Recent Advances in Otolaryngology and Rhinology Case Report Open Access | Research Biofilm Forming Bacteria in Adenoid Tissue in Upper Respiratory Tract Infections Mariana Pérez1*, Ariana García1, Jacqueline Alvarado1, Ligia Acosta1, Yanet Bastidas1, Noraima Arrieta1 and Adriana Lucich1 1Otolaryngology Service Hospital de niños” JM de los Ríos” Caracas, Venezuela Abstract Introduction: Biofilm formation by bacteria is studied as one of the predisposing factors for chronicity and recurrence of upper respiratory tract infections. Objective: To determine the presence of Biofilm producing bacteria in patients with adenoid hypertrophy or adenoiditis. Methodology: A prospective and descriptive field study. The population consisted of 102 patients with criteria for adenoidectomy for obstructive adenoid hypertrophy or recurrent adenoiditis. Bacterial culture was performed, and specialized adenoid tissue samples were taken and quantified to determine by spectrophotometry the ability of Biofilm production. Five out of 10 samples were processed with electronic microscopy. Results: A The mean age was of 5.16 years, there were no significant sex predominance (male 52.94 %). There was bacterial growth in the 69.60% of the cultures, 80.39% for recurrent Adenoiditis and 19.61% for adenoid Hypertrophy, Staphylococcus Aureus predominating in 32.50% (39 samples). 88.37 % were producing bacteria Biofilm. 42.25% in Adenoiditis showed strong biofilm production, compared with samples from patients with adenoid hypertrophy where only 5.65 % were producers. The correlation was performed with electronic microscopy in 10 samples with 30 % false negatives. Conclusions: The adenoid tissue serves as a reservoir for biofilm producing bacteria, being the cause of recurrent infections in upper respiratory tract. Therapeutic strategies should be established to prevent biofilm formation in the early stages and to try to stop bacterial binding to respiratory mucosa. When biofilm is formed in adenoid, this tissue must be removed to prevent recurrent infections. Keywords: Bacteria; Biofilm; Upper Respiratory Tract Infection; Adenoiditis; Adenoid Hypertrophy Introduction Citation: Mariana P, Ariana G, Alvarado J, Ligia A, et al. (2019) Biofilm Forming Bacteria in Adenoid Tissue in In medical practice, Upper Respiratory Tract infections Upper Respiratory Tract Infections. Recent Advances in (URTI) are common in the first years of life and constitute 1 Otolaryngology and Rhinology 1(1): 1-4. one of the first causes of consultation . According to the World Received Date: October 04, 2019; Accepted Date: October Health Organization (WHO), respiratory tract infections 16, 2019; Published Date: October 18, 2019. make up to 50% of all causes of pediatric consultation,three *Corresponding author: Mariana Pérez, Otolaryngology quarters of which are represented by URTI. The chronic and Service Hospital de niños” JM de los Ríos” Caracas– Venezu- recurrent forms of URTI cause high morbidity responsible ela, Tel: +58 412 2250475, E-mail: [email protected] for absenteeism and negatively interfere with the growth and 2 Copyright: © Mariana P, Open Access 2019. This article, integral development of the child . published in Recent Advances in Otolaryngology and There are factors that predispose to chronicity and recurrence Rhinology (Attribution 4.0 International), as described by of these diseases. One of them, which has become one of http://creativecommons.org/licenses/by/4.0/. the most influential issues now, is the process of formation Rec Adv Oto Rhin (RAOR) 2019| Volume 1 | Issue 1 1 Biofilm Forming Bacteria in Adenoid Tissue in Upper Respiratory Tract Infections of Biofilm by the bacteria involved in these pathologies. investigation. Consterton in 1995, defined the Biofilm as a complex General Objective community of microorganisms, fixed to a surface, growing irreversibly attached, embedded in an extracellular matrix To determine the presence of Biofilm-producing bacteria in produced by them, which gives them a higher survival rate adenoids of patients with recurrent adenoiditis associated with against defense mechanisms such as the host’s immune other chronic or recurrent infections of upper respiratory tract response and bactericidal therapy3. infections in contrast to adenoids of patients with adenoid hypertrophy without infectious pathology, who attend the In recentstudies it has been showing the presence of Biofilms Otolaryngology clinic of the Hospital de Niños JM de Los in greater proportions in adenoids and tonsils of patients with Rios, Caracas, Venezuela. June - September 2013. chronic adenotonsilitis compared with samples from patients with obstructive symptoms, establishing an association Specifics Objectives between the presence of Biofilm and chronic infections 1. Analyze the frequency according to age and sex in patients ,representing a reservoir of bacteria responsible for maintaining who attended the Otolaryngology clinic of the Hospital this chronic inflammation and its resistance .Using electron de niños JM de los Ríos with the diagnosis of recurrent microscopy and confocal laser microscope techniques, it has adenoiditis and adenoid hypertrophy. been demonstrated the presence of organized bacterial cells in 2. Determine the frequency of chronic or recurrent URTI Biofilm microcolonies in Adenoid in childrens with cronic or associated with recurrent adenoiditis. recurrents UTRI4,5,6,7,8. 