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Merino LA, Ronconi MC, Hreñuk GE, de Pepe MG. Bacteriologic findings in Patients with Chronic Sinusitis. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130308201014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luis Antonio Merino
- Laboratory Dr. Botello, Corrientes, Argentina
- Department of Bacteriology, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | - María Cristina Ronconi
- Department of Bacteriology, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
| | - Gabriela Edith Hreñuk
- Department of Bacteriology, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
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Nishizawa T, Kanemura H, Jinta T, Tamura T. Septic pulmonary embolism caused by Pseudomonas aeruginosa after a CO 2 laser surgery for rhinitis. BMJ Case Rep 2019; 12:12/3/e228420. [PMID: 30936347 DOI: 10.1136/bcr-2018-228420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old healthy patient had a fever and chest pain three days after nasal carbon dioxide (CO2) laser surgery for chronic and allergic rhinitis. In the emergency room, he was diagnosed as a right pneumothorax and managed as outpatients with oral antibiotic therapy and close follow-up. Six days later, in follow-up clinic, his presenting signs and symptoms included right chest pain, tachypnoea and elevated levels of white blood cell count and C reactive protein. He was diagnosed as septic pulmonary embolism (SPE) by the detection of multiple nodules with cavitation on chest CT. Culture of pleural fluids showed Pseudomonas aeruginosa Intravenous antibiotic treatment and drainage of the pleural effusion improved his condition. Since SPE occurred after nasal CO2 laser surgery in this case, careful attention should be paid to infectious complications of nasal CO2 laser surgery.
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Affiliation(s)
- Toshinori Nishizawa
- Internal Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Hiroaki Kanemura
- Division of Pulmonary Medicine, Thoracic Center, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Torahiko Jinta
- Division of Pulmonary Medicine, Thoracic Center, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Tomohide Tamura
- Division of Pulmonary Medicine, Thoracic Center, St Luke's International University, Chuo-ku, Tokyo, Japan
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3
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Araujo E, Palombini BC, Cantarelli V, Pereira A, Mariante A. Microbiology of Middle Meatus in Chronic Rhinosinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700103] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Nasal endoscopy allows the collection of middle meatus secretion samples and is an alternative method for determining microorganisms in rhinosinusitis. This study assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with ipsilateral maxillary sinus aspirates and microbiological data of healthy individuals. Methods Middle meatus samples were collected from 114 CRS patients for aerobic, anaerobic, and fungal cultures; maxillary sinus secretions were collected from 13 of these patients. Twenty-three healthy volunteers served as controls. Results Aerobes were isolated in 86% of CRS patients, anaerobes were isolated in 8% of CRS patients, and fungi were isolated in 11% of CRS patients; the most frequent microorganisms were Staphylococcus aureus (36%), coagulase-negative Staphylococcus (20%), and Streptococcus pneumoniae (17%). Middle meatus and maxillary sinus cultures presented the same pathogens in 80% of cases. In healthy individuals, coagulase-negative Staphylococcus (56%), S. aureus (39%), and S. pneumoniae (9%) were the most frequent isolates. Conclusion The culture of endoscopically collected middle meatus secretions is effective in identifying microorganisms in CRS patients.
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Affiliation(s)
- Elisabeth Araujo
- From the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno C. Palombini
- From the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vladimir Cantarelli
- Bacteriology and Molecular Biology Section, Weinmann Laboratory, Porto Alegre, Brazil
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4
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Gergeleit H, Bienert-Zeit A, Ohnesorge B. Cytologic and Microbiological Examination of Secretions From the Paranasal Sinuses in Horses and Other Species. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
Bacterial pathogens and microbiome alterations can contribute to the initiation and propagation of mucosal inflammation in chronic rhinosinusitis (CRS). In this article, the authors review the clinical and research implications of key pathogens, discuss the role of the microbiome, and connect bacteria to mechanisms of mucosal immunity relevant in CRS.
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Affiliation(s)
- Thad W Vickery
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado, 12631 East 17th Avenue, B205, Aurora, CO 80045, USA.
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6
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Brook I. The role of antibiotics in pediatric chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2017; 2:104-108. [PMID: 28894828 PMCID: PMC5527363 DOI: 10.1002/lio2.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 01/05/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology. Data source Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis. Results Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta‐lactamase producing aerobic and anaerobic organisms, amoxicillin‐clavulanate is the first‐line regimen for most patients. Clindamycin is adequate for penicillin‐allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy. Conclusions Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. Level of Evidence 7.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics Georgetown University School of Medicine Washington D.C. U.S.A
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Di Luca M, Navari E, Esin S, Menichini M, Barnini S, Trampuz A, Casani A, Batoni G. Detection of Biofilms in Biopsies from Chronic Rhinosinusitis Patients: In Vitro Biofilm Forming Ability and Antimicrobial Susceptibility Testing in Biofilm Mode of Growth of Isolated Bacteria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1057:1-27. [PMID: 28389992 DOI: 10.1007/5584_2017_34] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic rhinosinusitis (CRS) is the most common illness among chronic disorders that remains poorly understood from a pathogenic standpoint and has a significant impact on patient quality of life, as well as healthcare costs. Despite being widespread, little is known about the etiology of the CRS. Recent evidence, showing the presence of biofilms within the paranasal sinuses, suggests a role for biofilm in the pathogenesis. To elucidate the role of biofilm in the pathogenesis of CRS, we assessed the presence of biofilm at the infection site and the ability of the aerobic flora isolated from CRS patients to form biofilm in vitro. For selected bacterial strains the susceptibility profiles to antibiotics in biofilm condition was also evaluated.Staphylococci represented the majority of the isolates obtained from the infection site, with S. epidermidis being the most frequently isolated species. Other isolates were represented by Enterobacteriaceae or by species present in the oral flora. Confocal laser scanning microscopy (CLSM) of the mucosal biopsies taken from patients with CRS revealed the presence of biofilm in the majority of the samples. Strains isolated from the specific infection site of the CRS patients were able to form biofilm in vitro at moderate or high levels, when tested in optimized conditions. No biofilm was observed by CLSM in the biopsies from control patients, although the same biopsies were positive for staphylococci in microbiological culture analysis. Drug-susceptibility tests demonstrated that the susceptibility profile of planktonic bacteria differs from that of sessile bacteria in biofilms.
