Bone: the final frontier for Staphylococcus aureus penetration in chronic rhinosinusitis.

UNLABELLED: The superantigenic properties of Staphylococcus aureus have been implicated in increasing the inflammatory process in airway diseases. Local formation of IgE antibodies against staphylococcal enterotoxins by secondary lymphoid tissue in nasal polyps has been demonstrated. Staphylococcus aureus is known to colonize the nasal mucosa, and has been found invading the nasal submucosa and intracellularly. OBJECTIVE: To evaluate the limits of Staphylococcus aureus invasion in the upper airway. MATERIAL AND METHODS: Inferior turbinate samples from 3 patients without sinus disease, 6 ethmoid samples from patients with chronic rhinosinusitis with nasal polyposis, and 6 ethmoid samples from patients with chronic rhinosinusitis without nasal polyposis were studied. A fluorescein-labeled PNA probe against Staphylococcus aureus was used to test for the presence of the bacterium in bone (after decalcification) and mucosa. RESULTS: We found Staphylococcus aureus invading the nasal submucosa in patients with nasal polyposis, but no cases of Staphylococcus aureus positivity in bone. In conclusion, we cannot support the hypothesis of nasal bone as a reservoir for Staphylococcus aureus, releasing massive amounts of staphylococcal enterotoxins and eliciting an inflammatory reaction, as occurs with the nasal mucosa.

Bacterial pathogens in the nasopharynx, nasal cavity, and osteomeatal complex during wellness and viral infection.

BACKGROUND: Viral sinusitis can precede acute bacterial sinusitis, but the influence of viral infection on bacterial colonization is unclear. The objective of this study was to evaluate the presence of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the osteomeatal complex (OMC), nasal cavity, and nasopharynx in adults during wellness and viral upper respiratory illness (URI). METHODS: Subjects were recruited for the study during wellness and at the time of acute viral rhinosinusitis. Swab cultures were obtained from the OMC, nasal cavity, and the nasopharynx. Swab eluates were inoculated on selective agars to detect S. pneumoniae, H. influenzae, and M. catarrhalis. RESULTS: The study included 237 subjects, 100 adults with URI and 137 well adults. Positive culture results were found for any site in 70% (n = 70) of ill subjects and 64% (n = 88) of well subjects (p = 0.393). Of the 91 OMC cultures, positive cultures were over five times more likely to be found in ill subjects than in well subjects (31% versus 8%; p = 0.010). The nasal cavity cultures were positively statistically significant more often in ill subjects versus well subjects (39% versus 25%; p = 0.022). The overall nasopharyngeal cultures did not show a statistically significant difference (65% versus 60%; odds ratio, 1.2; p = 0.461). S. pneumoniae was positively cultured in at least one site in 15% of ill subjects and 31% of well subjects (p = 0.006). H. influenzae was positively cultured in at least one site in 45% of ill subjects and 31% of well subjects (p = 0.027). M. catarrhalis was positively cultured in at least one site in 42% of ill subjects and 27% of well subjects (p = 0.018). CONCLUSION: This study defines the carriage rates of the three most common bacterial pathogens for acute sinusitis in the nasopharynx, nasal cavity, and OMC during illness and in the healthy state.

[Bacteriological study of ethmoid specimens from patients with nasal polyposis after ethmoidal surgery]. / Etude bactériologique des cavités d'ethmoïdectomie chez des patients ayant une polypose naso-sinusienne opérée.

OBJECTIVE: To compare the bacteriological and clinical findings in ethmoid specimens from patients with nasal polyposis after radical ethmoidal surgery. PATIENTS AND METHODS: From June to November 2008, 60 patients were prospectively included. For each patient, two samples for each ethmoidal cavity were taken. Aerobic and anaerobic bacterial cultures and fungal cultures were processed and the antibiotic susceptibility was evaluated for each isolated bacterial strain. RESULTS: Pathogenic bacteria were isolated in 48 patients (80%) including predominantly Staphylococcus aureus (60%) or a Gram-negative bacterium. The microorganisms were nearly all susceptible to antibiotics, including the aminoglycosides. No correlation between the presence of pathogenic bacteria and the clinical status of the patients was found. CONCLUSION: In this study, a great number of patients was colonized with pathogenic bacteria. However, the presence of pathogenic bacteria was not correlated with the clinical status of the patients.

Basilar meningitis associated with ethmoid and sphenoid cephaloceles.

Nontuberculous causes of basilar meningitis are rare. This study presents the case of a male who developed fever and meningitis caused by Streptococcus pneumoniae. He developed multiple cranial nerve palsies and imaging findings consistent with basilar meningitis and ventriculitis. Computed tomographic scans of the floor of the anterior fossa were performed after the detection of a cephalocele on magnetic resonance imaging. This imaging revealed a defect in the cribiform plate and fovea ethmoidalis with a large nasoethmoidal cephalocele. There was a second separate defect and cephalocele involving the middle cranial fossa. The association of basilar meningitis with an atypical organism should lead to a careful search for disruption in the floor of the anterior or middle cranial fossa.

[Ethmoiditis with orbital complications in children]. / Powiklania oczodolowe w przebiegu ostrego zapalenia zatok przynosowych u dzieci.

Five ethmoiditis cases with orbital complications in children aged 3.5 to 6 years were analysed. All were treated at almost at the same time in Warsaw hospitals in October 1994. Among the five presented cases, four were treated surgically. The value of CT examination in diagnosing ethmoiditis is stressed by the authors.

Effects of viral and bacterial infection on nasal and sinus mucosa.

There is still controversy over the role of viruses and bacteria in rhinologic infections, especially in sinusitis. Until recently it was not fully known whether the sinuses do in fact take part in the infectious process of a common cold (viral rhinitis). CT scans show that in the vast majority of otherwise healthy volunteers with a common cold, and without a previous history of recurrent or chronic sinusitis, the sinuses are involved; there was, however, in these individuals no typical symptomatology of acute sinusitis. A viral rhinitis alone does not seem to be able to elicit a "clinical" acute otitis. Bacteria determine the clinical picture and outcome of sinusitis. There is not much controversy about the role of bacteria in acute sinusitis, S. pneumoniae, H. influenzae, and M. catarrhalis being the most frequently involved. Much more conflicting reports are published about the normal flora of the sinuses, the role of anaerobes and the microbiology of chronic sinusitis. In this paper the mechanisms of viral and bacterial infection of the nasal and sinusal mucosa are described and the results of microbiological studies in sinusitis reported by other authors and our own group are discussed. It is postulated that, although bacteria are very important in acute sinusitis, their role in chronic sinusitis is minimal, the bacteria being opportunistic colonisers.