tonsillar disease [7], [8], [9]. Involvement of bacterial biofilm in a consistent proportion of children with
Financial disclosure
The authors have no sponsorships or competing interests to disclose in relation to this article.
Conflict of interest
None.
References (25)
- et al.
Antibiotic resistance of bacteria in biofilms
Lancet
(2001) - et al.
Tonsillolith: not just a stone but a living biofilm
Otolaryngol. Head Neck Surg.
(2009) Modern assessment of tonsils and adenoids
Pediatr. Clin. North Am.
(1989)Biofilms: microbial life on surfaces
Emerg. Infect. Dis.
(2002)- et al.
The role of biofilms in otolaryngologic infections
Curr. Opin. Otolaryngol. Head Neck Surg.
(2004) - et al.
Biofilms in pediatric respiratory and related infections
Curr. Allergy Asthma Rep.
(2009) - et al.
Diagnostic accuracy of nasopharyngeal swabs in detecting biofilm-producing bacteria in chronic adenoiditis: a preliminary study
Otolaryngol. Head Neck Surg.
(2011) - et al.
Biofilm surface area in the pediatric nasopharynx: chronic rhinosinusitis vs obstructive sleep apnea
Arch. Otolaryngol. Head Neck Surg.
(2007) - et al.
Anatomical evidence of microbial biofilms in tonsillar tissues: a possible mechanism to explain chronicity
Arch. Otolaryngol. Head Neck Surg.
(2003) - et al.
Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis
Acta Otorhinolaryngol. Ital.
(2007)