title: Evidence of an intracellular reservoir in the nasal mucosa of patients with recurrent Staphylococcus aureus rhinosinusitis.
abstract: Severe infections due to Staphylococcus aureus require prolonged therapy for cure, and relapse may occur even years after the first episode. Persistence of S. aureus may be explained, in part, by nasal carriage of S. aureus, which occurs in a large percentage of healthy humans and represents a major source of systemic infection. However, the persistence of internalized S. aureus within mucosal cells has not been evaluated in humans. Here, we provide the first in vivo evidence of intracellular reservoirs of S. aureus in humans, which were assessed in endonasal mucosa specimens from patients suffering from recurrent S. aureus rhinosinusitis due to unique, patient-specific bacterial clonotypes. Heavily infected foci of intracellular bacteria located in nasal epithelium, glandular, and myofibroblastic cells were revealed by inverted confocal laser scan fluorescence and electron microscopic examination of posttherapy intranasal biopsy specimens from symptom-free patients undergoing surgery on the sinuses. Intracellular residence may provide a sanctuary for pathogenic bacteria by protecting them from host defense mechanisms and antibiotic treatment during acute, recurrent S. aureus rhinosinusitis.
authors.affiliation: Department of Pathology and Immunology, University of Geneva, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Clement
authors.forename: Pierre
authors.initials: P
authors.lastname: Vaudaux
authors.forename: Patrice
authors.initials: P
authors.lastname: Francois
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Huggler
authors.forename: Sandy
authors.initials: S
authors.lastname: Kampf
authors.forename: Christine
authors.initials: C
authors.lastname: Chaponnier
authors.forename: Daniel
authors.initials: D
authors.lastname: Lew
authors.forename: Jean-Silvain
authors.initials: JS
authors.lastname: Lacroix
mesh_terms: D001706:Biopsy; D002353:Carrier State; D004848:Epithelium / Q000382:microbiology; D005347:Fibroblasts / Q000382:microbiology; D006801:Humans; D018613:Microscopy, Confocal; D008854:Microscopy, Electron; D009297:Nasal Mucosa / Q000382:microbiology* / Q000473:pathology; D012008:Recurrence; D012220:Rhinitis / Q000382:microbiology* / Q000473:pathology; D012852:Sinusitis / Q000382:microbiology* / Q000473:pathology; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification*