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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 1  |  Page : 71-74

Microbiota, biofilm, and chronic rhinosinusitis: A transitory general idea of writings


Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia

Date of Web Publication10-Sep-2018

Correspondence Address:
Prof. Mainul Haque
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_2_18

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  Abstract 


Chronic rhinosinusitis is one of the highly prevalent multifactorial inflammatory disorder of the paranasal sinuses and a public health problem in the developed and developing countries, which reduces the patient's quality of life. The membranes of the nasal and paranasal sinuses' mucosa are the motherland of numerous type of microorganisms such as fungi, bacteria, and viruses causing diseases or not. Furthermore, these complex polymicrobial microbiota families exist in within the nasal and paranasal sinus cavities of both patients without chronic rhinosinusitis and patients with chronic rhinosinusitis; the latter group was observed with minimum diversity when compared with controls. Biofilms are typically defined “as surface-associated microbial communities, surrounded by an extracellular polymeric substance matrix.” Nevertheless, if the microbes get ahead in establishing a biofilm within the human host, the infection frequently becomes fatal and difficult to treat and progresses into a chronic state. Multiple chronic infections such as cystic fibrosis pneumonia, chronic otitis media, chronic rhinosinusitis, and recurrent urinary tract infections, are linked to biofilm formation. S. aureus and P. aeruginosa are major delinquent in the growth of obstinate severe airway disease in chronic rhinosinusitis and cystic fibrosis patients. Moreover, the rapid development of resistant microorganism throughout the planet, jeopardizing the efficacy of antimicrobials, which have once changed medicine and protected millions of lives. Antimicrobial resistance has been currently identified as most dangerous threats to human health.

Keywords: Biofilm, chronic rhinosinusitis, microbiota


How to cite this article:
Abu Bakar MB, Haque M. Microbiota, biofilm, and chronic rhinosinusitis: A transitory general idea of writings. J Datta Meghe Inst Med Sci Univ 2018;13:71-4

How to cite this URL:
Abu Bakar MB, Haque M. Microbiota, biofilm, and chronic rhinosinusitis: A transitory general idea of writings. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2019 Sep 23];13:71-4. Available from: http://www.journaldmims.com/text.asp?2018/13/1/71/240889




  Introduction Top


Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the paranasal sinuses. Several host and environmental aspects have been drawn in the development of CRS; nevertheless, in depth recognition of the role of microbes has become increasingly important. It is commonly thought that contact to microorganism causes to diseases or poor health status. Additionally, reduced contact with microbiota results in a decrease of incidence of infectious diseases but may promote an increase in the incidence of allergic diseases. There is increasing evidence that biofilms playing are a crucial role in the pathophysiology CRS. This manuscript will try to provide a brief update regarding CRS, biofilm, and microbiota.


  Microbiome and Human Health Top


The normal flora is currently known as microbiota, its contribution toward human health was principally in mystery.[1] Human being harbor around 100 trillion (1014) symbiotic microorganisms [2] and quadrillion viruses [3] which play an imperative role in maintaining human health and defending diseases.[4],[5],[6],[7] These microbial fraternize that inhabit in and on the human body jointly known as human microbiota, and the genes microbiota encode is known microbiome. “This complex community contains taxa from across the tree of life, bacteria, eukaryotes, viruses, and at least one archaeon that interact with one another and with the host, greatly impacting human health and physiology.”[5] Among microbiota a minor fraction can be cultured in Petri dishes of the laboratory,[8] and furthermore, the recent development beyond current swab and culture techniques in bacterial detection with next-generation “high-throughput sequencing has greatly expanded the repertoire of known microbes both in our bodies and in the environment.”[9] As microbiota, especially the gut, microbiota contributes a major role in health and disease in humans; undeniably, it is now and then denoted to as human “forgotten organ,”[10] these microbes bearing almost 150 times more genes than the human genome.[11]


