The role of the local microbial ecosystem in respiratory health and disease

Wouter A A de Steenhuijsen Piters, Elisabeth A M Sanders, Debby Bogaert

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Respiratory tract infections are a major global health concern, accounting for highmorbidity and mortality, especially in young children and elderly individuals. Traditionally, highly common bacterial respiratory tract infections, including otitis media and pneumonia, were thought to be caused by a limited number of pathogens including Streptococcus pneumoniae andHaemophilus influenzae. However, these pathogens are also frequently observed commensal residents of the upper respiratory tract (URT) and form—together with harmless commensal bacteria, viruses and fungi—intricate ecological networks, collectively known as the ‘microbiome’. Analogous to the gut microbiome, the respiratory microbiome at equilibrium is thought to be beneficial to the host by priming the immune system and providing colonization resistance, while an imbalanced ecosystem might predispose to bacterial overgrowth and development of respiratory infections.We postulate that specific ecological perturbations of the bacterial communities in the URT can occur in response to various lifestyle or environmental effectors, leading to diminished colonization resistance, loss of containment of newly acquired or resident pathogens, preluding bacterial overgrowth, ultimately resulting in local or systemic bacterial infections. Here, we review the current body of literature regarding nichespecific upper respiratory microbiota profiles within human hosts and the changes occurring within these profiles that are associated with respiratory infections.

Original languageEnglish
Article number20140294g1647
JournalPhilosophical Transactions of the Royal Society B: Biological Sciences
Issue number1675
Publication statusPublished - 19 Aug 2015


  • Bacterial interaction
  • Colonization resistance
  • Microbiome
  • Pathogenesis
  • Respiratory infections
  • Upper respiratory tract

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