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Medical Forum / Diseases and Disorders / Sinusitis / July 2006Biofilms
JAMA: the Journal of the American Medical Association, reported this week that they did a study and directly observed biofilms in the ears of children with chronic otitis media: and they conclude "the biofilms persist and resist both the host immune response and antibiotic treatment." It's the 7/12/06 JAMA, "Direct Detection of Bacterial Biofilms on the MIddle-Ear Mucosa of Children with Chronic Otits Media", Hall-Stoodley, et al, vol 296, no 2 p202-211 The abstract is likely available without a subscription: http://jama.ama-assn.org/cgi/content/short/296/2/202 So, it's not that hard to extrapolate the theory to chronic sinusitis. We already know that biofilms are an issue in cystic fibrosis and a diffuse panbronchiolitis syndrome (where people get colonized with pseudomonas.) Both cystic fibrosis and the panbronchiolitis respond to macrolides: azithromycin pulses in cystic fibrosis and low dose macrolides in panbronchiolitis. The macrolides are lousy pseudomonas drugs, but they disrupt biofilms. I saw the article, and it seemed like it related to chronic sinusitis. Just my opinion. Judy > JAMA: the Journal of the American Medical Association, reported this > week that they did a study and directly observed biofilms in the ears > of children with chronic otitis media: and they conclude "the biofilms > persist and resist both the host immune response and antibiotic > treatment." So here's a lay question from one who hasn't read a lot about biofilms: do they only resist host immune response, or are they in any way possibly a result of it? Are they created by organisms as a way to maintain an environment more conducive to their survival? > It's the 7/12/06 JAMA, "Direct Detection of Bacterial Biofilms on the > MIddle-Ear Mucosa of Children with Chronic Otits Media", Hall-Stoodley, [quoted text clipped - 13 lines] > Just my opinion. > Judy It does seem highly relevent, thanks yet again. It kind of makes me feel unarmed and sort of hopeless in a battle with a tenacious foe, though. :-/ Susan Susan, We need a scientist here, but here's the quote from the intro to the article: "Biofilms consist of aggregated bacteria, usually adherent to a surface, surrounded by an extracellular matrix, and have been implicated in several chronic bacterial infections." They reference for this statement 1) Science 1999, Bacterial biofilms: a common cause of persistant infections., Costerton et al 2) Nat Rev Microbiol 2004, Biofilms, from the natural environment to infectious diseases. Hall-Stoodley et al I'm guessing, but I think the answer to both your questions is yes: definitely biofilms assist the organisms' survival, I'm less sure if if they're created in response to the host immune/inflammatory response. My husband is a dentist, and he gets all these articles warning him of biofilm development in his water tubing and the need to break it up with bleach/mechanical flushing. After the first article, I started boiling my irrigation water. But in water tubes, there's no host response. Judy > x-no-archive: yes > [quoted text clipped - 32 lines] > > Susan > Susan, > We need a scientist here, but here's the quote from the intro to the > article: > "Biofilms consist of aggregated bacteria, usually adherent to a > surface, surrounded by an extracellular matrix, and have been > implicated in several chronic bacterial infections." > They reference for this statement > 1) Science 1999, Bacterial biofilms: a common cause of persistant [quoted text clipped - 10 lines] > boiling my irrigation water. But in water tubes, there's no host > response. Thanks, Judy. I guess biofilm is what my teenager grew on the kitchen sponges while we were on vacation for a week last year. The smell! :-D Susan I believe that's why I have found the 10% xylitol solution has worked so well for me and hopefully others if they try it. The principle involved is that the xylitol solution prevents adhesion of the biofilm to the mucous membrane. When I started my 'sinus steeping' there were great gobs of mucous that would come out. Eventually, the amount of mucous was negligible which corresponded to my no longer having a sinus infection. For those interested here is the relevant part of the abstract. from PubMed: http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=... "Furthermore, in a double-blind, randomized, crossover study, xylitol sprayed for 4 days into each nostril of normal volunteers significantly decreased the number of nasal coagulase-negative Staphylococcus compared with saline control. Xylitol may be of value in decreasing ASL salt concentration and enhancing the innate antimicrobial defense at the airway surface". Geoff > Susan, > We need a scientist here, but here's the quote from the intro to the > article: > "Biofilms consist of aggregated bacteria, usually adherent to a > surface, surrounded by an extracellular matrix, and have been > implicated in several chronic bacterial infections." > I believe that's why I have found the 10% xylitol solution has worked > so well for me and hopefully others if they try it. The principle [quoted text clipped - 5 lines] > abstract. from PubMed: > http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=... This link didn't work for me. > "Furthermore, in a double-blind, randomized, crossover study, > xylitol sprayed for 4 days into each nostril of normal volunteers [quoted text clipped - 3 lines] > decreasing ASL salt concentration and enhancing the innate > antimicrobial defense at the airway surface". How does this address biofilm directly? Susan > How does this address biofilm directly? > > Susan I believe it has to do with adhesion of the bacteria to the mucous membrane. The bacteria are part of the biofilm. Here is the abstract of the first paper I posted on xylitol: Ultrastructure