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Affiliation(s)
- Mariagrazia Di Luca
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy. .,NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Pisa, Italy. .,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.
| | - Elena Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Melissa Menichini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Andrej Trampuz
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin, Berlin, Germany.,Center for Musculoskeletal Surgery, Septic Unit Charité-Universitätsmedizin, Berlin, Germany
| | - Augusto Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy.,Microbiology Unit, Pisa University Hospital, Pisa, Italy
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8
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Microbiology of chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis 2016; 35:1059-68. [DOI: 10.1007/s10096-016-2640-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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Rajiv S, Drilling A, Bassiouni A, James C, Vreugde S, Wormald PJ. Topical colloidal silver as an anti-biofilm agent in aStaphylococcus aureuschronic rhinosinusitis sheep model. Int Forum Allergy Rhinol 2015; 5:283-8. [DOI: 10.1002/alr.21459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Sukanya Rajiv
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Amanda Drilling
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Ahmed Bassiouni
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Craig James
- Adelaide Pathology Partners; Adelaide Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; University of Adelaide; Adelaide Australia
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Abstract
There has been great interest in unraveling the complex inter-relationships between microbes and humans as they relate to human health and disease. This review will focus on recent advances in the appreciation and understanding of these relationships in terms of the upper respiratory tract, specifically the nose and paranasal sinuses.
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Affiliation(s)
- Michael T Wilson
- The Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, 55 Fruit Street, Cox 2-201, Boston, MA, 02114, USA
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11
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Colloidal silver: a novel treatment forStaphylococcus aureusbiofilms? Int Forum Allergy Rhinol 2014; 4:171-5. [DOI: 10.1002/alr.21259] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/13/2013] [Accepted: 10/22/2013] [Indexed: 11/07/2022]
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Hamilos DL. Host-microbial interactions in patients with chronic rhinosinusitis. J Allergy Clin Immunol 2013; 133:640-53.e4. [PMID: 24290275 PMCID: PMC7112254 DOI: 10.1016/j.jaci.2013.06.049] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 12/26/2022]
Abstract
There has been considerable investigation of host-microbial interactions in patients with chronic rhinosinusitis (CRS) in hopes of elucidating mechanisms of disease and better treatment. Most attention has been paid to bacterial infection and potential underlying defects in innate immunity. Bacterial biofilm is present in most patients with CRS undergoing surgical intervention, and its presence is associated with more severe disease and worse surgical outcomes. A role for viral or fungal infection in patients with CRS is less clear. There is no evidence for a primary defect in mucociliary clearance in most patients with CRS. Decreased levels of certain antimicrobial proteins, most notably lactoferrin, have been found in sinus secretions, whereas levels of other antimicrobial proteins have been found to be normal. No primary defects in Toll-like receptors have been found in patients with CRS, although a 50% reduced expression of Toll-like receptor 9 was reported in patients with recalcitrant nasal polyps. A polymorphism in a bitter taste receptor was recently associated with refractory CRS and persistent Pseudomonas aeruginosa infection. A downregulation of innate immunity by maladaptive TH2 tissue inflammation has also been described in patients with recalcitrant nasal polyps, suggesting a link to persistent infection. To date, an effective means of restoring host-microbial balance and mitigating disease in patients with CRS remains elusive.
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Affiliation(s)
- Daniel L Hamilos
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, Mass.
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Goggin R, Jardeleza C, Wormald PJ, Vreugde S. Corticosteroids directly reduceStaphylococcus aureusbiofilm growth: An in vitro study. Laryngoscope 2013; 124:602-7. [DOI: 10.1002/lary.24322] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/30/2013] [Accepted: 06/30/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Rachel Goggin
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Camille Jardeleza
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery; Queen Elizabeth Hospital and the University of Adelaide; Adelaide South Australia Australia
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Cleland EJ, Bassiouni A, Wormald PJ. The bacteriology of chronic rhinosinusitis and the pre-eminence of Staphylococcus aureus in revision patients. Int Forum Allergy Rhinol 2013; 3:642-6. [PMID: 23468020 DOI: 10.1002/alr.21159] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/15/2012] [Accepted: 12/14/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of bacteria in the etiopathogenesis of chronic rhinosinusitis (CRS) remains an area of interest. The impact of surgery and factors such as the presence of polyps, asthma, and aspirin sensitivity on the bacterial state are poorly understood. To determine the effect of these factors, this study examines the culture results from a large cohort of CRS patients. METHODS This retrospective study used the culture results from 513 CRS patients, which were analyzed for species growth and compared to factors such as previous surgery, presence of polyps, aspirin sensitivity, and asthma. Univariate and multivariate logistic regression models were used for statistical analysis. RESULTS Eighty-three percent (83%) of patients had a positive culture result. The average number of isolates detected per patient was 0.95. S. aureus was the most frequently cultured organism (35%), followed by P. aeruginosa (9%), Haemophilus spp. (7%), and S. pneumonia (5%). Revision patients were more likely to grow S. aureus (p = 0.001), P. aeruginosa (p = 0.044) and have a positive culture (p = 0.001). Asthma was correlated with a positive culture (p = 0.039). No difference was determined between polyp and nonpolyp patients for any of the bacterial outcomes. CONCLUSION This study highlights important factors in the bacteriology of CRS patients. S. aureus was the most prevalent species identified in our cohort, followed by P. aeruginosa. S. aureus rates of isolation were also significantly higher in patients undergoing revision surgery. No association was found between the presence of nasal polyposis and culture rates.
