A new disease paradigm - Mucosal and stromal intracellular bacteria in the upper respiratory tract

Background Recently intracellular bacteria have been noted in the middle ear mucosa of children with recurrent acute otitis media (rAOM) and otitis media with effusion (OME). Intracellular mucosal bacteria have also been reported in the bladder mucosa and lower respiratory tract mucosa in children with cystic fibrosis. With evidence of bacterial biofilm being found commonly on the adenoids of children with rAOM and chronic sinusitis and within the crypts of the tonsillar fossae, we hypothesize that intracellular bacteria will be present in the adenoid and tonsillar tissue. Objective To show the presence of intracellular bacteria in the adenoid and tonsillar stromal tissues of children with rAOM and adeno-tonsillar hypertrophy, and to determine the bacterial types present in these tissues. Methods Fluorescence in situ hybridisation (FISH) coupled with confocal laser scanning microscopy of the adenoidal and tonsillar tissues of children with recurrent tonsillitis and obstructive sleep disorder was performed. Results Intracellular bacteria were found in the stroma of the adenoids and tonsils as noticed previously in the middle ear mucosa of children with rAOM. These were identified by FISH testing as being S pneumoniae, H. influenzae and M. catarrhalis species. Discussion The presence of intracellular bacteria in the stroma of the tonsils and adenoids in children with recurrent tonsillitis and obstructive sleep disorder and in the middle ear mucosa of children with rAOM/OME may explain the apparent failure of antibiotic treatment of these conditions. It may indicate a need for a different treatment regime for this disease utilizing antibiotics which can penetrate and concentrate intracellularly.