of Streptococcus pneumoniae after exposure to xylitol. Tapiainen T, Sormunen R, Kaijalainen T, Kontiokari T, Ikaheimo I, Uhari M. Department of Pediatrics, University of Oulu, PO Box 5000, FIN-90014, Oulu. OBJECTIVES: Xylitol is a sugar alcohol which reduces the growth of Streptococcus pneumoniae and the adherence of pneumococci and Haemophilus influenzae to nasopharyngeal cells. Xylitol prevents acute otitis media but does not decrease nasopharyngeal carriage of pneumococci. We hypothesized that xylitol could affect the surface structures of viable pneumococci, which would further explain the mechanism of action of xylitol in preventing acute otitis media. METHODS: We exposed five strains of pneumococci to 0.5%-5% xylitol, 5% glucose, 5% fructose and 5% sorbitol or control medium (brain heart infusion) for 0.5-2 h and examined the ultrastructure of bacteria by electron microscopy. RESULTS: The cell wall of pneumococci became more diffuse, the polysaccharide capsule became ragged and the proportion of damaged pneumococci increased after exposure to xylitol for 2 h, but not after exposure to other sugars or control medium. The phenotype of all pneumococcal strains was opaque before xylitol exposure and became almost transparent both in xylitol and in control medium during the experiment. CONCLUSIONS: This study demonstrates further that xylitol has a harmful effect on pneumococci. The observed changes in the polysaccharide capsule and the cell wall of pneumococci could affect the adherence and virulence of pneumococci, explaining the good clinical efficacy of xylitol in the prevention of acute otitis media. PMID: 15190027 [PubMed - indexed for MEDLINE] and here is the proper link to the other xylitol paper, Geoff http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=11027360 >>How does this address biofilm directly? >> [quoted text clipped - 3 lines] > membrane. The bacteria are part of the biofilm. Here is the abstract > of the first paper I posted on xylitol: Can you remind us again of the xylitol % and preparation you're using, and how often? Thanks. Susan No solution here: but a decent wikepedia site explaining biofilms: http://en.wikipedia.org/wiki/Biofilm I think the key is to break up the film with it's matrix, and solvents, or agents like xylitol, or even irrigation may all be helpful. I do think they are part of the reason why the sinuses, those remote areas, are so tough to clear up, and why in the face of a persisting biofilm, the infections come back. Judy > x-no-archive: yes > [quoted text clipped - 12 lines] > > Susan > Can you remind us again of the xylitol % and preparation you're using, > and how often? > > Thanks. > > Susan Hi Susan. Here's the xylitol solution I use: I mix 3 tablespoons or 45 ml of 100% pure xylitol in 250 ml of water. I used to mix salt but after reading how salt can reduce the anti-bacterial substances in the mucous I stopped. (See the link above to the complete paper at PubMed). I used to use this 100% solution about every 2 hours when I had my severe sinus infection back in the middle of June. But now the xylitol seems to have cured it. I can say unequivocally that the xylitol did cure it as the different antibiotics I tried had no effect. I steep my sinuses, by that I mean I put the solution in my sinuses and let this solution stay in there for several minutes. I get the mixture in my sinuses by tilting my head and gently squirting the mixture in through my nostril and then lying down for several minutes on my back being careful to try to prevent the solution from dribbling out of my nose. After several minutes, I drain the solution from my nostrils and gently blow my nose and then lean forward and shake my head back and forth to really get all the mucous that would come out of my nose but now there's almost nothing so I'm just doing this procedure once in the morning and once at night as a preventitive. I hope it helps you as it has helped me Good luck, Geoff >>Can you remind us again of the xylitol % and preparation you're using, >>and how often? [quoted text clipped - 23 lines] > doing this procedure once in the morning and once at night as a > preventitive. I hope it helps you as it has helped me Good luck, Geoff Thanks, I'll try it starting today. As it happens, my bad sinus, the right ethmoid always steeps, It can take forever to get stuff to drain out of it, unless I lie down on my left side or til forward and to the left. Susan > Can you remind us again of the xylitol % and preparation you're using, > and how often? > > Thanks. > > Susan Hi Susan. Here's the xylitol solution I use: I mix 3 tablespoons or 45 ml of 100% pure xylitol in 250 ml of water. I used to mix salt but after reading how salt can reduce the anti-bacterial substances in the mucous I stopped. (See the link above to the complete paper at PubMed). I used to use this 100% solution about every 2 hours when I had my severe sinus infection back in the middle of June. But now the xylitol seems to have cured it. I can say unequivocally that the xylitol did cure it as the different antibiotics I tried had no effect. I steep my sinuses, by that I mean I put the solution in my sinuses and let this solution stay in there for several minutes. I get the mixture in my sinuses by tilting my head and gently squirting the mixture in through my nostril and then lying down for several minutes on my back being careful to try to prevent the solution from dribbling out of my nose. After several minutes, I drain the solution from my nostrils and gently blow my nose and then lean forward and shake my head back and forth to really get all the mucous that would come out of my nose but now there's almost nothing so I'm just doing this procedure once in the morning and once at night as a preventitive. I hope it helps you as it has helped me Good luck, Geoff |
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