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Shao Y, Shen M, Peng D, Cheng W, Mao C, Zhang H, Sun Y. Observation of a Bone Invasion Model of Aspergillus fumigatus In Vitro and Analysis of the Antifungal Susceptibility. Mycopathologia 2024; 189:4. [PMID: 38231458 DOI: 10.1007/s11046-023-00817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Recently, the prevalence of invasive fungal infections has been on the rise, and one of the prevalent symptoms frequently observed is bone deterioration and bone loss. MATERIALS AND METHODS Using an in vitro model we studied how Aspergillus fumigatus invades the bone. Pathological analysis was then employed to observe the structure and distinctive features of the invading fungal elements within the bone invasion model. Meanwhile, the antifungal effects of itraconazole, voriconazole, posaconazole, and amphotericin B were evaluated. RESULTS The pathological findings showed that in the experimental group, fungal spores and hyphae invaded the bone tissue or were observed growing in the vicinity of the bone edge tissues, as indicated by both HE and PAS staining. In contrast, no fungal elements were observed in the control group, indicating that the in vitro bone invasion model of A. fumigatus was successfully constructed. Furthermore, the findings from the antifungal sensitivity test demonstrated that the lowest effective concentrations of antifungal drugs against the bone invasion model were as follows: 4 μg/ml for itraconazole, 0.5 μg/ml for voriconazole, 2 μg/ml for posaconazole, and 2 μg/ml for amphotericin B. DISCUSSION The successful construction of the bone invasion model of A. fumigatus has provided a solid basis for future investigations into the mechanisms underlying A. fumigatus bone invasion and the study of its virulence factors. Utilizing bone models is of utmost importance in advancing the development of novel antifungal treatment approaches, as well as in effectively preventing and treating fungal bone invasion and osteolytic diseases.
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Affiliation(s)
- Yan Shao
- Department of Orthopedics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Min Shen
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Dan Peng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Wenxu Cheng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Chenggang Mao
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Heng Zhang
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China.
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Chen H, Zhou B, Huang Q, Li C, Wu Y, Huang Z, Li Y, Qu J, Xiao N, Wang M. Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial. EAR, NOSE & THROAT JOURNAL 2024; 103:NP31-NP39. [PMID: 34315239 DOI: 10.1177/01455613211032020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. METHODS This was a prospective, self-controlled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. RESULTS A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea (P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment (P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. CONCLUSION Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.
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Affiliation(s)
- Han Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Bing Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Qian Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Cheng Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Yubin Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Yunxia Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Jing Qu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Nianci Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Mingjie Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
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Kanagamuthu P, Santhipalayam Ranganathan K. Bacteriological Profile of Chronic Rhinosinusitis and Adenotonsillitis: Evaluating the Role of Biofilm Production and Multidrug Resistance. Indian J Otolaryngol Head Neck Surg 2023; 75:2207-2216. [PMID: 37636622 PMCID: PMC10447323 DOI: 10.1007/s12070-023-03836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/24/2023] [Indexed: 08/29/2023] Open
Abstract
There is significant evidence that the etiology of chronic otorhinolaryngology infections such as chronic rhinosinusitis, adenotonsillitis, and otitis media depends on biofilms. As biofilm-forming bacteria can be resistant to the immune system, antibiotics, and other treatments, biofilm infections are often chronic. To identify the genus and species of the clinical isolates obtained from the swabs collected from the patients with chronic infections of the nasal and paranasal sinus, nasopharynx, and oropharynx and to evaluate phenotypic and genotypic methods for the detection of biofilms and antimicrobial resistance among the isolated organisms. A total of 100 patients with chronic rhinosinusitis and adenotonsillitis participated in this study. Various clinical samples from the nasal cavity, nasopharynx, and oropharynx were obtained and subjected to microbiological analysis and biofilm-forming capacity by three methods: tube methods, Congo red staining, and microtiter plate method. The various specific genes were amplified by polymerase chain reaction. The amplified gene products were separated by gel electrophoresis. This was a prospective cohort study conducted on a total of 100 patients with chronic rhinosinusitis and adenotonsillitis. The age of the study participants was between 7 and 53 years with a mean age of 29.22 ± 15.03. This study included 54 (54%) nasal tissue samples and 46 (46%) adenotonsillar tissue. The frequently cultured organisms are coagulase-negative staphylococci (17%), E. coli (10%), Citrobacter (10%), and Klebsiella (7%). Staphylococcus aureus (4), and Methicillin-resistant Staphylococcus aureus (3) produced strong biofilm. Acenobacter (3), Citrobacter (4), and E. coli (4) showed moderate biofilm production. Coagulase-negative Staphylococcus aureus (11), E. coli (6), and Klebsiella (7) showed weak biofilm formation. Citrobacter (6), and Coagulase negative Staphylococcus aureus (6) were negative for biofilm production. Staphylococcus aureus expressed mecA gene (3) and Panton-Valentine Leukocidin gene (2), Pseudomonas expressed mucA gene (2), Citrobacter expressed blaCARB-2 (4) qnrA gene (2), E. coli expressed bla SHV (2) and bla TEM1 gene (2) and Klebsiella expressed Kfu (2) and uge (1). Acenobacter was negative for blaIMP1, blaVIM2 genes. This study adds to the information on the common pathogens-forming biofilms in various nasal pathologies and adenotonsillitis. The knowledge that a particular organism has a higher biofilm-forming capacity will help to sensitize the physician that factors such as biofilms may be at play and take appropriate measures.
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Affiliation(s)
- Priya Kanagamuthu
- Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India
| | - Karthika Santhipalayam Ranganathan
- Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India
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Koefoed A, Wagner Mackenzie B, Douglas R, Biswas K. Current evidence of biofilms in chronic rhinosinusitis- a microbiological perspective. Expert Rev Clin Immunol 2023; 19:911-920. [PMID: 37378564 DOI: 10.1080/1744666x.2023.2231153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is characterized by inflammation of the paranasal sinus mucosa persisting for more than 12 weeks. This condition is associated with reduced quality-of-life and causes a high direct and indirect economic burden. Several pathogenic factors have been attributed to CRS, including bacterial and fungal biofilms on the sinonasal mucosa. Biofilms are well-established contributors to recalcitrance to treatment in other chronic inflammatory mucosal conditions such as cystic fibrosis and otitis media. AREAS COVERED This review will present an overview of the role of biofilms in CRS, including the evidence for biofilms being present on the sinonasal mucosa and their implications for disease severity. Furthermore, the interactions between biofilms and host-mediated immune factors are explored. EXPERT OPINION The eradication of biofilms has been a focus of research shortly after their recognition as a cause of disease. The currently available methodologies for identifying biofilms on mucosal surfaces are not sufficiently well-developed to be used in a clinical setting. A more accurate, cheaper, faster approach for biofilm detection is necessary, and molecular techniques may provide the possibility for this.
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Affiliation(s)
- Arne Koefoed
- Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand
| | | | - Richard Douglas
- Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand
| | - Kristi Biswas
- Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand
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Immunopathologic Role of Fungi in Chronic Rhinosinusitis. Int J Mol Sci 2023; 24:ijms24032366. [PMID: 36768687 PMCID: PMC9917138 DOI: 10.3390/ijms24032366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Airborne fungi are ubiquitous in the environment and are commonly associated with airway inflammatory diseases. The innate immune defense system eliminates most inhaled fungi. However, some influence the development of chronic rhinosinusitis. Fungal CRS is thought of as not a common disease, and its incidence increases over time. Fungi are present in CRS patients and in healthy sinonasal mucosa. Although the immunological mechanisms have not been entirely explained, CRS patients may exhibit different immune responses than healthy people against airborne fungi. Fungi can induce Th1 and Th2 immune responses. In CRS, Th2-related immune responses against fungi are associated with pattern recognition receptors in nasal epithelial cells, the production of inflammatory cytokines and chemokines from nasal epithelial cells, and interaction with innate type 2 cells, lymphocytes, and inflammatory cells. Fungi also interact with neutrophils and eosinophils and induce neutrophil extracellular traps (NETs) and eosinophil extracellular traps (EETs). NETs and EETs are associated with antifungal properties and aggravation of chronic inflammation in CRS by releasing intracellular granule proteins. Fungal and bacterial biofilms are commonly found in CRS and may support chronic and recalcitrant CRS infection. The fungal-bacterial interaction in the sinonasal mucosa could affect the survival and virulence of fungi and bacteria and host immune responses. The interaction between the mycobiome and microbiome may also influence the host immune response, impacting local inflammation and chronicity. Although the exact immunopathologic role of fungi in the pathogenesis of CRS is not completely understood, they contribute to the development of sinonasal inflammatory responses in CRS.