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Affiliation(s)
- Edward John Cleland
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Seiberling KA, Aruni W, Kim S, Scapa VI, Fletcher H, Church CA. The effect of intraoperative mupirocin irrigation on Staphylococcus aureus within the maxillary sinus. Int Forum Allergy Rhinol 2012. [PMID: 23192968 DOI: 10.1002/alr.21076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antibiotic irrigations are occasionally used during endoscopic sinus surgery when gross mucosal infection is present. These irrigations are thought to flush out pathogenic bacteria and decrease the bacterial load within the mucosal surfaces. This treatment, however, has not been studied in vivo and it is unknown whether antibiotic rinses produce a quantitative reduction in pathologic bacteria within the sinus mucosa. The objective of this study was to determine the relative abundance of Staphylococcus aureus within the maxillary sinus and to evaluate the impact of intraoperative mupirocin irrigation on bacterial burden. METHODS Sixteen patients with symmetric maxillary chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa on both sides. In each patient, the right side was irrigated with 240 mL of normal saline (NS) and the left side was irrigated with 240 mL of NS mixed with 60 mg mupirocin. Repeat maxillary sinus mucosal biopsies were taken from each side 7 to 10 days postsurgery. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and relative amount of S. aureus. RESULTS Mupirocin irrigations were found to significantly reduce the amount of S. aureus found within the maxillary sinus mucosa compared to NS alone. The average fold change between the pre- and posttreatment biopsies on the right and left was 9.05 and 97.42, respectively (p < 0.01). CONCLUSION Intraoperative mupirocin irrigations significantly reduce the amount of S. aureus detected within the diseased sinus mucosa at up to 10 days postoperatively.
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Affiliation(s)
- Kristin A Seiberling
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
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Jervis-Bardy J, Wormald PJ. Microbiological outcomes following mupirocin nasal washes for symptomatic, Staphylococcus aureus-positive chronic rhinosinusitis following endoscopic sinus surgery. Int Forum Allergy Rhinol 2011; 2:111-5. [DOI: 10.1002/alr.20106] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/20/2011] [Accepted: 10/09/2011] [Indexed: 11/11/2022]
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Abstract
Background Chronic rhinosinusitis (CRS) is a common inflammatory condition of the paranasal sinuses and nasal passages. CRS with nasal polyp (CRSwNP) is a subtype of CRS, and the pathogenesis of CRSwNP remains largely unclear. Methods This article reviews the literature regarding the pathophysiology of CRSwNP. Results Evidence suggests that altered innate immunity, adaptive immunity, tissue remodeling, and/or effects of microorganisms may play a role in the development of CRSwNP. Aberrant arachidonic acid metabolism may also contribute to the pathogenesis of CRSwNP in patients with aspirin-exacerbated respiratory disease. Conclusion There have been significant advances in the understanding pathophysiology of CRSwNP. Additional research is needed to elucidate these mechanisms and to determine their relative importance in the pathogenesis of CRSwNP.
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Affiliation(s)
- Joy Hsu
- From the Division of Allergy–Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anju T. Peters
- From the Division of Allergy–Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Jervis-Bardy J, Foreman A, Bray S, Tan L, Wormald PJ. Methylglyoxal-infused honey mimics the anti-Staphylococcus aureusbiofilm activity of manuka honey: Potential Implication in Chronic Rhinosinusitis. Laryngoscope 2011; 121:1104-7. [DOI: 10.1002/lary.21717] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ikeda K, Yokoi H, Kusunoki T, Saitoh T, Yao T, Kase K, Minekawa A, Inoshita A, Kawano K. Bacteriology of recurrent exacerbation of postoperative course in chronic rhinosinusitis in relation to asthma. Auris Nasus Larynx 2011; 38:469-73. [PMID: 21216117 DOI: 10.1016/j.anl.2010.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 10/06/2010] [Accepted: 10/06/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Co-mobidity of asthma is known to result in a poor prognosis of post-endoscopic sinus surgery (post-ESS). Bacterial infection may play a key role in recurrent pathophysiology of sinusitis in post-ESS. METHODS Forty-two patients with CRS associated with asthma undergoing ESS were enrolled. Bacterial culture was performed from the sinus cavity at the time of acute infectious episodes. Recurrence of sinonasal disease was analyzed in terms of steroid responsiveness and peak expiratory flow (PEF). RESULTS Totally 75 aspirates were obtained during post-ESS; 2 repeat aspirates from 10 patients, 3 from 5 patients, and 4 from 2 patients. Only 6 specimens (8.0%) obtained from 5 patients (11.9%) showed no growth whereas 83 isolates were recovered from 69 specimens. Sixteen patients had at least one episode of a significant decline of PEF. All except one patient complained of symptoms and signs of upper respiratory infections prior to a depression of PEF. Positive culture was obtained in 10 out of 11 patients examined at the time of acute exacerbation of CRS. CONCLUSION Bacterial infection may play a critical role of recurrent polyps and refractory symptoms during post-ESS follow-up. Moreover, worsening of sinusitis accompanies asthma exacerbation.
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Affiliation(s)
- Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington, DC, USA.
