Staphylococcus aureus nasal carriage in patients with rhinosinusitis

Toxic shock syndrome has been associated with rhinologic surgery and medical devices, and it has been linked to a circulating exotoxin of a toxogenic strain of Staphylococcus aureus. One hundred forty patients with rhinosinusitis were studied. Nasal cultures were obtained. The microbiological characteristics are described. The carrier rate for Staphylococcus aureus was 35%. Thirty percent of patients selected for surgery were Staphylococcus aureus carriers. Toxin-capable isolates were identified in 40% of those tested. Users of cocaine, topical decongestants, and steroid sprays had a statistically higher rate of Staphylococcus aureus carriage compared to non-users. It is hoped that by identifying the population at risk and defining the factors associated with the development of toxic shock syndrome, a cogent policy of prevention can be established.     

Staphylococcus aureus superantigens are associated with chronic rhinosinusitis with nasal polyps: a meta-analysis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common health problem in the world. However, its etiology remains unclear. Recent researches have hypothesized that Staphylococcus aureus (SA) exotoxins which act as superantigens might be associated with inflammatory mucosal changes seen in CRSwNP. The objective of this study is to evaluate the relationship between Staphylococcus aureus superantigens and CRSwNP. PubMed, MEDLINE, EMBASE, Cochrane Library and CNKI were searched to collect the case–control studies on the relationship between SA superantigens and CRSwNP from the date of establishment of the databases to May 2013. The extracted data were analyzed by RevMan 5.0. The main outcome measures were SA culture-positive rate, the detection rate of SA superantigens and its specific IgE. Twelve studies including 340 cases and 178 controls were selected. The results showed that SA culture-positive rate in the CRSwNP group was significantly higher than that in the control group (OR 4.85, 95 % CI 1.80–13.05, P = 0.002), the detection rate of SA superantigens and its specific IgE in the CRSwNP group were both significantly higher than that in the control group (OR 12.07, 95 % CI 4.57–31.90, P < 0.00001; OR 17.03, 95 % CI 5.43–53.39, P < 0.00001, respectively) and the CD4⁺ T cell counts and Lund-Mackay CT scores were statistically higher in the IgE-positive group than in the IgE-negative group (MD 16.26, 95 % CI 4.86–27.67, P = 0.005, MD 2.43, 95 % CI 0.39–4.48, P = 0.02, respectively). However, the eosinophil and CD8⁺ T cell counts showed no difference between IgE-positive group and -negative group. This meta-analysis indicated that the SA superantigens may be a risk factor for CRSwNP, and the presence of SA superantigen is related to the disease severity of CRSwNP.     

Methicillin-resistant Staphylococcus aureus infections in acute rhinosinusitis

OBJECTIVE/HYPOTHESIS: Methicillin-resistant Staphylococcus aureus (MRSA) has recently become a serious problem in various fields of medicine. However, it has rarely been studied in acute rhinosinusitis. The aim of this study was to identify the clinical manifestations and treatment outcome of community-acquired methicillin-resistant S. aureus in acute rhinosinusitis. STUDY DESIGN: This was a prospectively collected case series. METHODS: Since 2000, we have launched a prospective long-term study for bacteriology, drug susceptibility, and their changing trend in acute rhinosinusitis. Patients with the diagnosis of acute rhinosinusitis were enrolled from October 2000 through March 2003. Their middle meatus discharge was taken for aerobic culture. Antibiotic sensitivity test was performed for each isolate. RESULTS: A total of 601 patients with the diagnosis of acute rhinosinusitis were included in this study. MRSA was isolated in 16 specimens. Its prevalence rate in acute rhinosinusitis was 2.7% (16 of 601). Multiple pathogens were more frequently found in children with MRSA infection. Five of seven adults had previous nasal procedures. Eight of nine children had a history of antibiotic use. Except for two patients without follow up, the remaining 14 patients resolved after receiving oral antibiotics according to culture results. CONCLUSIONS: The incidence of MRSA infection in acute rhinosinusitis was 2.7% in our study. The most important risk factor was nasal surgeries in adults and previous antibiotic use in children. The treatment outcome of community-acquired MRSA was excellent with oral antibiotics.     