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Singh GB, Nair M, Kaur R. Is there fungal infestation in paediatric chronic otitis media - Mucosal disease? Am J Otolaryngol 2022; 43:103435. [PMID: 35398742 DOI: 10.1016/j.amjoto.2022.103435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/02/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the prevalence of fungal infestation in paediatric chronic otitis media (COM)-mucosal disease and to study the various factors that might influence the said infestation. METHODS A cross-sectional study was done on the cited subject in a sample size of 66 paediatric patients [Age group: 1-18 years] suffering from active COM-mucosal disease. In all we had 75 ears from which swab samples were taken as some patients had bilateral disease. Clinical record was documented in each case. Three sample swabs were analysed for aerobic, anaerobic and fungal infection respectively from the discharging ear. Fungal infection was diagnosed by culture. The data was tabulated and statistically analysed for any correlation of fungal infestation with age, sex, background, duration of COM, previous antibiotic/steroid usage and intractable otorrhoea. RESULTS We recorded a prevalence of 32% for fungal colonization of COM-mucosal disease in paediatric population i.e., 24 out of 75 ears. There was no association observed between fungal infestation and specific paediatric age group, sex, background or duration of the disease. However, a distinct statistical correlation was present between fungal infestation and previous antibiotic/steroid usage and intractable otorrhoea. CONCLUSION Findings of this study lead us to conclude that all cases of paediatric COM-mucosal disease should be analysed for fungal colonization, especially those with intractable otorrhoea and there should be judicious use of antibiotics and steroid ear drops in COM-mucosal disease.
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Affiliation(s)
- Gautam Bir Singh
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi 110001, India.
| | - Meenukrishnan Nair
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi 110001, India
| | - Ravinder Kaur
- Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi 110001, India
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Jiang H, Wu C, Xu J, Wang Q, Shen L, Ou X, Liu H, Han X, Wang J, Ding W, Hu L, Chen X. Bacterial and Fungal Infections Promote the Bone Erosion Progression in Acquired Cholesteatoma Revealed by Metagenomic Next-Generation Sequencing. Front Microbiol 2021; 12:761111. [PMID: 34803987 PMCID: PMC8604023 DOI: 10.3389/fmicb.2021.761111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023] Open
Abstract
An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction. Patients with acquired cholesteatoma generally present with chronic otorrhea and progressive conductive hearing loss. There are many microbes reportedly associated with acquired cholesteatoma. However, conventional culture-based techniques show a typically low detection rate for various pathogenetic bacteria and fungi. Metagenomic next-generation sequencing (mNGS), an emerging powerful platform offering higher sensitivity and higher throughput for evaluating many samples at once, remains to be studied in acquired cholesteatoma. In this study, 16 consecutive patients from January 2020 to January 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU) were reviewed. We detected a total of 31 microbial species in patients, mNGS provided a higher detection rate compared to culture (100% vs. 31.25%, p = 0.000034). As the severity of the patient’s pathological condition worsens, the more complex types of microbes were identified. The most commonly detected microbial genus was Aspergillus (9/16, 56.25%), especially in patients suffering from severe bone erosion. In summary, mNGS improves the sensibility to identify pathogens of cholesteatoma patients, and Aspergillus infections increase bone destruction in acquired cholesteatoma.
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Affiliation(s)
- Hua Jiang
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengpeng Wu
- Eye Center of the Second Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjie Xu
- Eye Center of the Second Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Wang
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Shen
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xunyan Ou
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyan Liu
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xu Han
- Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
| | - Jun Wang
- Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
| | - Wenchao Ding
- Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
| | - Lidan Hu
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiangjun Chen
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Eye Center of the Second Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
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The Role of Biofilms in Chronic Otitis Media-Active Squamosal Disease: An Evaluative Study. Otol Neurotol 2021; 42:e1279-e1285. [PMID: 34528922 DOI: 10.1097/mao.0000000000003259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the presence of biofilms in patients of chronic otitis media (COM)-active squamosal disease and to evaluate the microflora and clinical impact of biofilms. METHODS A total of 35 patients suffering from COM - active squamosal disease was studied. Cholesteatoma sample was collected at the time of mastoid surgery and the same was used to image for biofilms by scanning electron microscope. The said sample was also analyzed microbiologically. RESULTS Biofilms were present in 25 (72%) patients including 6 cases of fungal biofilms (24%). Biofilms were detected irrespective of the micro-organism growth. No statistically significant relationship was observed between biofilms and discharging ear and complications of COM. Though univariate analysis of our data found some correlation between duration of disease, the extent of cholesteatoma and ossicular necrosis but multivariate analysis revealed no such associations, thereby implying a doubtful association between these factors and biofilm. CONCLUSIONS Biofilms are an integral part of cholesteatoma ear disease and sometimes harbors fungal isolates.
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Jeican II, Gheban D, Barbu-Tudoran L, Inișca P, Albu C, Ilieș M, Albu S, Vică ML, Matei HV, Tripon S, Lazăr M, Aluaș M, Siserman CV, Muntean M, Trombitas V, Iuga CA, Opincariu I, Junie LM. Respiratory Nasal Mucosa in Chronic Rhinosinusitis with Nasal Polyps versus COVID-19: Histopathology, Electron Microscopy Analysis and Assessing of Tissue Interleukin-33. J Clin Med 2021; 10:4110. [PMID: 34575221 PMCID: PMC8468618 DOI: 10.3390/jcm10184110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most studied rhinological disorders. Modifications of the respiratory nasal mucosa in COVID-19 patients are so far unknown. This paper presents a comparative morphological characterization of the respiratory nasal mucosa in CRSwNP versus COVID-19 and tissue interleukin (IL)-33 concentration. (2) Methods: We analyzed CRSwNP and COVID-19 samples through histopathology, scanning and transmission electron microscopy and performed proteomic determination of IL-33. (3) Results: Histopathologically, stromal edema (p < 0.0001) and basal membrane thickening (p = 0.0768) were found more frequently in CRSwNP than in COVID-19. Inflammatory infiltrate was mainly eosinophil-dominant in CRSwNP and lymphocyte-dominant in COVID-19 (p = 0.3666). A viral cytopathic effect was identified in COVID-19. Scanning electron microscopy detected biofilms only in CRSwNP, while most COVID-19 samples showed microbial aggregates (p = 0.0148) and immune cells (p = 0.1452). Transmission electron microscopy of CRSwNP samples identified biofilms, mucous cell hyperplasia (p = 0.0011), eosinophils, fibrocytes, mastocytes, and collagen fibers. Extracellular suggestive structures for SARS-CoV-2 and multiple Golgi apparatus in epithelial cells were detected in COVID-19 samples. The tissue IL-33 concentration in CRSwNP (210.0 pg/7 μg total protein) was higher than in COVID-19 (52.77 pg/7 μg total protein) (p < 0.0001), also suggesting a different inflammatory pattern. (4) Conclusions: The inflammatory pattern is different in each of these disorders. Results suggested the presence of nasal dysbiosis in both conditions, which could be a determining factor in CRSwNP and a secondary factor in COVID-19.
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Affiliation(s)
- Ionuț Isaia Jeican
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (I.I.J.); (V.T.)
- Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Dan Gheban
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
| | - Lucian Barbu-Tudoran
- Electron Microscopy Laboratory, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania; (L.B.-T.); (S.T.)
- Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Patricia Inișca
- Department of Pathology, County Emergency Hospital, 330084 Deva, Romania;
| | - Camelia Albu
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
- Imogen Medical Research Institute, County Clinical Emergency Hospital, 400014 Cluj-Napoca, Romania
| | - Maria Ilieș
- Department of Proteomics and Metabolomics, MedFuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.I.); (C.A.I.)
| | - Silviu Albu
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (I.I.J.); (V.T.)
| | - Mihaela Laura Vică
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.L.V.); (H.V.M.)
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
| | - Horea Vladi Matei
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.L.V.); (H.V.M.)
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
| | - Septimiu Tripon
- Electron Microscopy Laboratory, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania; (L.B.-T.); (S.T.)
- Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, 400293 Cluj-Napoca, Romania
| | - Mihaela Lazăr
- Cantacuzino National Military-Medical Institute for Research and Development, 050096 Bucharest, Romania;
| | - Maria Aluaș
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Vasile Siserman
- Institute of Legal Medicine, 400006 Cluj-Napoca, Romania;
- Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
| | - Monica Muntean
- Department of Infectious Disease, Clinical Hospital of Infectious Disease, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Veronica Trombitas
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania; (I.I.J.); (V.T.)
| | - Cristina Adela Iuga
- Department of Proteomics and Metabolomics, MedFuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.I.); (C.A.I.)
