The initiation and perpetuation of chronic rhinosinusitis
(CRS) is known to be associated with host-microbial interactions. Many studies have investigated these
interactions with CRS in order to understand the mechanisms of the disease and
provide better treatment options. Dr. Hamilos summarizes the knowledge of host-microbial
interactions in regards to normal sinus physiology and pathology, patients with
CRS with and without polyps, and allergic fungal rhinosinusitis (AFRS) (J Allergy Clin Immunol 2014; 133(3): 640-653).
Much of the research on the subject of CRS has been on
bacterial infection and potential defects in innate immunity that might
predispose patients to sinus infections.
Of CRS patients undergoing surgical intervention, more than 50% have
bacterial biofilm in their diseased sinus tissues. Biofilm is an
important survival mechanism of bacteria allowing for attachment to
surfaces. The biofilm has been
described to have an enhanced resistance to antibiotics and is associated with
more severe disease and worse surgical outcomes. Dr. Hamilos explains that less is known about viral or
fungal infection in CRS; in fact it remains unclear if upper respiratory tract
viruses contribute causally to CRS analogous to their possible role in
asthma. Other research has ruled
out defects, such as defects in mucociliary clearance or toll like receptor function
as primary defects in CRS. A
decreased level of the antimicrobial protein lactoferrin has been found in
sinus secretions, however other antimicrobial protein levels have been found to be normal.
CRS research has focused on patients that have either
“refractory” disease which can be defined as no improvement following surgery and medical management or “recalcitrant” disease which is defined
as the recurrence of nasal polyps after polyp surgery. Studies suggest that patients with
recalcitrant nasal polyps have down regulated innate immunity associated with T
helper type 2 (Th2) inflammation, potentially causing persistent
infection. While surgical
treatment and use of culture-directed antibiotics remain the best treatment
options, Dr. Hamilos is hopeful that further understanding of the underlying
genetics of CRS and host-microbial interactions will allow for greater insight
and more effective treatment options.
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