Paired analysis of the microbiota of surface mucus and whole-tissue specimens in patients with chronic rhinosinusitis.

BACKGROUND: The role of bacteria in the pathogenesis of chronic rhinosinusitis (CRS) remains uncertain. Recent evidence suggests that bacteria are able to establish microcolonies within the underlying mucosa. However, to date there has been no systematic comparison of bacterial community composition and diversity in the surface mucosa with that of the underlying tissue. METHODS: Paired swabs and whole-tissue samples were collected from the middle meatus of 9 patients with CRS undergoing endoscopic sinus surgery. The bacterial composition and diversity of the samples were determined using 16S rRNA gene amplicon pyrosequencing. RESULTS: The bacterial communities of both swabs and tissues were dominated by known residents of the sinonasal cavity such as Staphylococcus, Corynebacterium, Prevotella, and Peptoniphilus. Although bacterial diversity (richness) did not differ between the 2 groups of samples, there were significant differences in the composition of bacterial communities. Molecular analyses revealed a large amount of interpersonal variation between patients. CONCLUSION: Swab and tissue samples revealed similar bacterial diversity to each other and to that of other microbiota studies reported in the CRS literature. However, bacterial composition was significantly different between the 2 sample types, even though the tissue biopsies also comprise bacteria from the surface. We speculate that the bacteria on the surface seed the underlying tissue via the damaged epithelium in CRS patients, which over time develops into a distinct bacterial community.

Chronic rhinosinusitis and cystic fibrosis: the interaction between sinus bacteria and mucosal immunity.

BACKGROUND: Chronic rhinosinusitis (CRS) is highly prevalent in cystic fibrosis (CF) patients, in whom a close correlation exists between the microbiology of the upper and lower respiratory tracts. We have reported intramucosal bacterial microcolonies in the sinus mucosa from idiopathic CRS patients and have made observations suggesting that these may result from mucosal immunotolerance secondary to altered macrophage function. In this study, we sought to determine whether intramucosal microcolonies exist in the mucosa of CF patients with CRS, and to investigate the associated mucosal immunology. METHODS: Mucus swabs and tissue biopsies were taken from 9 patients with CF undergoing functional endoscopic sinus surgery (FESS) for CRS, 11 with idiopathic CRS undergoing FESS, and 9 with normal sinuses having transnasal pituitary surgery. Microbiology samples were taken for culture and intramucosal microcolonies were sought using Gram staining. Mucosal immune cells were identified using fluorescent immunohistochemistry. RESULTS: Positive culture rates were similar between CRS patients and controls, but there were significantly more intramucosal microcolonies in the CRS groups (8/9 CF-CRS, 7/11 CRS), compared to controls (1/9). Furthermore, the biodensity of intramucosal microcolonies was significantly higher in CF-CRS than idiopathic CRS. Mirroring the microbiological observations, the number of CD163+ macrophages was significantly increased in CF-CRS compared to idiopathic CRS (p = 0.03). CONCLUSION: Intramucosal bacteria exist within the sinus mucosa of patients with CF, and in significantly greater numbers than in idiopathic CRS patients. We speculate that intramucosal microcolonies may also exist in the lower respiratory tract mucosa in CF and play a role in disease recalcitrance.

The interaction between bacteria and mucosal immunity in chronic rhinosinusitis: a prospective cross-sectional analysis.

BACKGROUND: We have detected intramucosal bacteria within the sinus mucosa of patients with chronic rhinosinusitis (CRS), but our attempts at characterizing these did not yield any discernible genotypic or phenotypic differences from surface bacteria. We hypothesized that the presence of intramucosal microcolonies reflected host mucosal immune dysfunction. This study characterizes the activation status of T cells, B cells, and macrophages in the sinus mucosa of patients with CRS and controls and determines the impact of bacteria on mucosal immunology. METHODS: Swabs and mucosal biopsy specimens were taken from 27 patients with CRS undergoing sinus surgery and 9 patients with normal sinuses having transnasal pituitary surgery. Microcolonies were detected using Gram staining, and the immune cells were characterized by immunohistochemical techniques. RESULTS: Swab culture rates for Staphylococcus aureus were similar between CRS and controls. However, there were significantly more intramucosal microcolonies in CRS (59% versus 11%) than in controls (p = 0.02). There were significantly more immune cells in CRS. Percentage of activated T and B cells were similar between CRS and controls, but there were significantly more CD163(+) M2 macrophages in patients with CRS (p = 0.0004). Furthermore, percentage of CD163(+) macrophages showed a positive correlation with disease severity. The presence of bacteria had no impact on immunology or disease severity. CONCLUSION: Tolerance of intramucosal microcolonies in CRS may reflect altered macrophage function in the host mucosa. The clinical severity of CRS is also dependent on the host mucosa immune dysfunction, rather than the presence of intramucosal microcolonies.

The interaction between bacteria and mucosal immunity in chronic rhinosinusitis: A prospective cross-sectional analysis.

BACKGROUND: We have detected intramucosal bacteria within the sinus mucosa of patients with chronic rhinosinusitis (CRS), but our attempts at characterizing these did not yield any discernible genotypic or phenotypic differences from surface bacteria. We hypothesized that the presence of intramucosal microcolonies reflected host mucosal immune dysfunction. This study characterizes the activation status of T cells, B cells, and macrophages in the sinus mucosa of patients with CRS and controls and determines the impact of bacteria on mucosal immunology. METHODS: Swabs and mucosal biopsy specimens were taken from 27 patients with CRS undergoing sinus surgery and 9 patients with normal sinuses having transnasal pituitary surgery. Microcolonies were detected using Gram staining, and the immune cells were characterized by immunohistochemical techniques. RESULTS: Swab culture rates for Staphylococcus aureus were similar between CRS and controls. However, there were significantly more intramucosal microcolonies in CRS (59% versus 11%) than in controls (p = 0.02). There were significantly more immune cells in CRS. Percentage of activated T and B cells were similar between CRS and controls, but there were significantly more CD163+ M2 macrophages in patients with CRS (p = 0.0004). Furthermore, percentage of CD163+ macrophages showed a positive correlation with disease severity. The presence of bacteria had no impact on immunology or disease severity. CONCLUSION: Tolerance of intramucosal microcolonies in CRS may reflect altered macrophage function in the host mucosa. The clinical severity of CRS is also dependent on the host mucosa immune dysfunction, rather than the presence of intramucosal microcolonies.

Supraclavicular artery island flap for reconstructing defects in the head and neck region.

PURPOSE OF REVIEW: The supraclavicular artery island flap is a rotation flap that offers a versatile reconstructive option for head and neck defects. Recent anatomical studies have improved our understanding of the vascular supply of the supraclavicular artery island flap. Furthermore, several published large series describe the utility and reliability of this flap. In this article, we review the scientific literature describing the vascular anatomy of the supraclavicular artery island flap, its clinical application, and limitations in reconstructing defects in the head and neck region. RECENT FINDINGS: The vascular anatomy and surface markings, optimal flap design, surgical techniques employed to improve reliability, and aesthetic and functional outcomes of the supraclavicular artery island flap in head and neck reconstruction are well documented in the literature. SUMMARY: The supraclavicular artery island flap offers a versatile and well tolerated option in reconstruction of head and neck defects with several advantages over more traditional regional flaps and distant-free flaps.