- Department of Pharmaceutical Analysis, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Iulian Opincariu
- Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Lia Monica Junie
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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Analysis of Microbiota and Mycobiota in Fungal Ball Rhinosinusitis: Specific Interaction between Aspergillus fumigatus and Haemophilus influenza? J Fungi (Basel) 2021; 7:jof7070550. [PMID: 34356929 PMCID: PMC8305266 DOI: 10.3390/jof7070550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
Fungal ball (FB) rhinosinusitis (RS) is the main type of non-invasive fungal RS. Despite positive direct examination (DE) of biopsies, culture remains negative in more than 60% of cases. The aim of the study was to evaluate the performance/efficacy of targeted metagenomics (TM) to analyze microbiota and mycobiota in FB and find microbial associations. Forty-five sinus biopsies from patients who underwent surgery for chronic RS were included. After DE and culture, DNA was extracted, then fungal ITS1–ITS2 and bacterial V3–V4 16S rDNA loci were sequenced (MiSeqTM Illumina). Operational taxonomic units (OTUs) were defined via QIIME and assigned to SILVA (16S) and UNITE (ITS) databases. Statistical analyses were performed using SHAMAN. Thirty-eight patients had FB and seven had non-fungal rhinosinusitis (NFRS). DE and culture of FB were positive for fungi in 97.3 and 31.6% of patients, respectively. TM analysis of the 38 FB yielded more than one fungal genus in 100% of cases, with Aspergillus in 89.5% (34/38). Haemophilus was over-represented in FB with >1000 reads/sample in 47.3% (18/38) compared to NFRS (p < 0.001). TM allowed fungal identification in biopsies with negative culture. Haemophilus was associated with FB. Pathogenesis could result from fungi–bacteria interactions in a mixed biofilm-like structure.
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Manciula LG, Jeican II, Tudoran LB, Albu S. Biofilms and inflammation in patients with chronic rhinosinusitis. Med Pharm Rep 2020; 93:374-383. [PMID: 33225263 PMCID: PMC7664719 DOI: 10.15386/mpr-1691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/15/2020] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Conclusion Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.
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Affiliation(s)
- Lavinia-Gianina Manciula
- 2 Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Isaia Jeican
- Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Department of Anatomy and Embryology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca
| | - Lucian Barbu Tudoran
- "Prof. C. Craciun" Electron Microscopy Laboratory, Faculty of Biology & Geology, Babes-Bolyai University; Electron Microscopy Integrated Laboratory, National Institute for R&D of Isotopic and Molecular Technologies, Cluj-Napoca, Romania
| | - Silviu Albu
- 2 Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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Testori T, Weinstein T, Taschieri S, Wallace SS. Risk factors in lateral window sinus elevation surgery. Periodontol 2000 2019; 81:91-123. [PMID: 31407430 DOI: 10.1111/prd.12286] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Maxillary sinus augmentation is the most predictable of the pre-prosthetic surgical procedures. There are, however, known and well-documented complications that can and do occur. The most common are the intraoperative complications of sinus membrane perforation and bleeding, and the postoperative complications of sinus graft infections, sinus infections, and sinusitis. The majority of these complications can be prevented, or their incidence greatly reduced, through a thorough understanding of maxillary sinus anatomy, the multifaceted etiologies of these conditions, and the steps that can be taken to avoid them. This volume of Periodontology 2000 will discuss both the preoperative and intraoperative procedures that will prevent these untoward outcomes and the necessary treatment modalities that will limit their adverse effects.
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Affiliation(s)
- Tiziano Testori
- Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Sciences, University of Milano, IRCCS, Galeazzi Institute, Milan, Italy.,Department of Periodontics and Oral Medicine, School of Dentistry, The University of Michigan, Ann Arbor, Michigan, USA.,Private Practice, Como, Italy
| | - Tommaso Weinstein
- Head of Diagnostic Department, Humanitas Dental Center, Humanitas Research Hospital, Milan, Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Faculty of Dentistry, University of Milan, Milan, Italy.,IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stephen S Wallace
- Department of Periodontics, Columbia University College of Dental Medicine, New York, New York, USA.,Private Practice, Waterbury, Connecticut
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13
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Comparison of photodynamic therapy efficiency using radiation sources with different wavelengths in the treatment of sinusitis. BIOMEDICAL PHOTONICS 2019. [DOI: 10.24931/2413-9432-2019-8-2-14-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory diseases of the sinuses – one of the most common nosologies in the practice of otorhinolaryngologist; its pathogenesis is well studied, and treatment recommendations are detailed. Following them, however, cannot completely prevent chronic disease or recurrence. Antimicrobial photodynamic therapy is a promising method of treating sinusitis, which has proved its effectiveness, but has not yet been widely used. This work describes our experience in photodynamic therapy with chlorin e6 of chronic sinusitis using a new laser diode-based irradiation source. For patients who had previous sinus surgery an adapter for penetration into the sinus through anastomosis was developed and tested. First group of the patients underwent photodynamic therapy (PDT) according to the conventional scheme, using a laser with a wavelength of 662 nm; while the second one underwent PDT using a 405 nm laser. With daily washing of the nasal sinus, the period of inflammation relief (evaluated by the absence of pathological discharge during washing) amounted to 3.8 full days on average in the first group of patients, compared to 5.4 days on average for the second group. We carried out the comparative analysis of the treatment results based on clinical assessment and radiological evaluation (CT) at the time of discharge from the hospital and 1 month later.
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14
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[Guideline for "rhinosinusitis"-long version : S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery]. HNO 2019; 66:38-74. [PMID: 28861645 DOI: 10.1007/s00106-017-0401-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Kim SM. Definition and management of odontogenic maxillary sinusitis. Maxillofac Plast Reconstr Surg 2019; 41:13. [PMID: 30989083 PMCID: PMC6439010 DOI: 10.1186/s40902-019-0196-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. Main body We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of "odontogenic," "odontogenic infection," "dental origin," "tooth origin," "sinusitis," "maxillary sinus," "maxillary sinusitis," "odontogenic maxillary sinusitis," "Caldwell Luc Procedure (CLP)," "rhinosinusitis," "functional endoscopic sinus surgery (FESS)," "modified endoscopy-assisted maxillary sinus surgery (MESS)," and "paranasal sinus." Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. Conclusion To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.
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Affiliation(s)
- Soung Min Kim
- Oral and Maxillofacial Microvascular Reconstruction LAB, Ghana Health Service, Brong Ahafo Regional Hospital, P.O. Box 27, Sunyani, Brong Ahafo Ghana.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
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16
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Ueki S, Hebisawa A, Kitani M, Asano K, Neves JS. Allergic Bronchopulmonary Aspergillosis-A Luminal Hypereosinophilic Disease With Extracellular Trap Cell Death. Front Immunol 2018; 9:2346. [PMID: 30364279 PMCID: PMC6193060 DOI: 10.3389/fimmu.2018.02346] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is characterized by an early allergic response and late-phase lung injury in response to repeated exposure to Aspergillus antigens, as a consequence of persistent fungal colonization of the airways. Here, we summarize the clinical and pathological features of ABPA, focusing on thick mucus plugging, a key observation in ABPA. Recent findings have indicated that luminal eosinophils undergo cytolytic extracellular trap cell death (ETosis) and release filamentous chromatin fibers (extracellular traps, ETs) by direct interaction with Aspergillus fumigatus. Production of ETs is considered to be an innate immune response against non-phagocytable pathogens using a "trap and kill" mechanism, although eosinophil ETs do not promote A. fumigatus damage or killing. Compared with neutrophils, eosinophil ETs are composed of stable and condensed chromatin fibers and thus might contribute to the higher viscosity of eosinophilic mucus. The major fate of massively accumulated eosinophils in the airways is ETosis, which potentially induces the release of toxic granule proteins and damage-associated molecular patterns, epithelial damage, and further decreases mucus clearance. This new perspective on ABPA as a luminal hypereosinophilic disease with ETosis/ETs could provide a better understanding of airway mucus plugging and contribute to future therapeutic strategies for this challenging disease.
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Affiliation(s)
- Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Akira Hebisawa
- Clinical Research Center and Pathology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masashi Kitani
- Clinical Research Center and Pathology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Josiane S Neves
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
PURPOSE OF REVIEW Microbial biofilms seem to play an active role in the pathogenesis of chronic rhinosinusitis (CRS). They represent an adaptive defense resource enabling resistance to antibiotics and host defense mechanisms. Biofilms are thought to be accountable for refractory cases of sinusitis by perpetuating local inflammation. The objective of this study was to assess the effectiveness of spray cryotherapy as a biofilm disruption agent in CRS in an in vitro model. RECENT FINDINGS A total of 23 patients with CRS undergoing endoscopic sinus surgery (ESS) were included. Rhinosinusal mucosa samples were harvested. Half of sample was left intact while the other half was treated with spray cryotherapy, so patients served as their own witnesses. Subsequently, they were processed to hematoxylin-eosin (HE) and toluidine blue (TB) staining and analyzed by light microscopy. Biofilms were detected in 17 of 23 patients with CRS. Staining by HE showed strong correlation with the results of TB staining protocol. The in vitro CRS study demonstrated that spray cryotherapy removed polymicrobial biofilms from the mucosa surface in 70.6% of cases and induced important structural changes in the remaining samples. Thus far, cryotherapy has proven to be a reliable method for the disruption of microbial biofilms in CRS with nasal polyps, in vitro conditions. Spray cryotherapy could be a considerable benefit in the management of recalcitrant CRS.
