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Open Access Original research article

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

Rogério Pezato13*, Luciano Bottura2, Rodrigo de Paula Santos3, Richard Louis Voegels1, Andre Luis Lacerda Bachi4 and Luis Carlos Gregório3

Author Affiliations

1 Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil

2 Military Police Hospital, São Paulo State Military Police, São Paulo, Brazil

3 Department of Otorhinolaryngology, Federal University of São Paulo - Unifesp, São Paulo, Brazil

4 Department of Immunology, Federal University of São Paulo - Unifesp, São Paulo, Brazil

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Journal of Otolaryngology - Head and Neck Surgery 2013, 42:45  doi:10.1186/1916-0216-42-45

Published: 19 July 2013

Abstract

The superantigenic properties of Staphylococcus aureus have been implicated in increasing the inflammatory process in airway diseases. Local formation of IgE antibodies against staphylococcal enterotoxins by secondary lymphoid tissue in nasal polyps has been demonstrated. Staphylococcus aureus is known to colonize the nasal mucosa, and has been found invading the nasal submucosa and intracellularly.

Objective

To evaluate the limits of Staphylococcus aureus invasion in the upper airway.

Material and methods

Inferior turbinate samples from 3 patients without sinus disease, 6 ethmoid samples from patients with chronic rhinosinusitis with nasal polyposis, and 6 ethmoid samples from patients with chronic rhinosinusitis without nasal polyposis were studied. A fluorescein-labeled PNA probe against Staphylococcus aureus was used to test for the presence of the bacterium in bone (after decalcification) and mucosa.

Results

We found Staphylococcus aureus invading the nasal submucosa in patients with nasal polyposis, but no cases of Staphylococcus aureus positivity in bone. In conclusion, we cannot support the hypothesis of nasal bone as a reservoir for Staphylococcus aureus, releasing massive amounts of staphylococcal enterotoxins and eliciting an inflammatory reaction, as occurs with the nasal mucosa.

Keywords:
Rhinosinusitis; Bone; Staphylococcus aureus; Airway