Bone: the final frontier for Staphylococcus aureus penetration in chronic rhinosinusitis

The superantigenic properties of Staphylococcus aureus have been implicated in increasing the inflammatory process in airway diseases. Local formation of IgE antibodies against staphylococcal enterotoxins by secondary lymphoid tissue in nasal polyps has been demonstrated. Staphylococcus aureus is known to colonize the nasal mucosa, and has been found invading the nasal submucosa and intracellularly.Objective: To evaluate the limits of Staphylococcus aureus invasion in the upper airway.Material and methods: Inferior turbinate samples from 3 patients without sinus disease, 6 ethmoid samples from patients with chronic rhinosinusitis with nasal polyposis, and 6 ethmoid samples from patients with chronic rhinosinusitis without nasal polyposis were studied. A fluorescein-labeled PNA probe against Staphylococcus aureus was used to test for the presence of the bacterium in bone (after decalcification) and mucosa.Results: We found Staphylococcus aureus invading the nasal submucosa in patients with nasal polyposis, but no cases of Staphylococcus aureus positivity in bone. in conclusion, we cannot support the hypothesis of nasal bone as a reservoir for Staphylococcus aureus, releasing massive amounts of staphylococcal enterotoxins and eliciting an inflammatory reaction, as occurs with the nasal mucosa.Univ São Paulo, Dept Otorhinolaryngol, São Paulo, BrazilSão Paulo State Mil Police, Mil Police Hosp, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Otorhinolaryngol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Immunol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Otorhinolaryngol, São Paulo, BrazilFed Univ São Paulo Unifesp, Dept Immunol, São Paulo, BrazilWeb of Scienc

Convergence of two major pathophysiologic mechanisms in nasal polyposis : immune response to Staphylococcus aureus and airway remodeling

This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus. These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response. In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling

This review is addressed two pathophysiologic mechanisms implicated in the pathogenesis of nasal polyposis: the unique remodeling process found in nasal polyp tissue and the immune response of patients with nasal polyposis to Staphylococcus aureus.\ud \ud These two theories converge to the same direction in different aspects, including decreased extracellular matrix production, impaired T regulation and favoring of a Th2 immune response.\ud \ud In patients with nasal polyposis, an exaggerated immune response to Staphylococcus aureus may aggravate the airway remodeling process

Evaluation of severe obstructive sleep apnea/hypopnea syndrome after maxillomandibular advancement surgery

Objective: To evaluate the effectiveness of the maxilomandibularadvancement surgery in patients suffering from obstructive sleepapnea/hypopnea syndrome by analysing it objectively and subjectively.Methods: Ten patients suffering from apnea/hypopnea syndrome indexabove 30 events per sleep hour, diagnosed by polysomnography wereexamined. The patients underwent physical, polysomnographic andcephalometric tests and were subjectively evaluated according to theEpworth Sleepness Scale. The data obtained was compared to theresults of the same group 6 months after the surgery. Results: Afterthe maxilomandibular advancement surgery, as related to an objectiveevaluation by polysomnography, the results were the following: 20% ofthe patents had a normal apnea/hypopnea index, 30% of the patientshad a moderate apnea/hypopnea index and 40% of the patients kepta severe apnea/hypopnea index, 60% of the patients had a 50%decrease in the apnea/hypopnea index and only 10% of the patientshad an increase in the apnea/hypopnea index. The average of thelowest oxyhemoglobin saturation in the preoperative was 63.4%, anda significant improvement was obtained after the maxilomandibularadvancement procedure when an average of 80.8%, and 70% of thepatients showed a lowest oxyhemoglobin saturation above 83%. Asfor the subjective evaluation using the Epworth Sleepness Scale,there was an improvement in 100% of the patients. Conclusions: Theobjective evaluation of the maxilomandibular advancement surgeryshowed that it was effective in 60% of the patients suffering fromsevere apnea/hypopnea index, while the subjective evaluation showedthat it was effective in 100% of the patients

Cytokine kinetics in nasal mucosa and sera: new insights in understanding upper-airway disease of marathon runners

Recently, many authors have proposed that mechanisms such as inflammation and/or allergies could be partly responsible for cases of upper respiratory tract illnesses that affect athletes after exhaustive exercise. Here we studied the kinetics of cytokines in the serum and nasal mucosa of athletes after a marathon. We were able to demonstrate an increase in serum levels of all interleukins studied immediately after the marathon in athletes that present or not with upper airways symptoms followed by a return to basal levels 72 hours after the race, as described in the literature. Interleukin (IL)-10 behaviour differed in the group of asymptomatic athletes. Measurement of this cytokine in protein extract of nasal mucosal cells showed increase 72 hours after the marathon. Levels of this cytokine in sera were increased at rest in athletes that did not present symptoms. These findings suggest that the maintenance of a non-inflammatory environment in the mucosal airways is an active process that requires participation of the systemic and mucosal immune systems. We propose that the understanding of the upper airway disease of the athlete involves the study of mucosal and systemic immune systems.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Paulo, Dept Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Microbiol & Immunol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Microbiol & Immunol, Sao Paulo, BrazilFAPESP: 2009/51800-1Web of Scienc

A Case of Primary Nasal Chromoblastomycosis

ESCOLA PAULISTA MED,RUA BOTUCATU 740,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA MICOL,DEPT MICROBIOL IMUNOL & PARASITOL,BR-04023 SAO PAULO,SP,BRAZILCONSELHO NACL PESQUISAS,PESQUISADORA,BR-22290 RIO DE JANEIRO,RJ,BRAZILESCOLA PAULISTA MED,DISCIPLINA DOENCAS INFECCIOSAS & PARASITARIAS,DEPT MED,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA OTORRINOLARINGOL,DEPT OFTALMOL & OTORRINOLARINGOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,RUA BOTUCATU 740,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA MICOL,DEPT MICROBIOL IMUNOL & PARASITOL,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA DOENCAS INFECCIOSAS & PARASITARIAS,DEPT MED,BR-04023 SAO PAULO,SP,BRAZILESCOLA PAULISTA MED,DISCIPLINA OTORRINOLARINGOL,DEPT OFTALMOL & OTORRINOLARINGOL,BR-04023 SAO PAULO,SP,BRAZILWeb of Scienc