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Unlock the Mystery of Microbial Biofilms in Chronic and Recurrent Infections

Likely, you are familiar with situations where an illness proves difficult to treat. For instance, a person consults a doctor, who prescribes an antibiotic, but the problem only temporarily subsides, only to return later. Subsequent attempts to use a broader spectrum of antibiotics also prove ineffective. Sometimes, after treatment, the situation even worsens. All of this can lead to a loss of faith in medicine and even self-medication or seeking help from traditional healers.

In reality, there is no mystique here; the problem of biofilm formation and its impact on treatment effectiveness is known and actively studied in medical science. The understanding of biofilm existence emerged more than 15 years ago. However, often treatment is still directed at individual microorganisms that are not part of the biofilm. This may help in treating an acute illness, but once the biofilm has formed, attention must be paid to its treatment; otherwise, the problem may seem insurmountable.

It is also important for doctors to consider the possibility of biofilm presence when treating infections and adjust their treatment strategies accordingly. This approach will allow for a more effective fight against infections and prevent their recurrence, ultimately helping to maintain patients’ trust in medical care and prevent self-medication.

What are biofilms?

So, what are biofilms? Biofilms are communities of microorganisms that form complex structures on various surfaces, such as skin, teeth, respiratory, circulatory systems, and the digestive tract. These structures consist of microorganisms and include bacteria, fungi, mold, viruses, heavy metals, and other substances. Biofilms form dense matrices of biopolymers that protect them from external factors, including antimicrobial agents, the surrounding environment, and the body’s immune system.

Biofilms play an important role in many aspects of health. They can be both beneficial and harmful to the body. For example, biofilms on the skin protect it from infections, while biofilms on teeth can lead to the development of cavities and periodontitis.

How can the symptoms indicating the presence of a biofilm appear?

Symptoms associated with biofilms may include pain, inflammation, bleeding gums, tooth sensitivity, frequent urination, stomach and intestinal pain, vaginal discharge, etc. However, these same symptoms can also be present in a regular infection that has not yet formed a biofilm. It is more important to understand how these issues may manifest in the long term.

How might problems associated with biofilms appear?

  1. Chronic infections: Biofilms can cause chronic infections, resulting in persistent or periodic symptoms such as pain, discomfort, swelling, discharge, etc.
  2. Treatment resistance: Infections associated with biofilms may resist standard treatment methods such as antibiotics. This can lead to ineffective treatment outcomes or temporary improvement followed by symptom recurrence.
  3. Adverse reactions to antibiotics: Some individuals may experience adverse side effects from antibiotics used to treat biofilm-related infections. This may include gastrointestinal disturbances, allergic reactions, dysbiosis, etc.
  4. Vague or indefinite symptoms: Since biofilm infections can be challenging to detect and diagnose, symptoms may be nonspecific and diverse, complicating accurate diagnosis and treatment. Symptoms may also affect the individual’s mental and emotional well-being, leading to depression, fatigue, and more.
  5. Recurrence: Infections associated with biofilms tend to recur, with symptoms temporarily diminishing after treatment but then returning because biofilms persist and continue to cause infection.

How do biofilms affect health?

Biofilms can have a significant impact on health, causing various diseases and worsening quality of life. If the problems persist for a prolonged period, this can lead to serious consequences and diagnosis. Here are some of these problems:

Dental caries: Biofilms on the surface of teeth can lead to the development of cavities. Microbes in biofilms can produce acids that erode tooth enamel, leading to the formation of cavities.

Periodontitis: Biofilms accumulating on the gums and tooth roots can cause periodontal inflammation, which in turn can lead to periodontitis – a serious gum and bone disease supporting the teeth.

Urinary tract infections: Biofilms forming on the mucous membranes of the urinary tract can be a source of chronic and recurrent urinary tract infections, such as cystitis and pyelonephritis.

Osteomyelitis: Biofilms on the surface of bones can cause inflammation and infection of the bone marrow, leading to a serious condition – osteomyelitis.