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18
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Lee K, Pletcher SD, Lynch SV, Goldberg AN, Cope EK. Heterogeneity of Microbiota Dysbiosis in Chronic Rhinosinusitis: Potential Clinical Implications and Microbial Community Mechanisms Contributing to Sinonasal Inflammation. Front Cell Infect Microbiol 2018; 8:168. [PMID: 29876323 PMCID: PMC5974464 DOI: 10.3389/fcimb.2018.00168] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
Recent studies leveraging next-generation sequencing and functional approaches to understand the human microbiota have demonstrated the presence of diverse, niche-specific microbial communities at nearly every mucosal surface. These microbes contribute to the development and function of physiologic and immunological features that are key to host health status. Not surprisingly, several chronic inflammatory diseases have been attributed to dysbiosis of microbiota composition or function, including chronic rhinosinusitis (CRS). CRS is a heterogeneous disease characterized by inflammation of the sinonasal cavity and mucosal microbiota dysbiosis. Inflammatory phenotypes and bacterial community compositions vary considerably across individuals with CRS, complicating current studies that seek to address causality of a dysbiotic microbiome as a driver or initiator of persistent sinonasal inflammation. Murine models have provided some experimental evidence that alterations in local microbial communities and microbially-produced metabolites influence health status. In this perspective, we will discuss the clinical implications of distinct microbial compositions and community-level functions in CRS and how mucosal microbiota relate to the diverse inflammatory endotypes that are frequently observed. We will also describe specific microbial interactions that can deterministically shape the pattern of co-colonizers and the resulting metabolic products that drive or exacerbate host inflammation. These findings are discussed in the context of CRS-associated inflammation and in other chronic inflammatory diseases that share features observed in CRS. An improved understanding of CRS patient stratification offers the opportunity to personalize therapeutic regimens and to design novel treatments aimed at manipulation of the disease-associated microbiota to restore sinus health.
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Affiliation(s)
- Keehoon Lee
- Department of Biological Sciences, Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Steven D Pletcher
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Susan V Lynch
- Division of Medicine, Department of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew N Goldberg
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Emily K Cope
- Department of Biological Sciences, Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
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19
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Singh GB, Solo M, Kaur R, Arora R, Kumar S. Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study. Am J Otolaryngol 2018; 39:157-161. [PMID: 29306568 DOI: 10.1016/j.amjoto.2017.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
AIMS & OBJECTIVES To detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance. STUDY DESIGN Prospective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital. MATERIALS & METHODS Forty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed. RESULTS Out of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established. CONCLUSIONS There is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.
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20
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Szaleniec J, Górski A, Szaleniec M, Międzybrodzki R, Weber-Dąbrowska B, Stręk P, Składzień J. Can phage therapy solve the problem of recalcitrant chronic rhinosinusitis? Future Microbiol 2017; 12:1427-1442. [PMID: 29027819 DOI: 10.2217/fmb-2017-0073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic rhinosinusitis (CRS) affects 5-15% of the global population. In some patients, the infectious exacerbations of the disease are recalcitrant to medical treatment and surgery. These cases are probably associated with the presence of bacterial biofilms. Bacteriophage (phage) therapy seems to be a promising antibiofilm strategy. The efficacy of phage therapy in sinonasal infections has been demonstrated both in vitro and in animal models. In the past, phage preparations were also administered to humans with CRS with favorable outcomes and no significant side effects. Very recently, the safety and efficacy of phage therapy in otolaryngological infections has been demonstrated in pioneer Phase I/II clinical trials. This review addresses the potential of phage therapy to treat CRS. We also discuss issues that require further research.
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Affiliation(s)
- Joanna Szaleniec
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
| | - Andrzej Górski
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland.,Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland
| | - Maciej Szaleniec
- Jerzy Haber Institute of Catalysis & Surface Chemistry, Polish Academy of Sciences, Niezapominajek 8, 30-239 Krakow, Poland
| | - Ryszard Międzybrodzki
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland.,Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland
| | - Beata Weber-Dąbrowska
- Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wroclaw, Poland
| | - Paweł Stręk
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
| | - Jacek Składzień
- Department of Otolaryngology, Jagiellonian University Medical College, Sniadeckich 2, 31-531 Krakow, Poland
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21
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Ueki S, Ohta N, Takeda M, Konno Y, Hirokawa M. Eosinophilic Otitis Media: the Aftermath of Eosinophil Extracellular Trap Cell Death. Curr Allergy Asthma Rep 2017; 17:33. [PMID: 28455742 DOI: 10.1007/s11882-017-0702-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Eosinophilic otitis media (EOM) is a refractory disease characterized by the accumulation of eosinophils in middle ear effusion and mucosa. We summarize current knowledge regarding the clinical characteristics and management of EOM. Although eosinophil activation in inflamed foci is involved in the pathogenesis of EOM, little is known about the fate of the eosinophils and aftermath of their cell death. We discuss the possibility that eosinophils undergo non-apoptotic cell death that worsens tissue damage and increases effusion viscosity. RECENT FINDINGS Unlike chronic otitis media, EOM is strongly associated with an allergic background. Corticosteroids are currently the only effective pharmacological treatment, and surgical intervention is often required. Mucosal eosinophils infiltrate extensively into the middle ear cavity where they are stimulated by locally produced activators including interleukin-5 and eotaxin. The eosinophils undergo cytolysis in the effusion, which represents a major fate of activated eosinophils in vivo. Recent data revealed cytolysis could be renamed as extracellular trap cell death (ETosis). ETosis represents suicidal cell death involving total cell degranulation and development of sticky chromatin structures (extracellular traps (ETs)). The characteristics of eosinophil- and neutrophil-derived ET polymers might contribute to the difference in viscosity of secretions between EOM and common chronic otitis media. The extracellular products remaining after eosinophil ETosis are an important aspect of EOM pathology. The concept of ETosis also has novel implications for potential therapeutic modalities in various eosinophilic disorders.
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Affiliation(s)
- Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan.
| | - Nobuo Ohta
- Department of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahide Takeda
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
| | - Yasunori Konno
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
- Department of Dentistry and Oral Surgery, Akita University Hospital, Akita, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
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Chronic Rhinosinusitis and the Evolving Understanding of Microbial Ecology in Chronic Inflammatory Mucosal Disease. Clin Microbiol Rev 2017; 30:321-348. [PMID: 27903594 DOI: 10.1128/cmr.00060-16] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic rhinosinusitis (CRS) encompasses a heterogeneous group of debilitating chronic inflammatory sinonasal diseases. Despite considerable research, the etiology of CRS remains poorly understood, and debate on potential roles of microbial communities is unresolved. Modern culture-independent (molecular) techniques have vastly improved our understanding of the microbiology of the human body. Recent studies that better capture the full complexity of the microbial communities associated with CRS reintroduce the possible importance of the microbiota either as a direct driver of disease or as being potentially involved in its exacerbation. This review presents a comprehensive discussion of the current understanding of bacterial, fungal, and viral associations with CRS, with a specific focus on the transition to the new perspective offered in recent years by modern technology in microbiological research. Clinical implications of this new perspective, including the role of antimicrobials, are discussed in depth. While principally framed within the context of CRS, this discussion also provides an analogue for reframing our understanding of many similarly complex and poorly understood chronic inflammatory diseases for which roles of microbes have been suggested but specific mechanisms of disease remain unclear. Finally, further technological advancements on the horizon, and current pressing questions for CRS microbiological research, are considered.
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Ueki S, Tokunaga T, Fujieda S, Honda K, Hirokawa M, Spencer LA, Weller PF. Eosinophil ETosis and DNA Traps: a New Look at Eosinophilic Inflammation. Curr Allergy Asthma Rep 2017; 16:54. [PMID: 27393701 DOI: 10.1007/s11882-016-0634-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The traditional paradigm of eosinophils as end-stage damaging cells has mainly relied on their release of cytotoxic proteins. Cytokine-induced cell survival and secretion of granular contents from tissue-dwelling eosinophil are thought to be important mechanisms for eosinophilic inflammatory disorders, although the occurrence of cytolysis and its products (i.e., free extracellular granules) has been observed in affected lesions. Recent evidence indicates that activated eosinophils can exhibit a non-apoptotic cell death pathway, namely extracellular trap cell death (ETosis) that mediates the eosinophil cytolytic degranulation. Here, we discuss the current concept of eosinophil ETosis which provides a new look at eosinophilic inflammation. Lessons from eosinophilic chronic rhinosinusitis revealed that ETosis-derived DNA traps, composed of stable web-like chromatin, contribute to the properties of highly viscous eosinophilic mucin and impairments in its clearance. Intact granules entrapped in DNA traps are causing long-lasting inflammation but also might have immunoregulatory roles. Eosinophils possess a way to have post-postmortem impacts on innate immunity, local immune response, sterile inflammation, and tissue damage.
