Staphylococcal infection and toxin production in chronic rhinosinusitis

Background: The association between bacterial colonization and different forms of chronic rhinosinusitis (CRS) has not been well documented. One of the most recent hypotheses is superantigen (SA)-induced inflammation, resulting in tip-regulation of lymphocytes to produce cytokines, and other inflammatory mediators that strongly modify the disease. Staphylococcus aureus, frequently encountered in nasal passages, can produce enterotoxins that can act as SAs. Methods: A prospective case control study was performed. Sixty-four patients diagnosed with CRS (group 1), CRS with nasal polyps (CRSwNP) (group 2), and 15 control subjects were enrolled. Swabs were taken from the middle meatus of all subjects for identification of S. aureus carriers. Positive carriers were analyzed for the presence of toxic shock syndrome toxin (TSST) 1 using reverse passive latex agglutination as well as polymerase chain reaction. Results: The rate of nasal carriage of S. aureus in CRS was 42.8%, that of CRSwNP was 45.4%, and that of the control group was 13.3%. The difference between both groups of CRS and the control group was found to be highly significant (p < 0.001). The detection of TSST-1 was significantly higher (p < 0.001) in both groups of CRS patients than in the control group. Finally, the difference in colonization of TSST-1 was highly significant (p < 0.001) between the CRS group 1 and CRSwNP group 2 patients. Conclusion: Identifying SAs and understanding how they elicit the pathogenic condition in CRS will be central in revealing ways to ameliorate their effects and properly treat these conditions. (Am J Rhinol Allergy 23, 264-267, 2009; doi: 10.2500/ajra.2009.23.3313)