Chronic wounds: Biofilms can form in chronic wounds, hindering their healing and increasing the risk of chronic infection.

Bacterial endocarditis: Biofilms on the surface of heart valves can be a source of infection, leading to bacterial endocarditis.

Other infectious diseases: Biofilms can also be associated with other infectious diseases, such as respiratory tract infections, gastrointestinal infections, vaginal infections, and other problems.

The process of biofilm formation

Now, let’s understand how biofilms can form. The process of biofilm formation plays a crucial role in creating a stable community of microorganisms on a surface. Here’s a brief overview of each stage:

  1. Bacterial accumulation: Initially, bacteria move towards the surface, where they can be transported by fluid flow or move chaotically.
  2. Attachment to the surface: Bacteria rarely attach directly to the surface. Instead, they deposit a layer of molecules called conditioning film, to which they then attach.
  3. Colonization: At this stage, bacteria begin to synthesize molecules of extracellular matrix, which contributes to an increase in the number of attached bacteria and the formation of dense bacterial clusters.
  4. Growth and spreading: Colonized cells continue to grow, leading to the formation of larger biofilm structures. If parts of the biofilm detach, they can reattach to another surface, contributing to the spread of the biofilm.

This process is essential for creating biofilm structures and ensuring the survival and resistance of microorganisms in diverse conditions.

What microorganisms can create biofilms?

Biofilms play a crucial role in the course of infections as they represent complex communities of microorganisms grouped into a matrix of extracellular polymers. The composition of biofilms can be highly complex, which, of course, affects their viability and resistance to medications and changing environmental conditions.

  • Bacteria such as Staphylococcus aureus and Streptococcus mutans are known for their ability to form biofilms. Within the biofilm, they can create a protective layer, making them more resistant to antibiotics and immune attacks.
  • Pseudomonas aeruginosa produces extracellular polymers such as alginate, making the biofilms it forms particularly dangerous for patients with weakened immune systems.
  • Helicobacter pylori – this bacterium adapts to the acidic environment of the stomach and forms biofilms on the surface of the mucous membrane, making it more resistant to treatment and leading to chronic gastritis and gastric ulcer disease.
  • Fungi such as Candida albicans and Aspergillus spp. can also form biofilms. These fungi are capable of forming dense structures in the respiratory tract or on tissue surfaces, which complicates their treatment.
  • Parasites, including Plasmodium spp., Toxoplasma gondii, Giardia lamblia, and Entamoeba histolytica, can also form biofilms. This makes them more resistant to antiparasitic drugs and increases their ability to cause chronic infections.
  • Viruses, including herpes simplex virus, influenza viruses, and coronaviruses, can also be found in biofilms. This can prolong the duration of infection and make it more resistant to treatment.
  • Heavy metals such as lead, mercury, and cadmium can also influence the formation and strengthening of biofilms. Accumulation of these metals in the body can create conditions for the formation of more resistant biofilms, leading to prolonged infections and complications.

How to prevent biofilm formation?

Preventive measures are always better and simpler than treating already-formed biofilms. In each specific case, there will be specific actions and agents that target that particular biofilm. Here are a few examples:

  • Regular oral hygiene, including brushing teeth twice a day, flossing periodically, and undergoing professional cleanings by hygienists, helps reduce the accumulation of biofilms on the tooth surfaces and gums. This also reduces the risk of serious cardiovascular complications.
  • Skin care, including daily washing and moisturizing, is also important for preventing pathogenic biofilms on the skin.
  • Proper use of the urinary system, such as frequent urination, urination after sexual activity, and adherence to hygienic practices, helps prevent urinary tract infections associated with biofilms.

