Nasal carriage of Staphylococcus aureus and endonasal activity in Wegener s granulomatosis as compared to rheumatoid arthritis and chronic Rhinosinusitis with nasal polyps.
OBJECTIVE
Nasal colonisation with Staphylococcus aureus (S. aureus) has been implicated in Wegener's granulomatosis (WG) disease activity. In this study, the frequency of nasal colonisation with S. aureus in WG was compared to healthy and disease control groups for the first time. Moreover, endonasal activity was correlated to colonisation.


METHODS
Nasal carriage of S. aureus of a well-defined group of 89 patients with WG was compared to 40 patients with chronic rhinosinusitis with nasal polyps (CRS), 35 patients with rheumatoid arthritis (RA), 50 hospital staff members and 25 subjects without regular hospital contact and correlation analysis of nasal carriage and endonasal activity of WG was performed.


RESULTS
WG patients showed significantly higher rates (72%) of nasal colonisation with S. aureus compared to CRS patients (28%) and healthy subjects without regular hospital contact (25%, 95%-CI), but not to RA patients (46%) and hospital staff members (58%). WG patients with nasal carriage of S. aureus had significantly higher endoscopically proven endonasal activity (p=0.01), significantly more often first manifestation of WG in the upper respiratory tract (p=0.02) and higher relapse-rates (p=0.052) than WG patients without such carriage.


CONCLUSIONS
Endonasal activity in WG is associated with higher nasal S. aureus colonisation rates and subsequent higher relapse rates. The higher frequency of S. aureus colonisation could be a consequence of a recently shown mucosal barrier defect in WG and facilitate chronic inflammation and granuloma formation in the upper respiratory tract.
Laudien
Martin
M
Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Kiel, Germany. laudien@hno.uni-kiel.de
Gadola
Stefan D
SD
Podschun
Rainer
R
Hedderich
Jürgen
J
Paulsen
Jens
J
Reinhold-Keller
Eva
E
Csernok
Elena
E
Ambrosch
Petra
P
Hellmich
Bernhard
B
Moosig
Frank
F
Gross
Wolfgang L
WL
Sahly
Hany
H
Lamprecht
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology; D002908:Chronic Disease; D014890:Granulomatosis with Polyangiitis / Q000453:epidemiology* / Q000382:microbiology; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology; D009298:Nasal Polyps / Q000453:epidemiology* / Q000382:microbiology; D012008:Recurrence; D012220:Rhinitis / Q000453:epidemiology / Q000382:microbiology; D012852:Sinusitis / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D055815:Young Adult
D019268:Antibodies, Antineutrophil Cytoplasmic