Characterization and frequency of biofilms in adenotonsillitis: a retrospective study from a tertiary hospital in North-Eastern Nigeria

Background: Adenotonsillitis, a common condition characterized by inflammation of the adenoids and tonsils, is caused by bacterial and fungal pathogens. Biofilm formation has been linked to disease chronicity and antibiotic resistance. However, the role of biofilms in adenotonsillitis remains poorly understood. This study aims to explore biofilms in adenotonsillitis biopsies, focusing on their characterization, frequency, and demographic distribution by determining the expression of polysaccharides in the biofilm matrix using Congo red stain, determining the presence and frequency of bacterial as well as fungal biofilms in adenotonsillar tissue, investigating any potential associations with disease severity, and evaluating the age and sex distribution of patients with adenotonsillitis. Methods: This retrospective study analyzed formalin-fixed paraffin-embedded adenotonsillitis biopsies (n=50) collected from the university of Maiduguri teaching hospital. The expression of polysaccharides in the biofilm matrix was assessed using congo red stain. Bacterial and fungal biofilms were visualized using crystal violet and Gomori methenamine silver (GMS) stains, respectively. Data on patient demographics, diagnoses, and biofilm characteristics were analyzed. Results: Adenoidtonsillitis was the most common diagnosis (82%), predominantly affecting children aged 0-9 years (76%). Gram's reaction was positive in 70% of cases, while Congo red staining indicated polysaccharide expression in 60%. GMS staining revealed fungal elements in 18% of cases. Conclusions: This study sheds light on the characterization and frequency of bacterial and fungal biofilms in adenotonsillitis, emphasizing importance of biofilms in disease development and persistence. Understanding biofilm-associated infections can improve diagnostic and treatment strategies for adenotonsillitis in Nigeria and beyond