Incidence of methicillin-resistant Staphylococcus aureus causing chronic rhinosinusitis

OBJECTIVE/HYPOTHESIS: To identify the incidence of methicillin-resistant Staphylococcus aureus (MRSA) causing chronic rhinosinusitis (CRS) and identify whether antibiotic use and previous endoscopic sinus surgeries (ESS) contribute to its development. STUDY DESIGN: A retrospective case control analysis, with the control group randomly selected and matched for age and sex. METHODS: All patients undergoing an endonasal culture in a tertiary otolaryngology center between April 2001 and March 2003 for mucopurulent rhinosinusitis were identified. A chart review was undertaken to identify those patients with a positive MRSA culture result. An age- and sex-matched control group was randomly chosen, and an interview was conducted to identify antibiotic use and previous ESS. A statistical analysis on these two variables was carried out using a t test and the Wilcoxon rank-sum test. RESULTS: Two hundred eighty cultures were identified in 188 patients, and of these, 264 cultures in 173 patients met the inclusion criteria. There were 141 positive cultures and 13 positive MRSA cultures. The overall incidence of MRSA in this population was 9.22%. The mean number of antibiotic courses in the MRSA and the control groups was 33.2 and 26.7, respectively, which was not statistically significant (P =.43). The 95% confidence interval (CI) for this mean difference of 6.5 is -9.8 to 22.8. The mean number of ESS in the MRSA and control groups was 2.0 and 1.9, respectively, which was not statistically significant (P =.93). The 95% CI for this mean difference of 0.06 is -1.3 to 1.4. CONCLUSIONS: We identified a 9.22% incidence of MRSA-causing CRS. The frequency of antibiotic use and previous ESS were found not to be statistically significant causes of MRSA sinusitis. However, the 95% CI for antibiotic usage is skewed to the right, indicating a possible role for its contribution to the emergence of MRSA-causing CRS.     

Nasal lavage with sodium hypochlorite solution in Staphylococcus aureus persistent rhinosinusitis

OBJECTIVE: To determine a selected concentration of sodium hypochlorite (NaOCl) in saline solution for nasal lavage and evaluate its clinical efficiency in the treatment of symptomatic patients with persistent, Staphylococcus aureus (SA) associated rhinosinusitis (RS). MATERIAL AND METHODS: In vitro tests for cilia and epithelial cell viability were done on reconstituted primary epithelial cells in vitro. Cells were exposed for 5 and 15 minutes twice daily for 5 consecutive days to one of the following conditions, (1) saline, (2) 0.5% NaOCl in saline, and (3) 0.05% NaOCl in saline. In order to evaluate tolerance, immunostaining was done for ezrin and F-actin network and observed with confocal microscopy. The patients (n=20) were all persistent SA symptomatic carriers, with unique patient-specific SA clonotypes, and multiple infection recurrence despite effective systemic antibiotic therapy. Each patient applied first saline alone for 3 months followed by saline + 0.05% NaOCl solution, as nasal lavage twice daily on both nostrils for 3 months. Symptom intensity and endoscopic findings were recorded with visual analogue scale (VAS). Nasal airway resistance (NAR) and nasal Nitric Oxide (NO) levels were measured before and after the saline lavage regimen, and after the saline + NaOCl treatment. RESULTS: F-actin network loss and decreased expression of ezrin were significant in cells exposed to 0.5%, but not in those exposed to 0.05% NaOCl. These changes were more obvious when exposed for 15 min. than 5 min. daily. The nasal lavage with 0.05% NaOCl in saline was well tolerated and a significant improvement in nasal obstruction (p = 0.001), posterior nasal discharge (p = 0.018), olfaction (p = 0.007) and headache (p = 0.009) was demonstrated. Significant improvement was also recorded in nasal endoscopic grading of oedema (p = 0.001), erythema (p = 0.001), purulent discharge (p = 0.002), nasal crusts (p = 0.001), and NAR (p = 0.05) as measured by rhinomanometry. There was no significant improvement in nasal NO production or subjective anterior nasal discharge. Bacteriological cultures of middle meatus secretions collected one month after the end of the treatment revealed the persistence of SA. CONCLUSION: Nasal lavage with 0.05% NaOCl solution in saline is suitable for long-term use and seems to be a good alternative to lavage with saline alone in the management of symptomatic RS associated with recurrent SA infections due to patient-specific SA clonotypes.     

Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations

INTRODUCTION: Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA. OBJECTIVE: The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA. MATERIALS AND METHODS: Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed. RESULTS: Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months). CONCLUSIONS: Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.     

Parapharyngeal abscess is frequently associated with concomitant peritonsillar abscess

To characterize patients with parapharyngeal abscess admitted to a Danish tertiary care centre and evaluate our management. This is a retrospective chart review. All records of patients with parapharyngeal abscess admitted to the Ear-Nose-Throat Department at Aarhus University Hospital, Denmark, from January 2001 through December 2011 were reviewed. In total, 63 patients (41 males), aged 4–89 years (median, 45 years) were included in the study. The mean annual incidence of parapharyngeal abscess was 0.9 cases/100,000 population. Thirty-three (52 %) patients had concomitant peritonsillar abscess. In two patients the parapharyngeal abscess was accompanied by necrotizing fasciitis. The most frequent surgical approach used was intrapharyngeal incision in combination with tonsillectomy. The most commonly used antibiotic regimen was benzylpenicillin plus metronidazole. Seven (13 %) patients returned to the operating theatre due to post-tonsillectomy haemorrhage or insufficient abscess drainage. Tonsillectomy and internal incision of the abscess in combination with a narrow-spectrum intravenous penicillin and metronidazole is a safe and efficient approach for managing parapharyngeal abscesses. This approach, however, carries a relatively high complication rate, requiring close surveillance in the early post-operative period. This is especially true for parapharyngeal abscess patients without peritonsillar abscess. In our series, these patients were more ill, more likely to experience complications, require intensive care, intubation, and tracheotomy, than parapharyngeal abscess patients with concurrent peritonsillar abscess. The frequent co-existence of parapharyngeal abscess and peritonsillar abscess favours careful consideration of addition of tonsillectomy to intrapharyngeal incision.     

金黄色葡萄球菌在变应性鼻炎和慢性鼻窦炎伴鼻息肉中的研究进展

金黄色葡萄球菌（金葡菌）定植与变应性鼻炎（AR）和慢性鼻窦炎伴鼻息肉（CRSwNP）的加重及预后密切相关。本文详细阐述了金葡菌造成AR及CRSwNP难以控制的机制,同时概括性描述了金葡菌在AR和CRSwNP患者的局部定植情况及对血清炎症的影响。     

慢性鼻窦炎鼻息肉患者血清金黄色葡萄球菌肠毒素IgE抗体检测

目的检测慢性鼻窦炎伴和不伴鼻息肉患者金黄色葡萄球菌肠毒素(Staphylococcus aureus enterotoxins,SEs)A、B、C型的血清特异性IgE抗体,探讨SEs在慢性鼻窦炎、鼻息肉发病中的作用。方法研究对象包括慢性鼻窦炎不伴鼻息肉(CRSsNP)患者30例、慢性鼻窦炎伴鼻息肉(CRSwNP)患者40例和健康对照组30例,应用ImmunoCAP100E系统检测血清SEA、SEB和SEC特异性IgE水平,并采用统计学软件SPSS11.0进行分析。结果 CRSsNP和CRSwNP患者的血清SEB特异性IgE水平较之对照组均明显增高,差异有统计学意义(P0.05),而血清SEA和SEC特异性IgE水平未见明显升高(P0.05)。结论金黄色葡萄球菌感染产生的肠毒素B(SEB)在慢性鼻窦炎、鼻息肉的发病过程中发挥一定作用。     