Treatment of biofilms

This approach to treating biofilms allows for the best results and prevents the recurrence of infections. Let’s take a closer look at these stages:

  1. Destruction of the biofilm: This is the initial stage of treatment, where the goal is to destroy the biofilm and its structure. This can be achieved through various methods such as the use of antibiotics, ozone therapy, chelating agents, digestive enzymes, glutathione, and other specialized medications specifically designed to disrupt the biofilm structure.
  2. Elimination of microorganisms: After disrupting the external protective layer of the biofilm, the microorganisms within it are exposed on the surface and can be destroyed using various antimicrobial agents. This helps reduce the concentration of pathogens and prevents their further proliferation.
  3. Removal of toxins: After destroying the microorganisms, it’s important to remove the toxins they produced during their life cycle and those that emerged during their destruction. This can be achieved through detoxification procedures, increased fluid intake, the use of binding agents, adsorbents, and other methods.
  4. Restoration of healthy microflora: After cleansing the surface and removing pathogens, it’s essential to repopulate it with beneficial bacteria. This helps create a friendly biofilm that protects the body and prevents recurrence of infections.

Only a comprehensive approach to treating biofilms takes into account all aspects of this process and helps achieve the best results, minimizing the risk of complications and recurrences.

What is the Herx reaction?

The Herxheimer (Herx) reaction, also known as the die-off reaction or Jarisch-Herxheimer reaction, is a temporary worsening of symptoms in response to the treatment of an infection. It can occur when treating infections caused by bacteria, fungi, parasites, or viruses.

Here are some of the symptoms of a Herxheimer reaction:

  • Flu-like symptoms;
  • Fever and chills;
  • Nausea and vomiting;
  • Headache;
  • Low blood pressure;
  • Hyperventilation;
  • Tachycardia (a heart rate over 100 beats a minute);
  • Flushing;
  • Myalgia;
  • Worsening of skin lesions.

The reaction occurs because dying microorganisms release toxins into the bloodstream as a result of treatment. This leads to a temporary worsening of disease symptoms or the appearance of new symptoms.

Although the Herx reaction can be unpleasant and cause discomfort, it is usually considered a positive sign that the treatment is effective and the body is fighting the infection. However, in some cases, the reaction may be too strong and require adjustment of the treatment. It is currently believed that the Herx reaction more likely indicates that the treatment process is progressing too quickly and the protocol should be adjusted.

What else should be known about biofilms?

Biofilms play a key role in the evolution of microorganisms, ensuring their survival in diverse conditions. However, this is also what creates challenges in treating such infections.

  1. Genetic exchange: Microorganisms in biofilms can exchange genetic information, including plasmids, phages, and other mobile genetic elements. This process, known as horizontal genetic exchange, allows for the rapid transfer of genes, including those associated with antibiotic resistance.
  2. Rapid adaptation to changing environments: Biofilms have diverse areas, including those with increased or decreased concentrations of oxygen, nutrients, and other factors. This creates conditions for quick adaptation to changing environmental conditions, such as the presence of antibiotics or pH changes.
  3. Protection from stressful conditions: Biofilms provide protection for microorganisms from stressful conditions, such as high concentrations of antibiotics, extreme temperatures, or lack of nutrients. This is because biofilms create microenvironments where protective mechanisms can operate, such as antibiotic-induced resistance or the production of extracellular polymers.
  4. Adaptation to new conditions: Biofilms can quickly adapt to new conditions, including changes in the composition of microorganisms in response to changes in the surrounding environment or the presence of new pathogens. This allows them to effectively compete for resources and survive in diverse ecological niches.
  5. Importance of healthy microbiota: Healthy gut microbiota also constitutes a biofilm that protects us from pathogens and helps maintain our health. It’s important to note that for the same reason, taking antibiotics and antiparasitic drugs cannot instantly eradicate your gut microbiota. Healthy microbiota is also a biofilm that protects itself. Top of Form


Biofilms are a dual phenomenon: they help microorganisms survive and adapt, but they can also cause problems, especially when associated with infections. Their ability to exchange genes makes them even more resistant to drugs. However, it is important to remember that biofilms can also be created by beneficial bacteria to protect the body. Proper management of biofilms and prevention of the formation of pathogenic biofilms can significantly improve health and prevent serious issues.