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Zurak K, Vagić D, Drvis P, Prohaska Potocnik C, Dzidic S, Kalogjera L. Bacterial colonization and granulocyte activation in chronic maxillary sinusitis in asthmatics and non-asthmatics. J Med Microbiol 2009; 58:1231-1235. [PMID: 19528156 DOI: 10.1099/jmm.0.010579-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The impact of bacterial colonization on the severity and pattern of chronic inflammation in rhinosinusitis is not clear. In this study, it was hypothesized that bacterial colonization of the sinus mucosa would have a greater impact on inflammatory response modulation in asthmatic patients than in non-asthmatic patients with chronic rhinosinusitis. In order to test this hypothesis, granulocyte activation was measured and related to bacteria identified in the sinus lavage. Lavages from the maxillary sinuses of 21 asthmatic and 19 non-asthmatic patients with chronic rhinosinusitis (CRS) were microbiologically examined for aerobic and anaerobic growth. Eosinophil cationic protein (ECP), an eosinophil activation marker, and myeloperoxidase (MPO), a neutrophil activation marker, were measured in the sinus lavages. Bacteria were recovered in 20/32 samples from the asthmatics and in 21/33 samples from the non-asthmatics. Gram-positive aerobes and anaerobes were slightly more common than Gram-negative bacteria. A different bacterial profile was found when comparing Gram-negatives between the groups. Concentrations of MPO were significantly higher in samples with bacterial recovery from asthmatic patients, compared to sterile samples of both groups. Concentrations of ECP in the samples from asthmatic patients were significantly higher than in the controls, with no significant difference related to bacterial colonization. Bacterial colonization in chronically inflamed sinuses may have an impact on neutrophil granulocyte activation in patients with bronchial asthma, which was not confirmed for patients with CRS without asthma.
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Affiliation(s)
- Kreso Zurak
- Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital 'Sestre Milosrdnice', Zagreb, Croatia
| | - Davor Vagić
- Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital 'Sestre Milosrdnice', Zagreb, Croatia
| | - Petar Drvis
- Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital 'Sestre Milosrdnice', Zagreb, Croatia
| | | | - Senka Dzidic
- Department of Molecular Genetics, 'Rudjer Boskovic' National Institute, Zagreb, Croatia
| | - Livije Kalogjera
- Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital 'Sestre Milosrdnice', Zagreb, Croatia
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Yamin M, Holbrook EH, Gray ST, Harold R, Busaba N, Sridhar A, Powell KJ, Hamilos DL. Cigarette smoke combined with Toll-like receptor 3 signaling triggers exaggerated epithelial regulated upon activation, normal T-cell expressed and secreted/CCL5 expression in chronic rhinosinusitis. J Allergy Clin Immunol 2008; 122:1145-1153.e3. [PMID: 18986692 DOI: 10.1016/j.jaci.2008.09.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 09/15/2008] [Accepted: 09/19/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is characterized by persistent mucosal inflammation and frequent exacerbations. OBJECTIVE To determine whether innate epithelial responses to cigarette smoke or bacterial or viral pathogens may be abnormal in CRS leading to an inappropriate inflammatory response. METHODS Primary nasal epithelial cells (PNECs) were grown from middle turbinate biopsies of 9 healthy controls and 11 patients with CRS. After reaching 80% to 90% confluence, PNECs were exposed to medium or cigarette smoke extract (CSE) 5% (vol/vol) for 1 hour, washed, then stimulated with staphylococcal lipoteichoic acid, LPS, or double-stranded RNA (dsRNA). After 24 hours, gene expression was quantified by QRT-PCR. RESULTS At baseline, PNECs revealed elevated TNF-alpha and growth-related oncogene-alpha (a C-X-C chemokine)/CXCL1 (GRO-alpha) (4-fold increase, P = .02; and 16-fold increase, P = .004, respectively) in subjects with CRS compared with controls with normal levels of IL-1beta, IL-6, IL-8/CXCL8, human beta-defensin-2, monocyte chemoattractant protein 2/CCL8, monocyte chemoattractant protein 3/CCL7, and regulated upon activation, normal T-cell expressed and secreted (RANTES)/CCL5. Immunostaining of nasal biopsies, however, revealed comparable epithelial staining for TNF-alpha, GRO-alpha, and RANTES. There were no differences in mRNA induction by CSE, TNF-alpha, lipoteichoic acid, LPS, or dsRNA alone. The combination of CSE+dsRNA induced exaggerated RANTES (12,115-fold vs 1500-fold; P = .03) and human beta-defensin-2 (1120-fold vs 12.5-fold; P = .05) in subjects with CRS. No other genes were differentially induced. Furthermore, CSE+dsRNA induced normal levels of IFN-beta, IFN-lambda1, and IFN-lambda2/3 mRNA in subjects with CRS. CONCLUSION Cigarette smoke extract plus dsRNA induces exaggerated epithelial RANTES expression in patients with CRS. We propose that an analogous response to cigarette smoke plus viral infection may contribute to acute exacerbations and eosinophilic mucosal inflammation in CRS.
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Affiliation(s)
- Moshe Yamin
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
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Nasal Lavage With Mupirocin for the Treatment of Surgically Recalcitrant Chronic Rhinosinusitis. Laryngoscope 2008; 118:1677-80. [DOI: 10.1097/mlg.0b013e31817aec47] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Araujo E, Dall C, Cantarelli V, Pereira A, Mariante AR. Microbiologia do meato médio na rinossinusite crônica. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0034-72992007000400015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC) e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31% das amostras, e o Staphylococcus coagulase-negativo (SCN) em 23%. Gram-negativos ou facultativos foram isolados em 37% das amostras, anaeróbios em 12%, e fungos em 14%. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74% das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40% das amostras e o Staphylococcus aureus em 18%. Em 12% dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.