  Microbiota, Probiotics, and Chronic Rhinosinusitis Top


The thought of the human microbiota was first made known to the scientific community by Joshua Lederberg, who defined it as “the ecological community of commensal, symbiotic, and pathogenic microorganisms that literally share our body space and have been all but ignored as determinants of health and disease.”[12] CRS is one of the highly prevalent multifactorial inflammatory disorder of the paranasal sinuses and a public health problem in the developed and developing countries, which reduces the patient's quality of life.[13],[14],[15],[16],[17] The membranes of the nasal and paranasal sinuses' mucosa are the motherland of numerous type of microorganisms such as fungi, bacteria, and viruses causing diseases or not.[18] Furthermore, these complex polymicrobial microbiota families exist in within the nasal and paranasal sinus cavities of both patients without CRS and patients with CRS; the latter group was observed with minimum diversity when compared with controls.[19] The native microbiota colony of the nasal and paranasal sinuses preserves a healthy state of the sinonasal mucosa. However, dysbiosis (interruption of this balance) possibly will uphold inflammation through a variety of mechanisms.[20],[21] In addition, dysbiosis of normal flora likely will cause an adverse effect on mucosal physiology and promote several chronic diseases, for example, autoimmunity, inflammatory bowel disease, infections, obesity, colorectal cancer, neurological disorders, and autism.[22],[23],[24] Individual patients will behave differently as their protection status and invade pathogenic organism will be dissimilar.[25]

The Food and Agricultural Organization and the World Health Organization, probiotics are defined as “living microorganisms, which when administered in adequate amounts confer health benefits on the host.”[26] Probiotic supplementations can restore the microbiota; hence, many probiotics modulate immunomodulatory effects by the production of certain factors and metabolites that affect the growth and function of intestinal epithelial and immune cells, henceforth, introduce beneficial functions to gut microbial communities, resulting in improvement or inhibition of gut inflammation and other intestinal or systemic disease.[23],[27],[28] Probiotic microorganisms are archetypally eaten as fermented foods, for example, cheeses, yoghurts, and generally comprise of lactobacilli and/or bifidobacterium. They are classically anaerobic organisms and ferment consumed food to yield lactic acid in intestines. Probiotics control and defeat the prospective pathogenic microorganisms in the human digestive tract through their inherent natural physiognomies.[28] Furthermore, probiotics control hosts innate and adaptive immune responses by modulating the functions of dendritic cells, macrophages, and T and B lymphocytes, and upregulating or potentiating the generation of Tregs by tolerogenic dendritic cells in mesenteric lymph node.[28],[29],[30],[31] Henceforth, probiotics can be utilized in the treatment of allergic rhinitis.[28] Another study reported that “the combination of antibiotics and anti-inflammatory therapy significantly decreased sinus microbiota biodiversity in postoperative maxillary sinuses.”[32] Furthermore, patients often became populated by the spices that were less susceptible to the prescribed antibiotics.[32] Another study reported that the dissimilarity in microbiota arrangement could be clarified by interpersonal differences, rather than sampling from anterior nares, inferior turbinate, and middle meatus on each side of the sinuses or even disease status of CRS. Furthermore, a big difference observed between folks, predominantly within the CRS cohort, proposes that dysbiosis in microbial community assembly could be the hammering force behind the CRS.[17] The microbial community varies greatly among CRS patients compared to healthy individuals. Nevertheless, the bacterial multiplicity of CRS patients was reduced.[17] Similar observations also noticed in cystic fibrosis and inflammatory bowel disease.[33],[34] A well-built and sustainable microbiota colony observed among healthy individuals proposes that dysbiosis in the microbial municipal is related to the incidence of CRS.[17] Consumption multiple regimens of prescribed antibiotics among CRS patients possibly instrumental for the lower bacterial diversity.[32]


