ROLE OF STAPHYLOCOCCUS AUREUS AND ITS BIOFILM FORMATION IN THE CLINICAL COURSE OF ACUTE TONSILLITIS: ANALYSIS OF CLINICAL INDICATORS
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i4.15779Keywords:
Staphylococcus aureus, bacteriological analysis, VAS scale, Centor, smoking, Streptococcus pyogenes, biofilmAbstract
SUMMARY. Acute tonsillitis remains one of the most common diseases of the ENT organs in the practice of a family doctor. Traditionally, the focus has been on group A β-haemolytic streptococcus as the leading pathogen, but the involvement of other bacteria, such as Staphylococcus aureus, requires further study, especially given their ability to form biofilms.
The aim – to evaluate the role of S. aureus (including biofilm forms) and β-haemolytic streptococcus in the clinical course of acute tonsillitis.
Material and Methods. 53 patients diagnosed with acute tonsillitis (mean age – 33.98±16.52 years) were included in the prospective study. All patients underwent bacteriological examination of tonsil swabs and clinical parameters were evaluated: duration of symptoms, pain intensity (VAS), Centor scale. The associations between the presence of biofilm, pathogens, pain, and clinical course were studied.
Results. β-haemolytic streptococcus was detected in 5.6 % of cases, S. aureus – in 13.2 %, of which 85.7 % formed a biofilm. Biofilm S. aureus was significantly associated with a longer course (66.7 % had symptoms for 6-9 days; p<0.00001). There was no association between biofilm and pain intensity or smoking. In all cases of streptococcus detection, patients had a Centor score of 3–4.
Conclusions. S. aureus, especially those with biofilm-forming capabilities, can affect the duration of acute tonsillitis. The Centor scale is a useful tool for detecting streptococcal etiology, but does not allow predicting the course of the disease.
References
Caldwell JM, Ledeboer NA, Boyanton BL. Review: Known, Emerging, and Remerging Pharyngitis Pathogens. J Infect Dis. 2024 Nov 15;230(Suppl 3):S173–81. DOI: 10.1093/infdis/jiae391. DOI: https://doi.org/10.1093/infdis/jiae391
Biała M, Babicki M, Malchrzak W, Janiak S, Gajowiak D, Żak A, et al. Frequency of Group A Streptococcus Infection and Analysis of Antibiotic Use in Patients with Pharyngitis - A Retrospective, Multicenter Study. Pathogens (Basel). 2024 Oct;13(10):846. DOI: https://doi.org/10.3390/pathogens13100846
Mustafa Z, Ghaffari M. Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review. Front Cell Infect Microbiol. 2020;10:563627. DOI: 10.3389/fcimb.2020. 563627. DOI: https://doi.org/10.3389/fcimb.2020.563627
Barsenga S, Mitiku H, Tesfa T, et al. Throat carriage rate, associated factors, and antimicrobial susceptibility pattern of group A Streptococcus among healthy school children in Jigjiga City, Eastern Ethiopia. BMC Pediatr. 2022;22(1):227. DOI: 10.1186/s12887-022-03294-2. DOI: https://doi.org/10.1186/s12887-022-03294-2
Hussein SA, Rasheed TK. Role of Staphylococcus aureus and Streptococcus pyogenes Biofilms on the Alternation of Cellular Immunity in Pediatric Tonsillitis Patients. Karbala Int J Mod Sci. 2025;11(3):Article 9. DOI: 10.33640/2405-609X.3418. DOI: https://doi.org/10.33640/2405-609X.3418
Kravets NYa, Klumnyk SI, Romanyuk LB, Borak VP. Biofilm-forming properties of pathogenic micro-organisms in children with recurrent tonsillitis. Svit Med Biol. 2022;2(80):210–3. DOI: 10.26724/2079-8334-2022-2-80-210-213 DOI: https://doi.org/10.26724/2079-8334-2022-2-80-210-213
Kostić M, Ivanov M, Babić SS, Tepavčević Z, Radanović O, Soković M, et al. Analysis of Tonsil Tissues from Patients Diagnosed with Chronic Tonsillitis—Microbiological Profile, Biofilm-Forming Capacity and Histology. Antibiotics (Basel). 2022 Dec;11(12):1747. DOI: 10.3390/antibiotics11121747. DOI: https://doi.org/10.3390/antibiotics11121747
Zautner AE, Krause M, Stropahl G, Holtfreter S, Frickmann H, Maletzki C, et al. Intracellular Persisting Staphylococcus aureus Is the Major Pathogen in Recurrent Tonsillitis. PLoS One. 2010 Mar;5(3):e9452. DOI: 10.1371/journal.pone.0009452. DOI: https://doi.org/10.1371/journal.pone.0009452
Viksne R, Racenis K, Broks R, Balode AO, Kise L, Kroica J. In Vitro Assessment of Biofilm Production, Antibacterial Resistance of Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Obtained from Tonsillar Crypts of Healthy Adults. Microorganisms. 2023 Feb;11(2):258. DOI: 10.3390/microorganisms11020258. DOI: https://doi.org/10.3390/microorganisms11020258
Shi L, Wu Y, Yang C, et al. Effect of nicotine on Staphylococcus aureus biofilm formation and virulence factors. Sci Rep. 2019 Dec;9(1):20243. DOI: 10.1038/s41598-019-56627-0. DOI: https://doi.org/10.1038/s41598-019-56627-0
Ogba OM, Ewa JJ, Olorode OA, Mbah M. Effect of Tobacco Smoking on Oral Microbial Flora and the Relationship with Oral Health in Calabar, Nigeria. Int J Biomed Lab Sci. 2017;6(1-2):1–5.
Kjerulff B, Kaspersen KA, Dinh KM, Boldsen J, Mikkelsen S, Erikstrup LT, et al. Smoking is associated with infection risk in healthy blood donors. Clin Microbiol Infect. 2023 Apr;29(4):506-14. DOI: 10.1016/j.cmi.2022. 10.020. DOI: https://doi.org/10.1016/j.cmi.2022.10.020
Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy. Tonzylit. [Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. Tonsillitis.] 2021. URL: https://www.dec.gov.ua/wp-content/uploads/2021/04/ 2021_639_kn_tonzylit.pdf. Ukrainian
Bergey’s Manual of Systematic Bacteriology. New York: Springer-Verlag; 2012. p. 2083.
Klymniuk SI, Sytnyk IO, Shirobokov VP. Praktychna mikrobiolohiya: navchal'nyy posibnyk [Practical microbiology: a textbook]. Vinnytsia: Nova Knyga; 2018. 576 p. Ukrainian.
Stepanovic S, Vukovic D, Dakic I, Savic B, Svabic-Vlahovic M. A modified microtiter-plate test for quantification of staphylococcal biofilm formation. J Microbiol Methods. 2000 Apr;40(2):175–9. DOI: 10.1016/s0167-7012(00)00122-6. DOI: https://doi.org/10.1016/S0167-7012(00)00122-6
Bakar Z, McKimm J, Haque A, et al. Chronic tonsillitis and biofilms: a brief overview of treatment modalities. J Inflamm Res. 2018;11:421–430. DOI: 10.2147/JIR.S162486 DOI: https://doi.org/10.2147/JIR.S187032
