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Eosinophilic bacterial chronic rhinosinusitis
Berrylin J Ferguson1, Raja Seethala, William A Wood
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. fergusonbj@upmc.edu
Background:
A subset of Chronic Rhinosinusitis (CRS) patients are those with eosinophilic CRS (ECRS). These patients remain the most refractory to medical and surgical intervention, and are thought to reflect an inflammatory process arising from a variety of causes. Recently the role of fungus in ECRS, defined as the presence of fungi in the eosinophilic mucin of CRS, has been proposed as causal in many cases. Other proposed causes of ECRS include bacterial superantigen induction of inflammation and aspirin sensitivity.
Design:
Retrospective review.
Methods:
Histopathology from patients with previously diagnosed ECRS was prospectively re-reviewed for bacterial and fungal presence and correlated with patients' demographic data. The study population was comprised of 55 specimens with ECRS from 34 patients, over a 3-year period from a single investigator at the University of Pittsburgh Medical Center.
Results:
Histologic presence of bacteria was shown in 34 of 55 (62%) of all ECRS specimens. Specimens with fungal colonization were more often associated with bacterial presence than without bacteria (17 of 22 [77%] vs. 5 of 22 [23%], P < .02).
Conclusion:
Bacteria were present in almost two-thirds of all specimens, and most cases of fungal presence were accompanied by bacterial presence, potentially providing support for bacteria as a source of superantigen. Other possible reasons for the high rate of bacterial and fungal colonization of ECRS include increased pathogen exposure, or failure to eliminate pathogens.
Insights
Bacteria were found in most eosinophilic chronic rhinosinusitis (ECRS) cases, often alongside fungi. This suggests bacteria may play a role in ECRS inflammation, possibly through superantigens.
Area of Science:
- Otolaryngology
- Microbiology
- Immunology
Background:
- Eosinophilic chronic rhinosinusitis (ECRS) is a severe form of chronic rhinosinusitis.
- ECRS is refractory to standard treatments, with diverse potential causes.
- Fungal and bacterial roles in ECRS pathogenesis are under investigation.
Purpose of the Study:
- To investigate the prevalence of bacterial and fungal presence in ECRS.
- To explore the relationship between bacterial and fungal colonization in ECRS.
Main Methods:
- Retrospective review of histopathology specimens from ECRS patients.
- Prospective re-evaluation of 55 ECRS specimens from 34 patients.
- Correlation of microbial findings with demographic data.
Main Results:
- Bacteria were identified in 62% of ECRS specimens.
- Fungal colonization was more frequent in specimens with bacterial presence (77%) compared to those without (23%).
Conclusions:
- Bacterial presence is common in ECRS, supporting the superantigen hypothesis.
- The high co-occurrence of bacteria and fungi in ECRS warrants further investigation.
- Potential factors include increased pathogen exposure or impaired pathogen clearance.
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