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Araujo E, Dall C, Cantarelli V, Pereira A, Mariante AR. Microbiology of middle meatus in chronic rhinosinusitis. Braz J Otorhinolaryngol 2007; 73:549-55. [PMID: 17923927 PMCID: PMC9443770 DOI: 10.1016/s1808-8694(15)30108-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 01/29/2007] [Indexed: 10/31/2022] Open
Abstract
UNLABELLED This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31%), coagulase-negative Staphylococcus (CNS) (23%). Gram-negative or facultative microorganisms were isolated in 37% of the samples, anaerobes in 12% and fungi in 14%. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76% of cultures were positive for aerobes and 12% for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40%), Staphylococcus aureus (18%). CONCLUSION The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.
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Abstract
Sinusitis is one of the most common complaints resulting in physician visits in the United States. An antecedent viral infection of the upper respiratory tract is the most common presentation. Despite its prevalence, most cases resolve spontaneously. Only a small proportion develops a secondary bacterial infection that will benefit from antimicrobial therapy. This article discusses the microbiology and pathogenesis of acute and chronic bacterial sinusitis. The role anaerobic bacterial in chronic and recurrent sinusitis is emphasized, and appropriate antimicrobial regimens are discussed.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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Sachse F, von Eiff C, Stoll W, Becker K, Rudack C. Induction of CXC chemokines in A549 airway epithelial cells by trypsin and staphylococcal proteases - a possible route for neutrophilic inflammation in chronic rhinosinusitis. Clin Exp Immunol 2006; 144:534-42. [PMID: 16734624 PMCID: PMC1941973 DOI: 10.1111/j.1365-2249.2006.03089.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
While various microorganisms have been recovered from patients with chronic rhinosinusitis, the inflammatory impact of virulence factors, in particular proteases from Staphylococcus aureus and coagulase negative staphylococci on the nasal epithelium, has not yet been investigated. Expression of CXC chemokines was determined in the epithelium of patients with chronic rhinosinusitis by immunohistochemistry. In a cell culture system of A549 respiratory epithelial cells, chemokine levels were quantified by enzyme-linked immunosorbent assay (ELISA) after stimulation with supernatants originating from three different staphylococcal strains or with trypsin, representing a serine protease. Inhibition experiments were performed with prednisolone, with the serine protease inhibitor 4-(2-aminoethyl)-benzenesulphonylfluoride (AEBSF) and with the nuclear transcription factor (NF)-kappaBeta inhibitor (2E)-3-[[4-(1,1-dimethylethyl)phenyl]sulphonyl]-2-propenenitrite (BAY) 11-7085. Electromobility shift assays (EMSA) were used to demonstrate NF-kappaB-dependent protein synthesis. CXC chemokines interleukin (IL)-8, growth-related oncogene alpha (GRO-alpha) and granulocyte chemotactic protein-2 (GCP-2) were expressed in the patients' epithelium whereas epithelial cell-derived neutrophil attractant 78 (ENA-78) was rarely detected. In A549 cells, chemokines IL-8, ENA-78 and GRO-alpha but not GCP-2 were induced by trypsin and almost equal levels were induced by staphylococcal supernatants. IL-8, GRO-alpha and ENA-78 synthesis was suppressed almost completely by AEBSF and BAY 11-7085, whereas prednisolone reduced chemokine levels differentially dependent on the supernatant added. CXC chemokines were detectable in the epithelium of patients with chronic rhinosinusitis. Staphylococcal serine proteases induced CXC chemokines in A549 cells, probably by the activation of proteases activated receptors, and thus might potentially be involved in neutrophilic inflammation in chronic sinusitis.
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Affiliation(s)
- F Sachse
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Germany.
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Solares CA, Batra PS, Hall GS, Citardi MJ. Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations. Am J Otolaryngol 2006; 27:161-5. [PMID: 16647979 DOI: 10.1016/j.amjoto.2005.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA. OBJECTIVE The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA. MATERIALS AND METHODS Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed. RESULTS Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months). CONCLUSIONS Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.
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Affiliation(s)
- C Arturo Solares
- The Cleveland Clinic Foundation, Head and Neck Institute, OH 44195, USA
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Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest 2006; 129:63S-71S. [PMID: 16428694 DOI: 10.1378/chest.129.1_suppl.63s] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To review the literature on postnasal drip syndrome (PNDS)-induced cough and the various causes of PNDS. Hereafter, PNDS will be referred to as upper airway cough syndrome (UACS). METHODS MEDLINE search (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," "etiology of cough," "postnasal drip," "allergic rhinitis," "vasomotor rhinitis," and "chronic sinusitis." Case series and prospective descriptive clinical trials were selected for review. Also, any references from these studies that were pertinent to the topic were obtained. RESULTS In multiple prospective, descriptive studies of adults, PNDS due to a variety of upper respiratory conditions has been shown either singly or in combination with other conditions, to be the most common cause of chronic cough. The symptoms and signs of PNDS are nonspecific, and a definitive diagnosis of PND-induced cough cannot be made from the medical history and physical examination findings alone. Furthermore, the absence of any of the usual clinical findings does not rule out a response to treatment that is usually effective for PND-induced cough. The differential diagnosis of PNDS-induced cough includes allergic rhinitis, perennial nonallergic rhinitis, postinfectious rhinitis, bacterial sinusitis, allergic fungal sinusitis, rhinitis due to anatomic abnormalities, rhinitis due to physical or chemical irritants, occupational rhinitis, rhinitis medicamentosa, and rhinitis of pregnancy. Because of a high prevalence of upper respiratory symptoms associated with gastroesophageal reflux disease (GERD), GERD may occasionally mimic PNDS. A crucial unanswered question is whether the conditions listed above actually produce cough through a final common pathway of PND or whether, in fact, in some circumstances they cause irritation or inflammation of upper airway structures that directly stimulate cough receptors and produce cough independently of or in addition to any associated PND. CONCLUSION PNDS (ie, UACS) secondary to a variety of rhinosinus conditions is the most common cause of chronic cough. Because it is unclear whether the mechanisms of cough are the PND itself or the direct irritation or inflammation of the cough receptors located in the upper airway, the guideline committee has decided that, pending further data that address this difficult question, the committee unanimously recommends that the term upper airway cough syndrome be used in preference to postnasal drip syndrome when discussing cough associated with upper airway conditions.
