There has been great interest in unraveling the complex inter-relationships between microbes and humans as they relate to human health and disease. This review will focus on recent advances in the appreciation and understanding of these relationships in terms of the upper respiratory tract, specifically the nose and paranasal sinuses.
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Confocal scanning laser microscopy
Fluorescence in situ hybridization
Human beta defensin
Intraepithelial Staphyloccus aureus
Methicillin-resistant Staphylococcus aureus
Operational taxonomic unit
Scanning electron microscopy
A bitter taste receptor
A bitter taste receptor polymorphism
Transmission electron microscopy
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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Gosbell IB, van Hal SJ. Staphylococcus aureus colonisation: some questions answered. Lancet Infect Dis. 2013;13(5):380–1. This is an editorial regarding the den Heijer paper (reference 9) and the prevalence of S aureus and MRSA carriage across the world and their implications for public health measures.
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Ramakrishnan VR, Feazel LM, Gitomer SA, Ir D, Robertson CE, Frank DN. The microbiome of the middle meatus in healthy adults. PLoS One. 2013;8(12):e85507. This study examined the microbiome of the middle meatus in healthy adults using middle meatus swabs, quantitative PCR and 16S rRNA pyrosequencing thereby establishing a baseline for understanding how the sinonasal microbiome may impact diseases.
Abreu NA, Nagalingam NA, Song Y, Roediger FC, Pletcher SD, Goldberg AN, et al. Sinus microbiome diversity depletion and Corynebacterium tuberculostearicum enrichment mediates rhinosinusitis. Sci Transl Med. 2012;4(151):151ra24. This study compared sinus brushings from 10 healthy non-CRS controls and 7 CRS patients using a phylogenetic microarray and identified a protective role for the taxon Lactobacillales (that includes Lactobacillus sakei) and a pathogenic role for Corynebacteriaceae (including the organism Corynebacteium tuberculostericum) in CRS.
Hamilos DL. Host-microbial interactions in patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2014;133(3):640.e4–53.e4. This is a state-of-the-art review of evidence for microbial involvement in CRS (viral, bacterial and fungal) and the role of host mucociliary clearance and mucosal innate immunity as they relate to mucosal susceptibility toward microbial infection and the pathogenesis of CRS.
Psaltis AJ, Ha KR, Beule AG, Tan LW, Wormald PJ. Confocal scanning laser microscopy evidence of biofilms in patients with chronic rhinosinusitis. Laryngoscope. 2007;117(7):1302–6. This study investigate biofilm presence in 38 CRS patients and 9 non-CRS controls using CSLM and identified biofilm in 44 % of CRS patients and none of the non-CRS controls.
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Cryer J, Schipor I, Perloff JR, Palmer JN. Evidence of bacterial biofilms in human chronic sinusitis. ORL J Otorhinolaryngology Relat Spec. 2004;66(3):155–8. This study used electron microscopy to confirm the presence of biofilms on sinus mucosa of patients with recalcitrant chronic sinusitis and identified them in patients infected with P. aeruginosa.
Corriveau MN, Zhang N, Holtappels G, Van Roy N, Bachert C. Detection of Staphylococcus aureus in nasal tissue with peptide nucleic acid-fluorescence in situ hybridization. Am J Rhinol Allergy. 2009;23(5):461–5. This study described the detection of intramucosal Staphylococcus aureus within nasal tissue in patients with CRS using a peptide nucleic acid-FISH technique.
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Feazel LM, Robertson CE, Ramakrishnan VR, Frank DN. Microbiome complexity and Staphylococcus aureus in chronic rhinosinusitis. Laryngoscope. 2012;122(2):467–72. This study compared conventional culture techniques and DNA pyrosequencing of middle meatus swabs during sinus surgery on CRS patients and non-CRS controls and demonstated increased biodiversity identifiable by DNA pyrosequencing when compared to bacterial culture as well as altered microbial composition and greater abundance of S aureus in CRS patients.
Boase S, Foreman A, Cleland E, Tan L, Melton-Kreft R, Pant H, et al. The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection. BMC Infect Dis. 2013;13:210. This study used multiple techniques to characterize bacterial and fungal unvolvement of sinonasal mucosa in CRS patients and controls including conventional culture, PCR coupled with electrospray ionization time-of-flight mass spectrometry, and FISH and found an increased abundance of S aureus in CRS.
Choi EB, Hong SW, Kim DK, Jeon SG, Kim KR, Cho SH, et al. Decreased diversity of nasal microbiota and their secreted extracellular vesicles in patients with chronic rhinosinusitis based on a metagenomic analysis. Allergy. 2014;69(4):517–26. This study evaluated the microbiota and extracellular vesicles in CRS patients with and without polyposis and non-CRS controls using pyrosequencing to quantify diversity and abundance and found decreased abundance of Bacteroidetes and increased abundance of Firmicutes in CRS patients.
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Kim MR, Hong SW, Choi EB, Lee WH, Kim YS, Jeon SG, et al. Staphylococcus aureus-derived extracellular vesicles induce neutrophilic pulmonary inflammation via both Th1 and Th17 cell responses. Allergy. 2012;67(10):1271–81. This study evaluated innate immune responses in vitro after the application of extracellular vesicles from S. aureus to airway epithelial cells and alveolar macrophages as well as combining EV with ovalbumin for in vivo sensitization studies demonstrating induction of Th1 and Th17 immune responses.
Aurora R, Chatterjee D, Hentzleman J, Prasad G, Sindwani R, Sanford T. Contrasting the microbiomes from healthy volunteers and patients with chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1328–38. This study analyzed the microbiome of CRS patients and healthy controls using deep sequencing of bacterial 16S and fungal 18S ribosomal RNA genes suggesting a similar composition of the microbiomes between patients and controls but an altered immune response to normal commensal bacteria among the CRS patients.
Lee RJ, Xiong G, Kofonow JM, Chen B, Lysenko A, Jiang P, et al. T2R38 taste receptor polymorphisms underlie susceptibility to upper respiratory infection. J Clin Invest. 2012;122(11):4145–59. This study demonstrates the expression of the bitter taste receptor, T2R38, in upper respiratory epithelium and its activation in response to acyl-homoserine lactone quorum-sensing molecules secreted by P aeruginosa and other gram negative bacteria resulting in NO production and increased mucociliary clearance.
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Conflict of Interest
Michael T. Wilson and Daniel L. Hamilos report 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 the authors.
This article is part of the Topical Collection on Rhinosinusitis