3. Identify the bacteria present on the surface of adenoid Bacteria exist in nature in two forms or states: a) Planktonic tissue in patients with recurrent adenoiditis and URTI and 9 bacteria, free floating, and b) Biofilm bacteria, in colonies . compare with bacterial growth in adenoid tissue of patients Only a very small fraction of the bacteria is in planktonic or with adenoid hypertrophy. free-floating form, it is postulated that 99% of all bacterial cells exist as Biofilms, and only 1% live in planktonic state10. 4. Determine the production capacity of Biofilm of the isolated Bacterial biofilms represent an ancient prokaryotic survival bacteria in each group studied. strategy. This is because bacteria achieve significant advantages 5. Relate the Biofilm production capacity of isolated bacteria by Biofilms, protection against environmental fluctuations in adenoids with recurrent adenoiditis compared to those in humidity, temperature and pH, as well as concentrating isolated in patients with adenoid hypertrophy. nutrients and facilitating waste disposal. This ability to form Biofilm does not appear to be restricted to any specific group 6. Analyze 10 samples, five (5) of adenoid tissue with and of microorganisms3. without a history of recurrent URTI and five (5) samples taken from bacterial culture under visualization with Another extremely important advantage from the clinical point scanning electron microscopy. of view, is that Biofilms bacteria are very resistant to antibiotics, being able to survive against antibiotic concentrations Methodology thousands of times higher than planktonic bacteria. For Type of Investigation example, a strain of Klebsiella pneumoniae in the planktonic A descriptive, non-experimental, field and prospective cross- state has a minimum inhibitory concentration of 2 µg / ml to sectional study was conducted. ampicillin. This same strain, growing as Biofilm, exhibits 66% survival after therapy with 5,000 µg / ml ampicillin11,12,13. Population Antibiotic therapy seems to be the most appropriate option The population was represented by 102 patients, 82 with a for the treatment of UTRI; however, this therapeutic option diagnosis of recurrent adenoiditis with a history of chronic and competes against an impermeable barrier that these bacteria / or recurrent UTRI (otitis, rhinosinusitis and tonsillitis) and 20 create. This is a very difficult factor to eradicate since these with a diagnosis of obstructive adenoid hypertrophy without a are 1000 times more resistant to antibiotics than planktonic history of infections that assisted to the ENT department of the or free-living bacteria, explaining why many of these chronic Hospital de Niños JM de los Ríos. infections do not respond to this type of treatment and cannot Inclusion criteria be controlled by the immune system14,15,16. Age Group: All patients between the ages of 2 and 11 who It is vitally important to understand that chronic and / or attended the ENT clinic at the Hospital de Niños JM de los recurrent bacterial infections are closely related to the presence Ríos. of Biofilms and that the nasopharynx is an ideal site for its formation and spread, so recognition of production is essential Clinical: Patients with surgical criteria of adenoidectomy and in this way develop new strategies for their definitive for chronic or recurrent infectious processes of UTRI treatment or prevention, improving the quality of life of the (rhinosinusitis, tonsillitis and / or Otitis Media with symptoms patients who present that pathologies, object of the present for more than 12 weeks or 4 or more episodes per year) and Rec Adv Oto Rhin (RAOR) 2019| Volume 1 | Issue 1 2 Biofilm Forming Bacteria in Adenoid Tissue in Upper Respiratory Tract Infections obstructive processes (sleep apnea, night snoring, mouth allowed to dry. Finally, 80% ethanol solution was added. If the breathing with facial deformity) without infectious pathology. bacteria were producers of Biofilm, the fixation of the dye in the walls of the tubes was observed, the intensity of the color Patients with congenital malformations, lip and