Chronic rhinosinusitis is associated with increased risk of COVID-19 hospitalization

ObjectiveThe rationale of the study was to examine the association between chronic rhinosinusitis (CRS) and COVID-19 hospitalization.Study designRetrospective cohort study.SettingCleveland Clinic hospital inpatient and outpatient.MethodsA retrospective chart review of patients that were tested for COVID-19 at Cleveland Clinic. The study took place between March 8, 2020 and May 15, 2020.ResultsFrom a total of 23,282 Patients that underwent SARS-CoV-2 testing, 996 COVID-19 negative and 998 COVID-19 positive patients were included in the analysis. COVID-19 positive patients with chronic rhinosinusitis (CRS) were at higher risk for hospitalization compared to patients without CRS (39.2% vs 25.7%, p = 0.0486). There was no significant difference between the two groups in relation to ICU admission, mechanical ventilation, and death, After adjustment for covariates, our multivariate analysis showed that patients with chronic rhinosinusitis (CRS) were approximately 3.46 (OR = 3.19, 95% CI (1.12–10.68)) times more likely to be hospitalized compared to patients that have no CRS.ConclusionOur results demonstrated that patients with chronic rhinosinusitis are associated with higher risk of COVID-19 hospitalization, albeit no increased risk of mortality.     

Nasal teeth associated with rhinosinusitis

Intranasal ectopic dentition is a rare clinical entity. It may be asymptomatic or can be associated with different symptoms. In 25% of the reported cases an association with rhinosinisitis is suspected. The possible pathophysiology, diagnosis and treatment are discussed. Teeth in the floor of both nasal cavities, associated with chronic rhinosinusitis, are reported for the first time, and a new treatment option of endonasal extraction under microscopic control is presented.     

Nasal teeth associated with rhinosinusitis

Intranasal ectopic dentition is a rare clinical entity. It may be asymptomatic or can be associated with different symptoms. In 25% of the reported cases an association with rhinosinusitis is suspected. The possible pathophysiology, diagnosis and treatment are discussed. Teeth in the floor of both nasal cavities, associated with chronic rhinosinusitis, are reported for the first time, and a new treatment option of endonasal extraction under microscopic control is presented.     

金黄色葡萄球菌超抗原与慢性鼻窦炎鼻息肉发生相关性的研究

目的:探讨金黄色葡萄球菌(金葡菌)超抗原在鼻息肉发生中的作用。方法:对42例双侧鼻息肉患者(鼻息肉组)、27例单纯慢性鼻窦炎患者(鼻窦炎组)和12例无鼻窦疾病史的鼻外伤患者(对照组)的鼻腔分泌物进行细菌培养;采用酶联免疫吸附试验(ELISA)法检测各组患者的鼻黏膜或息肉组织中的金葡菌超抗原;在组织学上,对苏木精-伊红染色切片进行嗜酸粒细胞计数。结果:鼻腔分泌物中金葡菌阳性率鼻息肉组为7.1%,鼻窦炎组为3.7%,对照组为0,各组间差异均无统计学意义(均P>0.05)。ELISA结果显示:鼻息肉组金葡菌超抗原阳性率为54.76%,鼻窦炎组和对照组阳性率均为0。嗜酸粒细胞计数平均值:鼻息肉组23.94±13.88,鼻窦炎组0.29±0.51,对照组0.08±0.28,3组间均差异有统计学意义(均P<0.05)。鼻息肉组中ELISA结果阳性者嗜酸粒细胞水平比阴性者高,但差异无统计学意义(P>0.05)。结论:金葡菌超抗原与鼻息肉的发生存在相关性,有可能在鼻息肉的致病机制中起重要作用。