The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis
Purpose of Review
Staphylococcus aureus (S. aureus) is correlated with the development of persistent severe inflammatory disease of the upper airway including chronic rhinosinusitis with nasal polyps (CRSwNP). The presence of S. aureus is associated with atopic disease including allergic rhinitis and atopic dermatitis and is associated with poor outcomes.
Several different strains of S. aureus generate different toxins and gene products that can account for organism pathogenicity. S. aureus bacteria and its antigens shape the bacterial and fungal microbiome and the mucosal niche which generates host responses that can account for inflammation. The multiple disease phenotypes and molecular endotypes seen in CRSwNP can be characterized by T-helper cell environment within the inflammatory milieu, the presence of epithelial barrier dysfunction, aberrant eicosanoid metabolism, poor wound healing, and dysfunctional host-bacteria interactions which lead to recalcitrant disease and worse surgical outcomes.
Understanding the pathomechanisms that S. aureus utilizes to promote nasal polyp formation, prolonged tissue inflammation, and bacterial dysbiosis are essential in our efforts to identify new therapeutic approaches to resolve this chronic inflammatory process.
KeywordsChronic rhinosinusitis Nasal polyps Staphylococcus aureus Innate and adaptive immune system Superantigens
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 2.Fokkens WJ et al European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012;3. Preceding table of contents–1–298Google Scholar
- 5.•• Derycke L, Perez-Novo C, Van Crombruggen K, Corriveau M-N, Bachert C. Staphylococcus aureus and chronic airway disease. World Allergy Organ J. 2010;3:223–8 Comprehensive overview of the role of S. aureus. in upper airway disease. Google Scholar
- 25.• Takeda K, et al. Allergic conversion of protective mucosal immunity against nasal bacteria in patients with chronic rhinosinusitis with nasal polyposis. J Allergy Clin Immunol. 2018. https://doi.org/10.1016/j.jaci.2018.07.006. Study suggesting that immunoglobulin class switching of B cells (from IgA and IgG to IgE) during the mucosal response against nasal bacteria contributes to the IgE phenotyope often observed in CRSwNP.
- 31.• Valera FCP, et al. Staphylococcus aureus impairs sinonasal epithelial repair: effects in patients with chronic rhinosinusitis with nasal polyps and control subjects. J Allergy Clin Immunol. 2018. https://doi.org/10.1016/j.jaci.2018.05.035. Study demonstrating the negative impact of Staphylococcus on wound healing in CRSwNP.