RESUMO
BACKGROUND: We studied whether the sinuses might be foci for Pseudomonas aeruginosa lung infection. METHODS: Endoscopic Sinus Surgery was performed in 78 CF patients; PFGE was used for bacterial genotyping. Material from sinuses and lungs were Gram-stained to detect biofilms. Immunoglobulins were measured in serum and saliva. RESULTS: When P. aeruginosa was cultured simultaneously from the sinuses and the lungs they were genetically identical in 38 of the 40 patients (95%). In the sinuses, P. aeruginosa formed biofilms with minimal cellular inflammation, probably because of a significantly higher local production of secretory IgA compared with IgG (p<0.001). CONCLUSIONS: We have shown that P. aeruginosa form biofilm in the sinuses, which constitute an important bacterial reservoir for subsequent lung infection. The high amount of IgA in the upper airways probably protects P. aeruginosa from the inflammatory immune system, and they can proceed unnoticed into a permanent infectious focus that cannot be eradicated with antibiotics.
Assuntos
Biofilmes , Fibrose Cística/imunologia , Fibrose Cística/microbiologia , Neutrófilos/imunologia , Seios Paranasais/imunologia , Seios Paranasais/microbiologia , Adolescente , Adulto , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/metabolismo , Criança , Endoscopia , Feminino , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/cirurgia , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/metabolismo , Imunoglobulina G/sangue , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Seios Paranasais/cirurgia , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/cirurgia , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Sinusite/imunologia , Sinusite/microbiologia , Sinusite/cirurgia , Escarro/imunologia , Escarro/microbiologia , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/cirurgia , Adulto JovemRESUMO
Microbial biofilms are known to cause persistent foreign-body infections and have recently been acknowledged as involved in more than 65% of all human infections. Microbial biofilms have been detected in chronic rhinosinusitis, and chronic rhinosinusitis is mandatory in patients with cystic fibrosis. We believe that a reservoir for a sustained lung infection in these patients might be found in the nasal sinuses, and that the sinuses may act as a reservoir for reinfection after CF-patient lung transplants. Further studies are necessary.
Assuntos
Biofilmes , Fibrose Cística/microbiologia , Rinite/microbiologia , Sinusite/microbiologia , Biofilmes/crescimento & desenvolvimento , Doença Crônica , Fibrose Cística/complicações , Humanos , Pulmão/microbiologia , Seios Paranasais/microbiologia , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Rinite/complicações , Sinusite/complicaçõesRESUMO
This case-report describes an otherwise healthy younger woman with post partum onset of objective pulsatile tinnitus. Neuroradiological examination revealed a dural fistula that was later closed using endovascular coiling technique, after which the patient's tinnitus disappeared. At 6-month follow-up the patient was symptom-free. This case report emphasises the importance of examining for objective tinnitus in patients complaining of tinnitus, as the causes of objective pulsatile tinnitus can frequently be treated successfully.
