The role of atypical bacteria in chronic rhinosinusitis

Abstract

Problem: Conflicting studies exist on the microbiology of chronic rhinosinusitis (CRS), but none identify atypical bacteria, owing to these bacteria’s fastidious nature. Atypical bacteria are common causes of pneumonia. However, their role in upper respiratory disease is less clear. Recently the polymerase chain reaction has been valuable in detecting aerobic and anaerobic bacteria, fungi, and viruses implicated in chronic rhinosinusitis. This study examines the role of atypical bacterial infection in CRS by utilizing the polymerase chain reaction. Methods: Eleven patients (8 males, 3 females) with CRS were prospectively enrolled. All failed medical therapy requiring endoscopic sinus surgery (ESS). Ethmoid sinus mucosa was processed by polymerase chain reaction (PCR) to identify the presence of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. Also, intra-operative routine aerobic and anaerobic cultures were processed. The control group included 6 fresh corpses (3 males, 3 females) without evident sinus disease from the Miami-Dade County Medical Examiner. Their ethmoid mucosa was also obtained endoscopically and processed by PCR. Results: Of the 17 ethmoid mucosa samples (11 patients, 6 cadaver controls), 1 cadaver control was positive by PCR for M pneumoniae. All other samples were negative for M pneumoniae, C pneumoniae, and L pneumophila. The most common organism obtained from routine culture was coagulase negative staphylococci. Conclusion: Using highly sensitive PCR techniques, chronic rhinosinusitis mucosa did not reveal DNA from M pneumoniae, C pneumoniae, or L pneumophila. Atypical bacterial infection may not play a significant role in adult CRS. Significance: This study demonstrates that PCR is highly sensitive in detecting atypical bacteria and these bacteria are not identified in patients with CRS. Support: None reported.