Abstract
There is increasing evidence to suggest that the sinus microbiome plays a role in the pathogenesis of chronic rhinosinusitis (CRS). However, the concentration of these microorganisms within the sinuses is still unknown. We show that flow cytometry can be used to enumerate bacteria and virus-like particles (VLPs) in sinus flush samples of CRS patients. This was achieved through trialling 5 sample preparation techniques for flow cytometry. We found high concentrations of bacteria and VLPs in these samples. Untreated samples produced the highest average bacterial and VLP counts with 3.3 ± 0.74 x 107 bacteria ml-1 and 2.4 ± 1.23 x 109 VLP ml-1 of sinus flush (n = 9). These counts were significantly higher than most of the treated samples (p < 0.05). Results showed 103 and 104 times inter-patient variation for bacteria and VLP concentrations. This wide variation suggests that diagnosis and treatment need to be personalised and that utilising flow cytometry is useful and efficient for this. This study is the first to enumerate bacterial and VLP populations in the maxillary sinus of CRS patients. The relevance of enumeration is that with increasing antimicrobial resistance, antibiotics are becoming less effective at treating bacterial infections of the sinuses, so alternative therapies are needed. Phage therapy has been proposed as one such alternative, but for dosing, the abundance of bacteria is required. Knowledge of whether phages are normally present in the sinuses will assist in gauging the safety of applying phage therapy to sinuses. Our finding, that large numbers of VLP are frequently present in sinuses, indicates that phage therapy may represent a minimally disruptive intervention towards the nasal microbiome. We propose that flow cytometry can be used as a tool to assess microbial biomass dynamics in sinuses and other anatomical locations where infection can cause disease.
Highlights
Chronic rhinosinusitis (CRS) is a common disease amongst the human population, and there is increasing evidence to show that microorganisms are involved in the inflammation of the sinus mucosal layer leading to exacerbation of the disease [1,2,3]
Maxillary sinus flush fluid samples were obtained from nine patients diagnosed with CRS in accordance to criteria defined by the Chronic Rhinosinusitis Task Force [23]
Variations in bacterial and virus-like particles (VLPs) abundance were observed between patients regardless of the treatment method used on the samples
Summary
Chronic rhinosinusitis (CRS) is a common disease amongst the human population, and there is increasing evidence to show that microorganisms are involved in the inflammation of the sinus mucosal layer leading to exacerbation of the disease [1,2,3]. It is well established that the healthy sinus is not sterile, but is colonised by a diverse community of microorganisms [1, 2, 4, 5] These microorganisms exist in the sinuses within exopolysaccharide biofilms, the presence of which leads to difficulties in treating the disease [6,7,8,9,10,11,12]. As antibiotics are a common treatment option for CRS patients, there is concern surrounding the growing antimicrobial resistance [13, 14] Bacteria within these biofilms are able to secrete a polysaccharide matrix that acts as a protective barrier against host defences and antimicrobial agents [15]. Knowledge of population abundance of bacteria and phage in the sinuses is important for the development of appropriate phage concentrations for use in this therapy [19]
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