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|Title:||The multiplicity of Staphylococcus aureus in chronic rhinosinusitis: Correlating surface biofilm and intracellular residence|
|Citation:||Laryngoscope, 2012; 122(8):1655-1660|
|Publisher:||Lippincott Williams & Wilkins|
|Neil C.-W. Tan, Andrew Foreman, Camille Jardeleza, Richard Douglas, Hai Tran, Peter John Wormald|
|Abstract:||<h4>Objectives/hypothesis</h4>The biofilm paradigm of chronic rhinosinusitis (CRS) is increasingly understood to play a key role in the pathophysiology of this disease. The role of intracellular infection of sinonasal epithelial cells has been suggested as a potential reservoir of pathogenic organisms that can lead to recalcitrant disease despite maximal medical and surgical treatment. Could a surface biofilm play a role in allowing intracellular infection to occur, and what are the factors associated with potential intracellular infections? The aim of this study was to investigate these questions.<h4>Study design</h4>A prospective study including 36 CRS patients undergoing endoscopic sinus surgery and five control patients undergoing endonasal pituitary surgery.<h4>Methods</h4>Sinonasal mucosa harvested at the time of surgery was examined with a Staphylococcus aureus fluorescence in situ hybridization probe and propodium iodide counterstain using the confocal scanning laser microscope for both biofilm status and evidence of intracellular organisms.<h4>Results</h4>Intracellular S aureus was identified in 20/36 (56%) CRS patients compared to 0/8 (0%) control patients. CRS patients with intracellular infection were significantly more likely to harbor surface biofilm (20/20, P = .0014) and have a S aureus-positive culture swab (12/20, P = .0485).<h4>Conclusions</h4>This study gives further evidence supporting a role of intracellular S aureus in CRS. In all cases intracellular infection was associated with surface biofilm, suggesting a potential relationship between the two. Further work is required to delineate the true mechanisms of intracellular persistence and also the role that it plays in the recalcitrant nature of CRS.|
|Keywords:||Chronic rhinosinusitis; intracellular infection; biofilms; Staphylococcus aureus; Level of Evidence: 2c|
|Rights:||Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.|
|Appears in Collections:||Surgery publications|
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