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Abstract
Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are S. pneumoniae, H. influenzae, and M. catarrhalis, while anaerobic bacteria and S. aureus predominant in CRS.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle Street Northwest, Washington, DC 20016, USA.
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Brook I. Chronic sinusitis in children and adults: role of bacteria and antimicrobial management. Curr Allergy Asthma Rep 2006; 5:482-90. [PMID: 16216174 DOI: 10.1007/s11882-005-0030-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The nasopharynx serves as the reservoir for anaerobic bacteria as well as pathogenic bacteria that can cause respiratory infections including sinusitis. Some of these organisms possess the ability to interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may result from the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus. Anaerobes were identified in chronic sinusitis in adults and children whenever techniques for their cultivation were employed. The predominant isolates were pigmented Prevotella, Fusobacterium, and Peptostreptococcus spp. The choice of antimicrobial agent in chronic sinusitis should provide coverage for the usual pathogens in acute sinusitis as well as beta-lactamase-producing aerobic and anaerobic organisms.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.
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Brook I. The role of anaerobic bacteria in sinusitis. Anaerobe 2005; 12:5-12. [PMID: 16701606 DOI: 10.1016/j.anaerobe.2005.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 08/16/2005] [Accepted: 08/23/2005] [Indexed: 01/12/2023]
Abstract
The normal oropharyngeal flora contained aerobic and anaerobic bacteria that can cause respiratory infections including sinusitis. Some of these bacteria can interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may be the result of the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development over time of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus cavity. Anaerobes were isolated in acute maxillary sinusitis of odontogenic origin and in over half of the patients with chronic sinusitis whenever proper techniques for their cultivation were employed. These organisms were also recovered in acute sinusitis that was associated with dental infections. The predominant isolates were pigmented Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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Gillespie MB, Osguthorpe JD. Pharmacologic management of chronic rhinosinusitis, alone or with nasal polyposis. Curr Allergy Asthma Rep 2005; 4:478-85. [PMID: 15462715 DOI: 10.1007/s11882-004-0015-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients with chronic rhinosinusitis (CRS) and chronic rhinosinusitis with nasal polyposis (CRSwNP) commonly present with nasal obstruction, nasal discharge, facial pressure/pain, and hyposmia of prolonged duration. Recent evidence suggests that, despite clinical similarities, CRS and CRSwNP are distinct entities with separate inflammatory pathways and cytokine profiles. Antibiotics and nasal steroids are the mainstay of treatment in CRS, whereas combination systemic and nasal steroids are the foundation of CRSwNP management. Allergy therapy may play a significant role in CRS, whereas antileukotriene therapy has demonstrated promise in CRSwNP. Although prolonged medical therapy is usually necessary with both disorders, surgery may also be required to relieve refractory symptoms, and to improve sinus aeration and nasal access for topical therapy.
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Affiliation(s)
- M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, PO Box 250550, 135 Rutledge Avenue, Charleston, SC 29425, USA
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Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, Bachert C, Baraniuk J, Baroody FM, Benninger MS, Brook I, Chowdhury BA, Druce HM, Durham S, Ferguson B, Gwaltney JM, Kaliner M, Kennedy DW, Lund V, Naclerio R, Pawankar R, Piccirillo JF, Rohane P, Simon R, Slavin RG, Togias A, Wald ER, Zinreich SJ. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 2004; 114:155-212. [PMID: 15577865 PMCID: PMC7119142 DOI: 10.1016/j.jaci.2004.09.029] [Citation(s) in RCA: 589] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background There is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials. Objectives To develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials. Methods Five national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials. Results Committee members agreed to adopt the term “rhinosinusitis” and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition. Conclusion The recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials.
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Key Words
- rhinosinusitis
- sinusitis
- nasal polyposis
- quality of life
- clinical trials
- aaaai, american academy of allergy, asthma and immunology
- aao-hns, american academy of otolaryngology–head and neck surgery
- afrs, allergic fungal rhinosinusitis
- cfu, colony-forming units
- cns, coagulase-negative staphylococci
- crs, chronic rhinosinusitis
- crssnp, crs without nasal polyps
- crswnp, crs with nasal polyps
- ct, computed tomography
- ecp, eosinophilic cationic protein
- gerd, gastroesophageal reflux disease
- icam-1, intercellular adhesion molecule 1
- mmp, matrix metalloproteinase
- mri, magnetic resonance imaging
- np, nasal polyp
- pbmc, peripheral blood mononuclear cell
- pnif, peak flow nasal inspiratory flow
- qol, quality of life
- rsdi, rhinosinusitis disability index
- rsom-31, rhinosinusitis outcome measure-31
- sae, staphylococcus aureus enterotoxin
- serd, supraesophageal reflux disease
- sf-36, medical outcomes study short form-36
- snot-20, sino-nasal outcome test-20
- tgf-β1, transforming growth factor β1
- vβ, t-cell receptor variable region β chain
- vcam-1, vascular cell adhesion molecule 1
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Affiliation(s)
- Eli O Meltzer
- Department of Pediatrics, Allergy and Asthma Medical Group and Research Center, 9610 Granite Ridge Drive, Suite B, San Diego, CA 92123, USA.