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Affiliation(s)
- Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan.
| | - Takahiro Tokunaga
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Fukui, Fukui, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Fukui, Fukui, Japan
| | - Kohei Honda
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita Graduate School of Medicine, Akita, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
| | - Lisa A Spencer
- Divisions of Allergy and Inflammation and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter F Weller
- Divisions of Allergy and Inflammation and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
Our understanding of chronic rhinosinusitis (CRS) show biofilm and osteitis play a role in the disease's pathogenesis and refractory. Studies point to its role in pathogenesis and poor prognosis. Outside the research laboratory, biofilm detection remains difficult and specific treatment remains elusive. It is believed that osteitis is a nidus of inflammation and occurs more commonly in patients with refractory CRS. However, osteitis may be exacerbated by surgery and a marker of refractory disease, not a causative agent. Surgery remains the mainstay treatment for biofilm and osteitis with mechanical disruption and removal of disease load providing the most effective treatment.
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Affiliation(s)
- Yi Chen Zhao
- Department of Surgery - Otolaryngology Head & Neck Surgery, The University of Adelaide, Adelaide, Queen Elizabeth Hospital 28 Woodville Rd, Woodville South, South Australia 5011, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology Head & Neck Surgery, The University of Adelaide, Adelaide, Queen Elizabeth Hospital 28 Woodville Rd, Woodville South, South Australia 5011, Australia.
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25
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Li Y, Ding J, Xiao Y, Xu B, He W, Yang Y, Yang L, Su M, Hao X, Ma Y. 16S rDNA sequencing analysis of upper respiratory tract flora in patients with influenza H1N1 virus infection. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.flm.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Abstract
The goal of this review is to elucidate the pathogenic factors, histopathologic features, and special considerations that relate to pediatric versus adult chronic rhinosinusitis (CRS) and to emphasize differences and similarities between the adult and pediatric conditions. Emphasis is placed on understanding of the differences in pathogenic mechanisms, host-microbial interactions, potential defects in innate antimicrobial immunity, and the role of biofilm formation in pediatric versus adult CRS and how these translate to different approaches toward both medical and surgical management. Pediatric CRS can be viewed as evolving from acute bacterial rhinosinusitis into an uncomplicated "early" stage of CRS, later evolving into a persistent stage and, in some cases, evolving into a late "maladaptive-eosinophilic" stage disease. Given this potential evolution toward more irreversible disease, a plea can be made for improved recognition of and more aggressive early intervention for pediatric CRS, it is hoped, to prevent these long-term consequences. For the primary care physician, this may necessitate enlisting the support of a sinus specialist before the symptoms of CRS have persisted for months or years. It may also necessitate, in some cases, the use of sinus computed tomography imaging to demonstrate that sinus abnormalities have resolved. Other arguments can be made for prompt and comprehensive management of pediatric CRS, including the need to reduce the burden of illness, reduce health care costs, avoid unnecessary antibiotic use and its attendant effects toward promoting antibiotic resistant infections and, potentially, to reduce the development of important comorbidities, e.g., asthma.
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Affiliation(s)
- Daniel L Hamilos
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Adappa ND, Truesdale CM, Workman AD, Doghramji L, Mansfield C, Kennedy DW, Palmer JN, Cowart BJ, Cohen NA. Correlation of T2R38 taste phenotype and in vitro biofilm formation from nonpolypoid chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2016; 6:783-91. [PMID: 27309535 PMCID: PMC5500301 DOI: 10.1002/alr.21803] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 04/21/2016] [Accepted: 04/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sinonasal biofilms have been demonstrated in specimens collected from chronic rhinosinusitis (CRS) patients. Mounting evidence suggests that biofilms contribute to therapeutically recalcitrant CRS. Recently, the bitter taste receptor T2R38 has been implicated in the regulation of the sinonasal mucosal innate immune response. TAS2R38 gene polymorphisms affect receptor functionality and contribute to variations seen in sinonasal innate defense as well as taste perception reflected in gustatory sensitivity to the bitter compound phenylthiocarbamide (PTC). In a population of CRS patients with active infection or inflammation, we sought to determine if a correlation between T2R38 phenotype and in vitro biofilm formation existed. METHODS Endoscopically guided sinonasal swabs were obtained prospectively from CRS (±polyp) patients with evidence of persistent inflammation or mucopurulence. In vitro biofilm formation was assessed with a modified Calgary Biofilm Detection Assay. Patients' phenotypic (functional) expression of the bitter taste receptor T2R38 was evaluated with a taste test including the compound PTC. Linear regression was used to determine the level of significance between mean in vitro biofilm formation levels and mean PTC taste test intensity ratings across CRS patients. RESULTS Sinonasal swabs were obtained from 59 patients, with 42 of the 59 samples demonstrating in vitro biofilm formation. Analysis revealed an inverse linear association between in vitro biofilm formation and PTC taste intensity ratings (p = 0.019) for all patients. This association was exclusively driven by nonpolypoid CRS patients (p = 0.0026). CONCLUSION In vitro biofilm formation from sinonasal clinical isolates is inversely correlated with PTC taste sensitivity in nonpolypoid CRS patients.
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Affiliation(s)
- Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Carl M. Truesdale
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan D. Workman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Laurel Doghramji
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - David W. Kennedy
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Noam A. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Monell Chemical Senses Center, Philadelphia, PA
- Surgical Service, Philadelphia Veterans Administration Medical Center, Philadelphia, PA
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Fastenberg JH, Hsueh WD, Mustafa A, Akbar NA, Abuzeid WM. Biofilms in chronic rhinosinusitis: Pathophysiology and therapeutic strategies. World J Otorhinolaryngol Head Neck Surg 2016; 2:219-229. [PMID: 29204570 PMCID: PMC5698538 DOI: 10.1016/j.wjorl.2016.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 03/26/2016] [Accepted: 03/31/2016] [Indexed: 12/16/2022] Open
Abstract
Background There is increasing evidence that biofilms are critical to the pathophysiology of chronic infections including chronic rhinosinusitis (CRS). Until relatively recently, our understanding of biofilms was limited. Recent advances in methods for biofilm identification and molecular biology have offered new insights into the role of biofilms in CRS. With these insights, investigators have begun to investigate novel therapeutic strategies that may disrupt or eradicate biofilms in CRS. Objective This review seeks to explore the evidence implicating biofilms in CRS, discuss potential anti-biofilm therapeutic strategies, and suggest future directions for research. Results The existing evidence strongly supports the role of biofilms in the pathogenesis of CRS. Several anti-biofilm therapies have been investigated for use in CRS and these are at variable stages of development. Generally, these strategies: 1) neutralize biofilm microbes; 2) disperse existing biofilms; or 3) disrupt quorum sensing. Several of the most promising anti-biofilm therapeutic strategies are reviewed. Conclusions A better understanding of biofilm function and their contribution to the CRS disease process will be pivotal to the development of novel treatments that may augment and, potentially, redefine the CRS treatment paradigm. There is tremendous potential for future research.
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Affiliation(s)
- Judd H Fastenberg
- Department of Otorhinolaryngology - Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Wayne D Hsueh
- Department of Otorhinolaryngology - Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Ali Mustafa
- Department of Otorhinolaryngology - Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Nadeem A Akbar
- Department of Otorhinolaryngology - Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology - Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, Bronx, NY, 10467, USA
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Taschieri S, Torretta S, Corbella S, Del Fabbro M, Francetti L, Lolato A, Capaccio P. Pathophysiology of sinusitis of odontogenic origin. ACTA ACUST UNITED AC 2015; 8. [DOI: 10.1111/jicd.12202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/15/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Alessandra Lolato
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
| | - Pasquale Capaccio
- Department of Biomedical, Surgical and Dental Sciences; University of Milan; Milan Italy
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Biofilm Quantification on Nasolacrimal Silastic Stents After Dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2015; 31:396-400. [DOI: 10.1097/iop.0000000000000361] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Biofilms in chronic rhinosinusitis: what is new and where next? The Journal of Laryngology & Otology 2015; 129:744-51. [DOI: 10.1017/s0022215115001620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractBackground:Chronic rhinosinusitis is a common, heterogeneous condition. An effective means of mitigating disease in chronic rhinosinusitis patients remains elusive. A variety of causes have been implicated, with the biofilm theory gaining increasing prominence.Objective:This article reviews the literature on the role of biofilms in chronic rhinosinusitis, in terms of pathophysiology and with regard to avenues for future treatment.Methods:A systematic review of case series was performed using databases with independently developed search strategies, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, and Zetoc, in addition to conference proceedings and a manual search of literature, with the last search conducted on 18 January 2014. The search terms included the following, used in various combinations to maximise the yield of articles identified: ‘biofilms’, ‘chronic rhinosinusitis’, ‘DNase’, ‘extracellular DNA’ and ‘biofilm dispersal’.Results:The existing evidence lends further support for the role of biofilms (particularly the Staphylococcus aureus phenotype) in more severe, recalcitrant disease and poorer surgical outcomes.Conclusion:Multimodality treatment, with a shift in paradigm to incorporate anti-biofilm strategies, is likely to form the mainstay of future recalcitrant chronic rhinosinusitis management.
