An infection that lasts longer than 3 months is usually termed as a chronic infection. It causes low grade but persistent symptoms. Such an infection is not easy for the body to fight, nor is it easy to eradicate using medication. It becomes “stubborn”, and often leaves the sufferer clueless about how to deal with it. A factor that plays an important role in infections becoming chronic is Biofilm.
What is a Biofilm?
A biofilm is a colony that consists of microorganisms that stick to each other. These microbes like bacteria, fungi and protozoa, while sticking to each other, form a slimy film or coating around their colony to protect themselves from attack – whether by the immune system of the organism they are infecting, or by medicines like antibiotics.
Biofilms usually form on a surface. It could be a living surface like human tissue or a non-living surface like a catheter. A common example of a biofilm that forms within the human body is dental plaque. Biofilms can be notoriously difficult to eradicate. This is because of how the organisms within the biofilm interact with each other.
Biofilms and Bacteria
Biofilms typically consist of multiple bacterial species like Enterococcus, Staphylococcus, Streptococcus etc., and sometimes fungi and protozoa as well. These microbes that form the biofilm communicate with each other. Research into biofilms compares them to a microorganism city. They have communication and nutritional networks that allow all the microorganisms inside to live and thrive together. Their protective layer is impenetrable by the body’s immunity and most of the antibiotics available today.
The scary part is this – these microbes don’t just live together in the biofilm. They also share their resistance patterns and genes with other bacteria living in the biofilm. So, if an Enterococcus bacterium is resistant to an antibiotic, it can pass on that resistance to a Staphylococcus bacterium that lives in the same biofilm. This means that even if you initially get an infection that antibiotics can eradicate, once it forms a biofilm with another bacterium that is antibiotic resistant, the pathogen can acquire this resistance as well and continue to infect you despite your best measures to get rid of it.
Not all infections create biofilms. Acute infections generate an immediate response from our body, and our immune systems or the antibiotics we may take after proper testing are generally able to finish these infections successfully.
However, once a biofilm is formed, pathogens can live in it and stay protected. They keep releasing planktonic (or free floating) bacteria into the body. This is what causes the low grade but persistent symptoms that are characteristic of a chronic infection. When you take antibiotics for it, these planktonic bacteria may be eradicated, providing temporary relief in symptoms. But the colony itself stays unharmed, ready to send out more planktonic bacteria, and the cycle goes on.
Role of Biofilm in Chronic Prostatitis
Prostatitis is a condition that can easily become chronic. Once bacterial pathogens infect the prostate, the body’s immunity recognises the invasion and begins to send its soldiers, the White Blood Cells (or WBCs) to fight the infection. It also causes inflammation in the infected region to be able to contain the area of infection. However, the prostate is a gland that has limited blood supply (or vascularity). If it gets an infection, the low vascularity works counter-productively for the gland, as the WBCs do not reach in sufficient quantities to eradicate the infection.
Even if antibiotics are used to treat such infections, the low vascularity limits the quantity of antibiotics reaching the prostate gland. These sub-lethal doses of antibiotics and WBCs trigger resistance formation in the bacterial pathogens. As time passes, the bacteria stick together and attach themselves to the tissues on the inside of the prostate gland and form biofilms.
Once a biofilm is formed, the condition usually becomes chronic. Biofilms release planktonic bacteria that cause the low-grade symptoms of chronic prostatitis, but the main colony of the offending pathogens sits comfortably inside. You take antibiotics and feel better for the duration of the course because the antibiotics are killing the planktonic bacteria. But once you finish the course, the symptoms return, sometimes even a few months later, as the biofilm releases fresh planktonic bacteria.
Here is a video of Dr John William Costerton, popularly known as the “Father of Biofilms”, explaining the role of biofilms in chronic infectious diseases. I highly recommend a watch:
Chronic prostatitis is essentially a biofilm disease, and that is why it is so difficult to treat. The key to dealing with it successfully is to find a treatment that is able to attack and completely eradicate biofilms and the pathogens hidden inside them.