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Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, Bachert C, Baraniuk J, Baroody FM, Benninger MS, Brook I, Chowdhury BA, Druce HM, Durham S, Ferguson B, Gwaltney JM, Kaliner M, Kennedy DW, Lund V, Naclerio R, Pawankar R, Piccirillo JF, Rohane P, Simon R, Slavin RG, Togias A, Wald ER, Zinreich SJ. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 2004; 131:S1-62. [PMID: 15577816 PMCID: PMC7118860 DOI: 10.1016/j.otohns.2004.09.067] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background There is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials. Objectives To develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials. Study design Five national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials. Results Committee members agreed to adopt the term “rhinosinusitis” and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition. Conclusions The recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials.
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Affiliation(s)
- Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, Department of Pediatrics, University of California, San Diego 92123, USA.
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Abstract
Chronic rhinosinusitis is characterized by nasal purulence accompanied by malaise, postnasal drip and nasal dryness or crusting. It is a condition that is very difficult to treat and can be very disabling to the patients. A clinical diagnosis is based on history and evaluation with endoscopy, and computerized tomographic scanning. The etiology of chronic rhinosinusitis is multifactorial and comprises a vicious cycle of pathophysiological, anatomical, and constitutive factors. Predisposing factors include ciliary impairment, allergy, nasal polyposis, and immune deficiency. Treatment is aimed at reducing mucosal inflammation and swelling, controlling infection, and restoring aeration of the nasal and sinus mucosa. The choice of treatment is influenced by many factors including past medication, duration of symptoms and the presence of allergy/nasal polyps. Pharmacologic treatment, with local or systemic corticosteroids such as mometasone furoate, fluticasone propionate, beclometasone dipropionate or oral prednisolone coupled with nasal lavage with isotonic saline solutions are the cornerstones of disease management. Systemic antibiotics including amoxicillin/clavulanic acid, ciprofloxacin, clarithromycin, and trimethoprim/sulfamethoxazole (cotrimoxazole) are often administered to patients with chronic sinusitis and underlying bacterial infection. In patients with underlying allergy, additional treatment with antihistamines should be considered. Aeration of the sinuses may temporarily be improved with local nasal decongestants such as oxymetazoline. If symptoms persist after aggressive medical treatment, surgery should be considered. Surgery should be functional and involve widening the natural drainage openings of the sinuses and preserving the ciliated epithelium as much as possible. In the case of nasal polyposis surgery is more aggressive involving removal of the diseased polypous mucosa. It is recommended that medical treatment should be continued post sinus surgery.
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Abstract
Chronic sinusitis with recurrent acute infections continues to be a significant medical problem. Even after aggressive medical and surgical management, some patients continue to have recurrent infections. These infections are often multidrug-resistant. Topical delivery of medications into body cavities has been practiced for decades. Recently, the use of prescription antibiotic, antifungal, and anti-inflammatory topical medications has increased for sinus patients. This article examines emerging data on nebulized antimicrobials for patients with sinusitis.
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Affiliation(s)
- Winston C. Vaughan
- Stanford Sinus Center, R135, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Bhattacharyya N, Gopal HV, Lee KH. Bacterial Infection After Endoscopic Sinus Surgery: A Controlled Prospective Study. Laryngoscope 2004; 114:765-7. [PMID: 15064638 DOI: 10.1097/00005537-200404000-00032] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to determine whether infections occurring after endoscopic sinus surgery represent overgrowth of sinonasal flora versus de novo bacterial infection. STUDY DESIGN Prospective controlled cohort study. METHODS A cohort of adult patients was prospectively followed after endoscopic sinus surgery. Baseline postoperative control cultures of the ethmoid sinus were obtained. Patients with acute infectious exacerbations of chronic rhinosinusitis had endoscopic culture, and these results were compared with baseline culture data. RESULTS One hundred thirteen patients were followed for a mean period of 14.5 months after endoscopic sinus surgery. Baseline postoperative culture data revealed that the ethmoid labyrinth was sterile in 23% of cases, carried oral flora in 18% of cases, and was colonized in 60% of cases. Gram-positive cocci, particularly staphylococcal species, were the most common colonizing organisms (41% of cases). Twenty acute exacerbations were cultured in 17 patients during the follow-up period. All infectious cultures recovered bacteria; one culture recovered only oral flora. Gram-positive cocci predominated (56% of isolates) with Staphylococcus aureus being the most common isolate (28%). Of the 36 isolates, only 9 isolates (25%) corresponded to bacteria identified at the time of baseline culture. CONCLUSION Although the postoperative sinonasal cavity may be colonized by bacteria after endoscopic sinus surgery, infections arising postoperatively most commonly represent de novo infections by bacteria other than colonizing bacteria. Empirical therapy based on baseline data may be misleading; acute exacerbations of chronic rhinosinusitis after endoscopic sinus surgery should be cultured to guide optimal antibiotic therapy.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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39
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Abstract
The growing resistance to antimicrobial agents of all respiratory tract bacterial pathogens has made the management of sinusitis more difficult. The upper respiratory tract including the nasopharynx serves as the reservoir for pathogenic bacteria that can cause respiratory infections including sinusitis. During a viral respiratory infection, potential pathogens can relocate from the nasopharynx into the sinus cavity, causing sinusitis. Establishment of the correct microbiology of all forms of sinusitis is of primary importance, because it can serve as a guide for choosing the adequate antimicrobial therapy. This article summarizes the current information regarding the microbiology of all forms of sinusitis and approaches to antimicrobial therapy.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.