  Biofilm and Chronic Rhinosinusitis Top


Microbes parallely share the planet earth with a human being and similarly involved in the struggle for existence. This struggle for existence permits them to evolve and construct procedures and process for existence and propagation.[35] Microorganisms generally have two life forms during growth and proliferation. In one form, the bacteria exist as single, independent cells (planktonic) whereas, in the other form, bacteria are organized into sessile aggregates. The latter form is commonly referred to as the biofilm growth phenotype.”[36] The formation of biofilms is one of the leading instruments of microbes to defend their community. These biofilm-colonies often contain potentially pathogenic microorganisms and intimidating human health and increasing health-care cost.[35] The concept of biofilm dated back to the 17th century, when Antonie Van Leeuwenhoek - the architect of the microscope, saw microbial collections (now known to be Biofilms) on scrapings of tooth surfaces.[37],[38] The term “Biofilm” was developed by Bill Costerton in 1978.[37] Biofilms are typically defined “as surface-associated microbial communities, surrounded by an extracellular polymeric substance matrix.”[39] A biofilm is an accretion of microbial cells that is irrevocably allied (not detached by moderate washing) with a surface and bounded in a medium of the primary polysaccharide. Noncellular constituents may also compose the biofilm matrix such as mineral crystals, corrosion particles, clay or silt particles, or blood components, depending on the setting in which the biofilm has been developed.[40] Multiple chronic infections such as cystic fibrosis pneumonia, chronic otitis media, CRS, and recurrent urinary tract infections caused by Pseudomonas aeruginosa, Haemophilus influenzae and Streptococcus pneumoniae, Staphylococcus aureus, and enteropathogenic Escherichia coli, respectively, are linked to biofilm formation.[39] Acute infections are presumed to comprise of planktonic (a diverse collection of microorganisms), largely treatable with antimicrobials, although effective treatment depends on the early and precise diagnosis.[36],[41] Nevertheless, if the microbes get ahead in establishing a biofilm within the human host, the infection frequently becomes fatal and difficult to treat and progresses into a chronic state.[36] The most paramount clinical issues regarding chronic biofilm-based infections are life-threatening antimicrobial resistance, their utmost potential for escaping the human host defense mechanisms.[36],[42]

CRS is a polymicrobial disease, which comprises planktonic and biofilm infections with bacterial and fungal microorganisms.[41] Microorganism biofilms are exceedingly systematized assemblies comprised different colonies of microbes wrapped within a shielding with the extracellular matrix.[43] These biofilm microorganisms are “a very sophisticated community of pathogens,” some of which will likely survive a simple chemical treatment. Often these microorganisms are able to tolerate and survive chemical treatment. Cultures of sinus swab frequently fail to provide enough evidence of the cause of disease.[41] Furthermore, bacterial biofilms are 3-dimensional aggregates of bacteria that have superior qualities owing to their group organization, including increased resistance to antimicrobials.[44],[45] Multiple types of research reported that certain bacterial biofilms CRS did not respond to traditional medical and surgical therapies.[43],[45],[46]


  Role of Microbiota over Biofilm and Chronic Rhinosinusitis Top


Microbiota is known to impede a pathological microbial settlement; nevertheless, multifaceted host-microbe and microbe-microbe relations have made it tough to attain a comprehensive understanding of the mechanisms involved in the inhibition of colonization.[47]Staphylococcus epidermidis is an eternal member of the normal human microbiota, normally found on the skin and mucous membranes.[48] It had been observed that Staphylococcus epidermidis a symbiotic microbe secreting the serine protease inhibits S. aureus colonization and biofilm formation and disassembles preformed S. aureus biofilms in the nasal cavity.[48],[49],[50] The serine protease effectively degraded biofilm formed by methicillin-resistant S. aureus and vancomycin-intermediate S. aureus.[51],[52]S. aureus and P. aeruginosa are major delinquent in the growth of obstinate severe airway disease in CRS and cystic fibrosis patients.[53] Moreover, the rapid development of resistant microorganism throughout the planet, jeopardizing the efficacy of antimicrobials, which have once changed medicine and protected millions of lives. Antimicrobial resistance has been currently identified as most dangerous threats to human health.[54],[55] Henceforth, the manoeuver and instigation of precisely healthy microbiota may demonstrate to be beneficial for the treatment of CRS.[53],[56]


  Conclusion Top


“CRS involves a complex interplay of infectious, inflammatory, and host factors. Biofilms are the preferred state of bacterial existence.”[57] An imbalance or dysbiosis in community of microbiota could be the powerful energy behind CRS. Microbiota bacterial colonial multiplicity was suggestively lower in CRS samples compared to those from healthy subjects.[17] The microbiota of paranasal sinuses and nasal cavity gives the idea to have possibly auspicious roles in many aspects in treatment of CRS.[16] Finally, in future research will generate “a better understanding of biofilm function and their contribution to the CRS disease process will be pivotal to the development of novel treatments that may augment and potentially, redefine the CRS treatment paradigm.”[57]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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