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Abshirini H, Makvandi M, Seyyed Ashrafi M, Hamidifard M, Saki N. Prevalence of rhinovirus and respiratory syncytial virus among patients with chronic rhinosinusitis. Jundishapur J Microbiol 2015; 8:e20068. [PMID: 25861437 PMCID: PMC4386071 DOI: 10.5812/jjm.20068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/14/2014] [Accepted: 12/30/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Chronic rhinosinusitis (CRS) is one of the most common chronic illnesses, but the etiology and pathogenesis of CRS are not well understood. Few studies have been carried out on the role of viruses in patients with chronic sinusitis so far. Objectives: Regarding the high number of patients, we intended to evaluate the prevalence of rhinovirus and respiratory syncytial virus in patients with CRS. Doing so, we may pave the way for definitely achieving the causes and factors of the disease and consequently definite treatment of this debilitating disease in future studies. Patients and Methods: This cross-sectional study was carried out on 76 patients. Sample of the study consisted of patients with CRS who were candidates for functional endoscopic sinus surgery (FESS). The specimens were collected during FESS between February 2013 and December 2013. For this purpose, after entering into sinuses, the specimens were collected from their mucus. They were then placed in Dulbecco's modified Eagle's viral transport medium (DMEM). They were transferred to the virology lab of the university in a cold chain. The specimens were maintained in -70°C before examination. Reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to explore the presence of rhinovirus and respiratory syncytial virus. Results: In this study, 76 patients with rhinosinusitis underwent FESS as qualified candidates. The sample of the study consisted of 48 males (63.2%) and 28 females (36.8%) with the mean age of 44.3 years and an age range of 19-76 years. Among the 76 patients, 53 were with polyps and 23 without polyps. Among the patients, 66 were candidates of FESS for the first time. Other 11 patients had previously undergone the surgery. The results from PCR indicated that 22 (28.94%) patients had rhinovirus and 9 (11.84%) had respiratory syncytial virus (RSV). A total of 25 patients (32.89%) had one of the two viruses. In 6 (7.89%) specimens, both viruses were reported. Conclusions: CRS is a common disease with negative effects on the quality of patients’ lives. This study showed the high prevalence of these two common respiratory viruses in patients with CRS.
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Affiliation(s)
- Hassan Abshirini
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Manochher Makvandi
- Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Meghdad Seyyed Ashrafi
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mojtaba Hamidifard
- Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nader Saki
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Nader Saki, Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Fax: +98-6132921838, E-mail:
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Mao YJ, Chen HH, Wang B, Liu X, Xiong GY. Increased expression of MUC5AC and MUC5B promoting bacterial biofilm formation in chronic rhinosinusitis patients. Auris Nasus Larynx 2015; 42:294-8. [PMID: 25638393 DOI: 10.1016/j.anl.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/06/2014] [Accepted: 12/29/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Binding of bacteria to mucin and then colonizing is the first step of bacterial biofilm (BBF) formation in chronic rhinosinusitis (CRS) patients. Yet, information is sparse on how mucins effects on BBF formation. In this study, we aimed to investigate the relationship between mucin expression and the formation of BBF in CRS patients. METHODS Sinus mucosa were harvested from 24 patients undergoing endoscopic surgery for CRS. The positive of BBF formation were detected by scanning electronic microscopy (SEM) and the expression of MUC1, MUC2, MUC5AC, and MUC5B were determined by immunohistochemistry (IHC). The difference expression of mucins were analyzed between the BBF positive and negative cohorts in CRS patients. RESULTS MUC5AC and MUC5B are two major mucins in CRS mucosa with the former mainly restricted to the goblet cells of epithelium and the latter mainly restricted to the submucosal glands. Expression of MUC5AC and MUC5B in the sinus mucosa of BBF(+) CRS group was significantly higher than those in BBF(-) CRS group (p<0.05). For MUC1 and MUC2, no significant difference was found between the two groups (p>0.05). CONCLUSION Our study indicated that increased expression of MUC5AC and MUC5B may play an important role in the pathogenesis of BBF formation.
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Affiliation(s)
- Yong-Jun Mao
- Department of Head-Neck Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hai-Hong Chen
- Department of Head-Neck Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Bo Wang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiang Liu
- Department of Head-Neck Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Gao-Yun Xiong
- Department of Head-Neck Otolaryngology, TongDe Hospital of Zhejiang Province, Hangzhou 310012, China
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Chalermwatanachai T, Velásquez LC, Bachert C. The microbiome of the upper airways: focus on chronic rhinosinusitis. World Allergy Organ J 2015; 8:3. [PMID: 25624972 PMCID: PMC4306241 DOI: 10.1186/s40413-014-0048-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/20/2014] [Indexed: 01/27/2023] Open
Abstract
Upper airway diseases including allergic rhinitis, chronic rhinosinusitis with or without polyps, and cystic fibrosis are characterized by substantially different inflammatory profiles. Traditionally, studies on the association of specific bacterial patterns with inflammatory profiles of diseases had been dependent on bacterial culturing. In the past 30 years, molecular biology methods have allowed bacterial culture free studies of microbial communities, revealing microbiota much more diverse than previously recognized including those found in the upper airway. At presence, the study of the pathophysiology of upper airway diseases is necessary to establish the relationship between the microbiome and inflammatory patterns to find their clinical reflections and also their possible causal relationships. Such investigations may elucidate the path to therapeutic approaches in correcting an imbalanced microbiome. In the review we summarized techniques used and the current knowledge on the microbiome of upper airway diseases, the limitations and pitfalls, and identified areas of interest for further research.
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Affiliation(s)
- Thanit Chalermwatanachai
- Department of Oto-Rhino-Laryngology, The Upper Airways Research Laboratory (URL), Ghent University Hospital, Ghent, 9000 Belgium ; Department of Otolaryngology, Phramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, 10400 Thailand
| | - Leydi Carolina Velásquez
- Department of Oto-Rhino-Laryngology, The Upper Airways Research Laboratory (URL), Ghent University Hospital, Ghent, 9000 Belgium ; Basic Biomedical Sciences Department, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Claus Bachert
- Department of Oto-Rhino-Laryngology, The Upper Airways Research Laboratory (URL), Ghent University Hospital, Ghent, 9000 Belgium ; Division of ENT Diseases, Clintec, Karolinska Institutet, Stockholm, Sweden
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Wang X, Dong D, Cheng J, Fan X, Zhao Y. Relationship between biofilms and clinical features in patients with sinus fungal ball. Eur Arch Otorhinolaryngol 2014; 272:2363-9. [PMID: 25359193 DOI: 10.1007/s00405-014-3361-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/19/2014] [Indexed: 02/07/2023]
Abstract
The presence of bacterial biofilms (BBF) and fungal biofilms (FBF) is associated with greater disease severity in chronic rhinosinusitis. However, researches on biofilms in fungal rhinosinusitis are rare. This study investigated the relationship between biofilms and clinical features in patients with sinus fungal ball (SFB). Sixty-four SFB patients undergoing endoscopic sinus surgery and 21 controls were enrolled in this study. Mucosal samples from nasal sinuses were collected for biofilm detection under confocal scanning laser microscopy (CSLM). The general clinical data, Lund-Mackay computed tomography (CT) score, Lund-Kennedy endoscopy score, Global Osteitis Scoring Scale (GOSS) score, Sinonasal Outcome Test (SNOT)-22 score and visual analog scale (VAS) score were recorded. Associations between these parameters and biofilms were assessed. Under CSLM, the positive rates of BBF and FBF were 45.3 % (29/64) and 21.9 % (14/64), respectively in the SFB group but none in controls. When sub-classified according to biofilm status, the BBF-positive subgroup had significantly higher Lund-Mackay score and GOSS score than the BBF-negative one, but there were no differences in demographic characteristics, health-related quality-of-life and endoscopic inflammatory severity. BBF and FBF coexisted on the sinus mucosa of the patients with SFB. BBF was associated with more severe disease, but the distribution of FBF did not affect the severity of SFB.
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Affiliation(s)
- Xiao Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Construction East Road, Zhengzhou, 450000, China
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Nazzari E, Torretta S, Pignataro L, Marchisio P, Esposito S. Role of biofilm in children with recurrent upper respiratory tract infections. Eur J Clin Microbiol Infect Dis 2014; 34:421-9. [PMID: 25318897 DOI: 10.1007/s10096-014-2261-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/06/2014] [Indexed: 12/30/2022]
Abstract
Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
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Affiliation(s)
- E Nazzari
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122, Milan, Italy
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Abstract
PURPOSE OF REVIEW Biofilms have been observed on the sinus mucosa of patients with chronic rhinosinusitis and are associated with poor clinical outcomes after surgery. This article summarizes the recent studies which describe the efficacy of treating biofilms in chronic rhinosinusitis. RECENT FINDINGS Biofilms are polymicrobial communities comprised of bacteria that tend to be more antibiotic-resistant than when in planktonic forms. Antibiotic therapy against biofilms is usually associated with relapse following cessation of treatment and may also have an adverse effect on normal commensal microflora. Surfactants can improve clinical symptoms, but their use has been limited by side effects. Other treatment modalities that physically remove or disrupt biofilms, such as ultrasound, have shown some efficacy in small trials. The impact of surgery on biofilms has not been extensively investigated. SUMMARY The nature of biofilms makes their removal difficult. No currently available treatment directed against them has demonstrated lasting efficacy.
