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Vol. 26, Art. 25 (pp. 590-626)    |    2025       

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Pilot study of the oropharyngeal microbiota in patients with pharyngomycosis

Maryna O. Miazheinikava, Irina D. Shlyaga, Kovalev A. Aliaksei, Ziatskov A. Aliaksei, Shaforost S. Aliaksandr

Educational institution "Gomel State Medical University"(EI «GSMU»), Republic of Belarus, Gomel, 246000

Brief summary

Introduction. Pharyngomycosis (PM) is a fungal infection of the pharynx, often associated with respiratory diseases (RD). Modern research highlights the role of pharyngeal microbiota imbalance in the pathogenesis of PM and its connection to neuropsychological disorders via the "pharynx-gut-brain" axis. The relevance of this work stems from the increasing incidence of PM (up to 30% of pharyngeal infections) and the insufficient study of its microbial profile. Objective. A pilot study of the pharyngeal microbiota in patients with PM as part of an algorithm for organizational measures for the early detection and diagnosis of pharyngeal mycosis associated with respiratory diseases. Materials and methods: The study involved three patients (two children aged 4 years and a 38-year-old woman) with RD and symptoms of PM. In all patients, the composition of the bacterial and fungal microbiota of pharyngeal secretions was studied using 16S rRNA sequencing (Illumina MiSeq platform) and ITS analysis. Bioinformatic data processing included quality control (FASTQC), adapter trimming (Trimmomatic), and taxonomic classification (Kraken2). Patients were examined according to an original algorithm for early detection and diagnosis of pharyngeal mycosis. Statistical data analysis was performed. The patient inclusion criteria for the study were: long-term pharyngeal mycosis (>1 year) against a background of respiratory diseases, confirmed clinically, microscopically, and microbiologically. The exclusion criterion was: the use of antibiotics or antimycotics within one month prior to the study. Results. All patients showed moderate-to-high anxiety levels (8-11 points on the Throat Mycosis Anxiety Questionnaire (TMAQ)) and a high risk (more than 6 points) of developing pharyngeal mycosis (PM) based on the Express Oral Mycosis Questionnaire (EOMQ). High individual variability of the microbiota was revealed: anaerobes Prevotella (22.5-31.1%), Veillonella (9.7-17.0%), and Fusobacterium (4.0-8.5%) dominated. All patients showed a deficiency of protective bacteria (Lactobacillus < 0.1%, Streptococcus reduced). The mycobiota included clinically significant fungi: Candida and Malassezia predominated in children, while Aspergillus (15.8%) and Malassezia predominated in the adult. Alpha-diversity indices confirmed dysbiosis (Shannon: 3.56-3.95), with higher diversity observed in the adult patient. Candidatus Nanosynbacter (an epiparasite) was detected in children, and a reduction in butyrate producers (Fusobacterium) was associated with the risk of respiratory complications. Conclusions. The study confirmed the absence of a universal microbial profile in PM against the background of RD, revealing key patterns: dominance of anaerobes, deficiency of symbionts, and the association of dysbiosis with anxiety. A personalized approach integrating NGS diagnostics (16S/ITS), microbiota correction (probiotic S. salivarius K12), an antifungal diet, and neurorehabilitation (breathing exercises, Tomatis method) demonstrated effectiveness in achieving remission. The algorithm for early detection of PM shows promise for implementation in clinical practice but requires validation in large cohorts. Important directions for further research include the development of probiotics based on butyrate producers and the study of the role of Candidatus Nanosynbacter in the pathology under investigation


Key words

pharyngeal mycosis, pharyngomycosis, respiratory diseases, microbiota, mycobiota, metagenomic analysis, biodiversity, high-throughput sequencing, anxiety.

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