title: Bone: the final frontier for Staphylococcus aureus penetration in chronic rhinosinusitis.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil. pezatobau@ig.com.br.
authors.forename: Rogério
authors.initials: R
authors.lastname: Pezato
authors.forename: Luciano
authors.initials: L
authors.lastname: Bottura
authors.forename: Rodrigo
authors.initials: R
authors.lastname: de Paula Santos
authors.forename: Richard Louis
authors.initials: RL
authors.lastname: Voegels
authors.forename: Andre Luis Lacerda
authors.initials: AL
authors.lastname: Bachi
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Gregório
mesh_terms: D002908:Chronic Disease; D004197:Disease Reservoirs / Q000382:microbiology*; D004731:Endotoxins / Q000276:immunology; D005004:Ethmoid Bone / Q000382:microbiology*; D006801:Humans; D007150:Immunohistochemistry; D009297:Nasal Mucosa / Q000382:microbiology; D009298:Nasal Polyps / Q000382:microbiology; D012220:Rhinitis / Q000382:microbiology*; D012852:Sinusitis / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000276:immunology / Q000302:isolation & purification*; D018089:Superantigens / Q000276:immunology
chemical_list: D004731:Endotoxins; D018089:Superantigens