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Mycological study on cholesteatoma keratin obtained during primary mastoid surgery. The Journal of Laryngology & Otology 2014; 128:881-4. [DOI: 10.1017/s0022215114002059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Established middle-ear cleft cholesteatoma is associated with keratinous debris, which is likely to be an ideal medium for saprophytic fungal colonisation. This prospective case study aimed to explore the incidence and nature of fungal elements in cholesteatoma keratin samples obtained during primary mastoid surgery.Methods:All cases of middle-ear cleft cholesteatoma treated with primary mastoid surgery at the El-Sahel Teaching Hospital over a seven-month period were included. Keratinous debris obtained from the mastoid antrum was subjected to mycological analysis at the Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University. A literature search was performed to determine the clinical and pathological relevance of fungal colonisation in cholesteatoma.Results:Eighteen patients underwent primary mastoid surgery for cholesteatoma (nineteen ears in total) in a seven-month period starting 30 March 2013. Patients included 13 males and 5 females, with an age range of 9 to 45 years (mean 23 years). Fungal cultures were obtained from 17 keratin samples (89 per cent). Of these, five fungal isolates belonged to the dermatophyte group (21 per cent).Conclusion:Fungal colonisation in middle-ear cleft cholesteatoma probably plays a significant role in disease progression. Moreover, saprophytic fungal colonisation in cholesteatoma keratin may be responsible for the fetor commonly associated with the ear discharge.
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Abstract
Viral infection represents a common and problematic health care issue, particularly in younger and senior populations. The respiratory tract is a major portal for microbial exposure, where viral infection can result in nonsymptomatic, mild, and self-limiting or severe and sometimes fatal infection. Although it is well established that virus-specific properties, such as longevity and replication kinetics, impact clinical manifestations, it is less well understood why distinct infectious outcomes may occur across a population of individuals infected with the same strain of virus. Emerging evidence points to interpersonal variation in pulmonary and gastrointestinal microbiome composition, and specifically to members of the Lactobacillus genus, as key components in defining respiratory viral infection outcomes. Moreover, human studies of airway microbiota after pH1N1 demonstrate that the composition of the respiratory microbiome can be modified by viral infection in a manner that enriches for pathogens associated with secondary bacterial infection. In this article, current knowledge in the field of human microbiome research, particularly as it pertains to respiratory viral infection, is reviewed.
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Montone KT. The molecular genetics of inflammatory, autoimmune, and infectious diseases of the sinonasal tract: a review. Arch Pathol Lab Med 2014; 138:745-53. [PMID: 24878014 DOI: 10.5858/arpa.2013-0038-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The sinonasal tract is frequently affected by a variety of nonneoplastic inflammatory disease processes that are often multifactorial in their etiology but commonly have a molecular genetic component. OBJECTIVE To review the molecular genetics of a variety of nonneoplastic inflammatory diseases of the sinonasal tract. DATA SOURCES Inflammatory lesions of the sinonasal tract can be divided into 3 main categories: (1) chronic rhinosinusitis, (2) infectious diseases, and (3) autoimmune diseases/vasculitides. The molecular diagnosis and pathways of a variety of these inflammatory lesions are currently being elucidated and will shed light on disease pathogenesis and treatment. CONCLUSIONS The sinonasal tract is frequently affected by inflammatory lesions that arise through complex interactions of environmental, infectious, and genetic factors. Because these lesions are all inflammatory in nature, the molecular pathology surrounding them is most commonly due to upregulation and down-regulation of genes that affect inflammatory responses and immune regulation.
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Affiliation(s)
- Kathleen T Montone
- From the Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Hirotsu M, Shiozawa A, Ono N, Miwa M, Kikuchi K, Ikeda K. Fungal extracts detected in eosinophilic chronic rhinosinusitis induced cytokines from the nasal polyp cells. Laryngoscope 2014; 124:E347-53. [PMID: 24615892 PMCID: PMC4298786 DOI: 10.1002/lary.24655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/28/2014] [Accepted: 02/20/2014] [Indexed: 11/09/2022]
Abstract
Objectives/Hypothesis The role of fungi in chronic rhinosinusitis (CRS) is still controversial. The present study was conducted to detect and identify fungal species from the nasal polyp tissues of eosinophilic and noneosinophilic CRS, and to determine the role of fungal antigens in cytokine production. Study Design Prospective study. Methods Thirty-five specimens of nasal polyps were collected from patients with CRS and examined for fungus using culture, histology, and polymerase chain reaction analysis. The secretion of 14 cytokines stimulated by fungal extracts using dispersed nasal polyp cells (DNPCs) was determined by multiplex immunoassay. Results There was no microbiological growth (including fungus) in the cultures of homogenized nasal polyps. Furthermore, Grocott methanamine silver staining for all nasal polyps showed no fungal bodies. Sixteen of 35 samples of the nasal polyps showed amplification of fungal DNA. In none of the mucosa of the sphenoid sinus was fungal DNA detected. The number of eosinophils in the nasal polyps in which fungal DNA was detected was significantly higher than in the nasal polyps in which fungal DNA was not detected (P < .01). The extract of fungus enhanced the secretion of eosinophil-associated cytokines such as interleukine (IL)-5, IL-13, IL-17A, and RANTES (regulated on activation normal T-cell expressed and secreted), and proinflammatory cytokines such as IL-6, IL-8, tumor necrosis factor-α, and granulocyte-macrophage colony-stimulating factor from DNPCs. Conclusions The present study offers direct evidence supporting that fungal elements modify the inflammatory response in the nasal polyps of eosinophilic CRS. Level of Evidence: NA
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Affiliation(s)
- Mikio Hirotsu
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Cleland EJ, Bassiouni A, Bassioni A, Boase S, Dowd S, Vreugde S, Wormald PJ. The fungal microbiome in chronic rhinosinusitis: richness, diversity, postoperative changes and patient outcomes. Int Forum Allergy Rhinol 2014; 4:259-65. [PMID: 24500871 DOI: 10.1002/alr.21297] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/25/2013] [Accepted: 12/19/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Our understanding of fungi in chronic rhinosinusitis (CRS) has been limited by previously employed detection techniques. This study examines the fungal component of the microbiome in CRS patients and controls using a highly sensitive culture-independent molecular technique. The aims of this study include the characterization of fungal richness, prevalence, abundance, temporal changes, and their relationship with patient outcomes. METHODS Swabs were collected from the sinuses of 23 CRS patients and 11 controls. Collection occurred intraoperatively, and at 6 and 12 weeks postoperatively. DNA was extracted from the swabs and fungal outcomes were determined through 18S ribosomal DNA (rDNA) fungal tag-encoded FLX amplicon pyrosequencing. RESULTS Fungi were ubiquitous to all patients. A total of 207 fungal genera were detected, with a mean sample richness of 8.18 and 12.14 in the control and CRS groups, respectively. Malassezia was detected in all patients at surgery and was also the most abundant. Postoperatively, fungal richness decreased (p < 0.05) and was associated with declines in the prevalence of Fusarium and Neocosmospora (p < 0.05). Neocosmospora was also less abundant postoperatively (p < 0.05). No correlations were found with quality of life. CONCLUSION This is the first study to use a highly sensitive pyrosequencing technique to reveal the true diversity of fungi in the sinuses of CRS patients and postoperative changes in richness. The presence of Malassezia, a genus not previously described in the sinuses, is of great interest, and its potential as a disease modifier should see further investigation given its association with atopic disease.
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Affiliation(s)
- Edward John Cleland
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
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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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Gu X, Keyoumu Y, Long L, Zhang H. Detection of bacterial biofilms in different types of chronic otitis media. Eur Arch Otorhinolaryngol 2013; 271:2877-83. [PMID: 24132653 DOI: 10.1007/s00405-013-2766-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Abstract
Biofilms are organized bacterial communities that may be homogeneous or heterogeneous. They play a significant role in the pathogenesis of chronic nasal sinusitis, chronic tonsillitis, cholesteatomas, and device-related infections. Despite this, few studies have been done that examine the presence of bacterial biofilms in tissues from patients with different types of COM or middle ear cholesteatomas. In the current study, we examined the presence of biofilms in surgical tissue specimens from humans with chronic ear infections using scanning electron microscopy (SEM). We hypothesize that bacterial biofilms present differently in patients with different types of chronic otitis media. Our results provide new insights regarding treatment of chronic otitis media. A prospective study was conducted in which middle ear tissues were obtained from 38 patients who underwent tympanoplasty and/or tympanomastoid surgery due to chronic ear infections. A total of 50 middle and mastoid tissue samples were processed for SEM analysis. In addition, 38 middle ear secretion specimens were obtained for routine bacterial culture analysis. Bacterial biofilms were present in 85 % (11 of 13) of patients with middle ear cholesteatoma, 92 % (12/13) of patients with chronic otitis suppurative media (CSOM), and 16 % of patients (2/12) with tympanic membrane perforation (TMP). Fungal biofilms were found in two cases of cholesteatoma. The positive coincidence rate between bacterial biofilms visualized by SEM and bacteria detected by culture was 82 %. Our findings suggest that bacterial biofilms are very common in CSOM and middle ear cholesteatomas. Positive bacterial cultures imply the presence of biofilm formation in CSOM and cholesteatomas. As such, our results provide new insights regarding treatment of chronic otitis media.
