ORIGINAL ARTICLE

Spatial organisation of microbiota in quiescent adenoiditis and tonsillitis

A Swidsinski¹, Ö Göktas², C Bessler², V Loening-Baucke¹, L P Hale³, H Andree¹, M Weizenegger⁴, M Hölzl², H Scherer² and H Lochs¹

¹ Medizinische Klinik, Charité Humboldt Universität, CCM, Molekular-genetisches Labor für polymikrobielle Infektionen und bakterielle Biofilme, Berlin, Germany
² Charite Humboldt Universität, Hals-Nasen-Ohrenklinik, Berlin, Germany
³ Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
⁴ Limbach Laboratory, Heidelberg, Germany

Correspondence to:
Correspondence to:
Dr A Swidsinski
Humboldt Universität, Charité, Medizinische Klinik, 10098 Berlin, Germany; alexander.swidsinski{at}charite.de

Background: The reasons for recurrent adenotonsillitis are poorly understood.

Methods: The in situ composition of microbiota of nasal (5 children, 25 adults) and of hypertrophied adenoid and tonsillar tissue (50 children, 20 adults) was investigated using a broad range of fluorescent oligonucleotide probes targeted to bacterial rRNA. None of the patients had clinical signs of infection at the time of surgery.

Results: Multiple foci of ongoing purulent infections were found within hypertrophied adenoid and tonsillar tissue in 83% of patients, including islands and lawns of bacteria adherent to the epithelium, with concomitant marked inflammatory response, fissures filled with bacteria and pus, and diffuse infiltration of the tonsils by bacteria, microabscesses, and macrophages containing phagocytosed microorganisms. Haemophilusinfluenzae mainly diffusely infiltrated the tissue, Streptococcus and Bacteroides were typically found in fissures, and Fusobacteria,Pseudomonas and Burkholderia were exclusively located within adherent bacterial layers and infiltrates. The microbiota were always polymicrobial.

Conclusions: Purulent processes persist during asymptomatic periods of adenotonsillitis. Most bacteria involved in this process are covered by a thick inflammatory infiltrate, are deeply invading, or are located within macrophages. The distribution of the bacteria within tonsils may be responsible for the failure of antibiotic treatment.

Abbreviations: Cy3/Cy5, different carbocyanine dyes used in fluorescence microscopy to label the oligonucleotide probes; DAPI, 4',6-diamidino-2-phenylindole; FISH, fluorescence in situ hybridisation; FITC, fluorescein isothiocyanate

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