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

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

doi:10.3389/fcimb.2022.831887

Abstract

BackgroundThe 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.MethodsChildren 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).ResultsThe 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.ConclusionsAntimicrobials, particularly anti-biofilm therapies, may be a strategy for managing children with SDB.

Highlights

Adenotonsillectomy Is the Most Common Pediatric Surgery in AustraliaAdenotonsillectomy is a common surgical procedure performed on children in high-income countries (Harris et al, 2008)
Density, and relative abundance of 5 species of respiratory bacteria that are associated with upper airway and respiratory tissue infections: S. pyogenes, Staphylococcus aureus, Streptococcus pneumoniae, nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis, in nasopharyngeal swabs, oropharyngeal swabs, and in adenoid and tonsil tissue from children with adenotonsillar diseases, and in nasopharyngeal and oropharyngeal swabs from healthy controls
1 child in the sleep disordered breathing (SDB)+recurrent tonsillitis (RT) group was on antibiotics at the time of surgery

Summary

Introduction

Adenotonsillectomy Is the Most Common Pediatric Surgery in AustraliaAdenotonsillectomy is a common surgical procedure performed on children in high-income countries (Harris et al, 2008). Adenotonsillectomy Is the Most Common Pediatric Surgery in Australia. In Australia, it is estimated that ~750 per 100,000 children undergo tonsillectomy (with or without adenoidectomy) each year. This rate has increased by 3% between 2012 and 2018 (Australian Commision on Safety and Quality in Health Care, 2021). Children undergo adenotonsillectomy to treat a range of adenotonsillar diseases associated with infection and/or hypertrophy of the adenotonsillar tissue including sleep disordered breathing (SDB), recurrent tonsillitis (RT), or a combination of both. 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

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