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40
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Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003; 129:S1-32. [PMID: 12958561 DOI: 10.1016/s0194-5998(03)01397-4] [Citation(s) in RCA: 530] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
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41
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Vaughan WC, Carvalho G. Use of nebulized antibiotics for acute infections in chronic sinusitis. Otolaryngol Head Neck Surg 2002; 127:558-68. [PMID: 12501108 DOI: 10.1067/mhn.2002.129738] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Infections in patients with chronic sinusitis after surgery can be difficult to treat. Nebulized antimicrobial therapy was studied as a treatment option. STUDY DESIGN Patients with chronic sinusitis, previous sinus surgery, and an acute infection were offered nebulized antibiotics or standard therapy. Cultures were taken and sensitivity testing was performed. Retrospective chart reviews were also performed. RESULTS Forty-two patients were included. The most common side effects were sore throat and cough. Symptomatic and endoscopic data before and after nebulized therapy showed a longer infection-free period (average, 17 weeks) compared with standard therapy (average, 6 weeks). Improvements in posterior nasal discharge, facial pain/pressure, and emotional consequences were noted. CONCLUSION Nebulized therapy was safe and effective in this cohort. Endoscopy and outcome measure changes showed consistent improvements. SIGNIFICANCE A novel therapy for acute sinus infections in patients with chronic sinusitis and previous endoscopic sinus surgery is presented.
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Affiliation(s)
- Winston C Vaughan
- Division of Otolaryngology-Head and Neck Surgery, Sinus Center R135, Stanford University, 300 Pasteur Drive, Stanford, CA 94305-5328, USA.
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42
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Brook I. Bacterial contamination of saline nasal spray/drop solution in patients with respiratory tract infection. Am J Infect Control 2002; 30:246-7. [PMID: 12032501 DOI: 10.1067/mic.2002.119955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the potential for bacterial contamination of saline nasal spray/drop solution after 3 days of clinical use in patients. Twenty patients with upper respiratory infection used the saline as a spray, and 20 patients used the solution as drops. Bacterial growth was present in 18 (907%) solution containers of the spray group and in 3 (157%) solution containers of the drops group (P <.005). Twenty isolates were recovered from the spray group and 3 from the drops group. The predominate isolates included Staphylococcus aureus, Staphylococcus epidermidis, alpha Streptococcus species, Pseudomonas aeruginosa, Escherichia coli, and Proteus spp. This study demonstrates the contamination of nasal saline-dispensing solution used as a spray with micro-organisms that are part of the normal skin and nasal flora and gram-negative organisms of potential enteric origin. These data support the use of nasal saline-dispensing solution as drops, rather than as spray. They also illustrate the risk for crossinfection if a nasal solution is used by more than 1 patient.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA
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43
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Schubert MS. A superantigen hypothesis for the pathogenesis of chronic hypertrophic rhinosinusitis, allergic fungal sinusitis, and related disorders. Ann Allergy Asthma Immunol 2001; 87:181-8. [PMID: 11570613 DOI: 10.1016/s1081-1206(10)62222-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic eosinophilic-lymphocytic respiratory mucosal inflammatory disorders include hypertrophic sinus disease, allergic fungal sinusitis, allergic bronchopulmonary aspergillosis, and chronic severe asthma. They have many analogous or shared aspects of pathology at molecular, cellular, and clinical levels of analysis. OBJECTIVE To propose a theory, and supporting data through comprehensive literature review, that unifies these diseases' pathogenesis. METHODS AND DATA SOURCES: Current medical literature was used as supportive background information. Reinterpretation of existing studies and reasoned speculation were used when necessary and identified where used. English language MEDLINE articles that referenced sinusitis, rhinosinusitis, allergic fungal sinusitis, asthma, allergic bronchopulmonary aspergillosis, nasal polyp, superantigen, and T cell receptor from 1983 to present were potentially used as background or supportive information. Additional referenced articles, published abstracts, and National Center for Biotechnology Information Entrez protein database searches were used. Case reports, studies, review articles, and textbooks were included. RESULTS Multiple lines of evidence support the proposed hypothesis that microbial T cell superantigen production, persistence, and host-responsiveness are the fundamental components that unify the pathogenesis of all common chronic eosinophilic-lymphocytic respiratory mucosal inflammatory disorders. Superantigen amplification of preexisting immunopathology is the proposed mechanism for disease induction and maintenance. Preexisting immunopathology is created in the individual by a potential heterogeneity of immunopathologic signals that can include type I immediate hypersensitivity, other antigen-specific immune responses, cytokine dysregulation, eicosanoid dysregulation, various genetic mutations, and other molecular pathology. Although the ability to develop chronic severe inflammatory disease is dependent upon this immunopathology, host T cell receptor V beta genetics and persistent superantigen production/exposure at the respiratory mucosa by relevant superantigen-producing extra- or intracellular microbes are postulated to be required. This mechanism for disease pathogenesis may also apply to other disorders. Approaches to prove this theory and its predictions are presented. CONCLUSIONS The pathogenesis of all the disorders discussed can be unified through the superantigen hypothesis proposed. Multiple lines of evidence support this hypothesis. How we view these common conditions will change, and new research into pathogenesis and treatment will occur if this proves true.
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Affiliation(s)
- M S Schubert
- Allergy Asthma Clinic, Ltd, Phoenix, Arizona 85013, USA
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