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Affiliation(s)
- Xingzhi Gu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Xinjiang Medical University, 137 Carp Mountain South Road, Ürümqi, 830011, China
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Probiotic strategies for treatment of respiratory diseases. Trends Microbiol 2013; 21:485-92. [DOI: 10.1016/j.tim.2013.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/12/2013] [Accepted: 04/23/2013] [Indexed: 02/03/2023]
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The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection. BMC Infect Dis 2013; 13:210. [PMID: 23656607 PMCID: PMC3654890 DOI: 10.1186/1471-2334-13-210] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 05/01/2013] [Indexed: 02/08/2023] Open
Abstract
Background Bacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS). However their presence and relationship to disease is debated. This study used multiple detection methods to compare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa. The utility of contemporary detection methods is also examined. Methods Sinonasal mucosa was analyzed from 38 CRS and 6 controls. Bacterial and fungal analysis was performed using conventional culture, molecular diagnostics (polymerase chain reaction coupled with electrospray ionization time-of-flight mass spectrometry) and fluorescence in situ hybridization. Results Microbes were detected in all samples, including controls, and were often polymicrobial. 33 different bacterial species were detected in CRS, 5 in control patients, with frequent recovery of anaerobes. Staphylococcus aureus and Propionibacterium acnes were the most common organisms in CRS and controls, respectively. Using a model organism, FISH had a sensitivity of 78%, and a specificity of 93%. Many species were detected in both CRS and controls however, microbial abundance was associated with disease manifestation. Conclusions This study highlights some cornerstones of microbial variations in healthy and diseased paranasal sinuses. Whilst the healthy sinus is clearly not sterile, it appears prevalence and abundance of organisms is critical in determining disease. Evidence from high-sensitivity techniques, limits the role of fungi in CRS to a small group of patients. Comparison with molecular analysis suggests that the detection threshold of FISH and culture is related to organism abundance and, furthermore, culture tends to select for rapidly growing organisms.
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Montone KT. Role of fungi in the pathophysiology of chronic rhinosinusitis: an update. Curr Allergy Asthma Rep 2013; 13:224-8. [PMID: 23247763 DOI: 10.1007/s11882-012-0332-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The pathogenesis of chronic rhinosinusitis (CRS) is multi-factorial with an infectious process likely at least partly involved. While bacteria have been proposed to play a critical role in CRS, fungi have also been implicated by some investigators, although the pathogenesis of fungi in CRS represents a significant controversy among rhinologists. Fungal-associated factors believed to be involved in CRS include the ability of fungi to induce significant inflammatory reactions by different means through inducing localized cytokine production in the sinonasal tract. Despite these observations, randomized, controlled studies on CRS patients using antifungal therapy have not resulted in significant improvement in CRS patients. The role of fungi in the pathogenesis of CRS remains controversial.
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Affiliation(s)
- Kathleen T Montone
- Division of Surgical Pathology, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA.
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Abstract
Chronic rhinosinusitis (CRS) is a very common condition that remains poorly understood from a pathogenic standpoint. Recent interest has been sparked by a potential role for biofilms in this process, with a significant body of evidence implicating them in inciting sinonasal inflammation. Biofilms are clearly present on the sinus mucosa of CRS patients, and their presence there is associated with severe disease characteristics and surgical recalcitrance. We are beginning to understand the importance of the species within these biofilms, but there may be other as-yet-unidentified factors at play in influencing disease outcomes. Recent exciting research has emerged documenting the immune response to the presence of biofilms-research that will ultimately solidify the nature and extent of the contribution of biofilms in CRS pathogenesis. Future research should focus on evidence-based antibiofilm treatments with reference to efficacy and timing of treatment.
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Shields RC, Mokhtar N, Ford M, Hall MJ, Burgess JG, ElBadawey MR, Jakubovics NS. Efficacy of a marine bacterial nuclease against biofilm forming microorganisms isolated from chronic rhinosinusitis. PLoS One 2013; 8:e55339. [PMID: 23441151 PMCID: PMC3575374 DOI: 10.1371/journal.pone.0055339] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background The persistent colonization of paranasal sinus mucosa by microbial biofilms is a major factor in the pathogenesis of chronic rhinosinusitis (CRS). Control of microorganisms within biofilms is hampered by the presence of viscous extracellular polymers of host or microbial origin, including nucleic acids. The aim of this study was to investigate the role of extracellular DNA in biofilm formation by bacteria associated with CRS. Methods/Principal Findings Obstructive mucin was collected from patients during functional endoscopic sinus surgery. Examination of the mucous by transmission electron microscopy revealed an acellular matrix punctuated occasionally with host cells in varying states of degradation. Bacteria were observed in biofilms on mucosal biopsies, and between two and six different species were isolated from each of 20 different patient samples. In total, 16 different bacterial genera were isolated, of which the most commonly identified organisms were coagulase-negative staphylococci, Staphylococcus aureus and α-haemolytic streptococci. Twenty-four fresh clinical isolates were selected for investigation of biofilm formation in vitro using a microplate model system. Biofilms formed by 14 strains, including all 9 extracellular nuclease-producing bacteria, were significantly disrupted by treatment with a novel bacterial deoxyribonuclease, NucB, isolated from a marine strain of Bacillus licheniformis. Extracellular biofilm matrix was observed in untreated samples but not in those treated with NucB and extracellular DNA was purified from in vitro biofilms. Conclusion/Significance Our data demonstrate that bacteria associated with CRS form robust biofilms which can be reduced by treatment with matrix-degrading enzymes such as NucB. The dispersal of bacterial biofilms with NucB may offer an additional therapeutic target for CRS sufferers.
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Affiliation(s)
- Robert C. Shields
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Norehan Mokhtar
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Michael Ford
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Michael J. Hall
- School of Chemistry, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J. Grant Burgess
- School of Marine Science and Technology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mohamed Reda ElBadawey
- Department of Otolaryngology and Head & Neck Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Otolaryngology Department, Tanta University, Tanta, Egypt
| | - Nicholas S. Jakubovics
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Boase S, Jervis-Bardy J, Cleland E, Pant H, Tan L, Wormald PJ. Bacterial-induced epithelial damage promotes fungal biofilm formation in a sheep model of sinusitis. Int Forum Allergy Rhinol 2013; 3:341-8. [PMID: 23307805 DOI: 10.1002/alr.21138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 10/29/2012] [Accepted: 11/17/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fungal biofilms have been discovered in chronic rhinosinusitis (CRS) patients, but factors contributing to their establishment are obscure. A recent animal study showed bacterial co-inoculation was required. We examine the role of 4 bacterial species and a cilia toxin on fungal biofilm formation in a sheep sinusitis model. The importance of epithelial integrity on fungal biofilm formation is also examined. METHODS Forty-eight frontal sinuses were inoculated with Aspergillus fumigatus alone, with 1 of 4 bacteria, or a cilia toxin. Bacterial and fungal biofilm was determined using confocal scanning laser microscopy. Inflammation and cilia integrity were assessed using light microscopy and transmission electron microscopy, respectively. RESULTS No fungal biofilm formed when inoculated alone. Florid fungal biofilm developed in more than 75% of sinuses associated with bacterial biofilm of all species, except Haemophilus influenzae, which failed to establish bacterial biofilm. Fungal biofilm also established in association with cilia toxin. Significant cilial damage was incited by all bacterial biofilms and cilia toxin, and was associated with fungal proliferation. Fungal biofilm formation did not significantly increase mucosal inflammation or epithelial damage over that caused by the bacteria or cilia toxin alone. CONCLUSION Bacterial biofilms cause sinonasal mucosal inflammation and epithelial injury, which provides conditions appropriate for fungal biofilm proliferation. The role of cilia in sinonasal mucosal defense against fungal organisms has been demonstrated. Without such an insult, fungal biofilms fail to proliferate in occluded sinuses. Improving cilial recovery postoperatively and treating bacterial biofilms may be key factors in reducing recalcitrance in allergic fungal rhinosinusitis patients.
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Affiliation(s)
- Sam Boase
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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