title: The role of microbes in the pathogenesis of acute rhinosinusitis in young adults.
abstract: OBJECTIVE
  To provide information on the course of acute rhinosinusitis (ARS) with sequential nasal and paranasal microbiological data and their correlation with clinical outcomes.
  
  
  METHODS
  We conducted a prospective cohort study among 50 Finnish military recruits with clinically diagnosed ARS in spring 2012.
  
  
  METHODS
  We collected symptom, nasal endoscopy, and cone-beam CT (CBCT) scores during the early (2-3 days from onset) and later phases (9-10 days). We took viral samples from the nasopharynx (multiplex respiratory virus polymerase chain reaction [PCR]), bacterial culture from the middle meatus during both phases, and both viral and bacterial samples from the maxillary sinus aspirate (respiratory virus PCR, bacterial culture, broad-range bacterial PCR) during the later phase. Cilia destruction and microbial biofilms were sought from a nasal mucosal biopsy sample.
  
  
  RESULTS
  We found that 42 (84%) of the subjects had viral nucleic acid in the nasopharynx during ARS. During the early phase, 28 (56%) of the subjects had nontypeable H. influenzae (NTHi) in the middle meatus, which was associated with wider paranasal mucosal changes in CBCT scans and increased symptoms during the study period. After 9 to 10 days from the onset, NTHi was found in the maxillary sinus in eight subjects (40%, 8/20) and led to prolonged symptoms. Bacterial biofilm was ruled out in 39 (78%) cases, and cilia destruction did not correlate with microbiological or clinical outcomes.
  
  
  CONCLUSIONS
  Nasal and paranasal H. influenzae coinfection during viral infection may modify the symptoms and the extent of sinonasal mucosal disease observed in CBCT scans already from the beginning of the ARS episode.
authors.affiliation: Department of Otoaryngology, University of Helsinki, Helsinki, Finland.
authors.forename: Timo J
authors.initials: TJ
authors.lastname: Autio
authors.forename: Terhi
authors.initials: T
authors.lastname: Tapiainen
authors.forename: Timo
authors.initials: T
authors.lastname: Koskenkorva
authors.forename: Mervi
authors.initials: M
authors.lastname: Närkiö
authors.forename: Maija
authors.initials: M
authors.lastname: Lappalainen
authors.forename: Simo
authors.initials: S
authors.lastname: Nikkari
authors.forename: Heidi
authors.initials: H
authors.lastname: Hemmilä
authors.forename: Katja A
authors.initials: KA
authors.lastname: Koskela
authors.forename: Markku
authors.initials: M
authors.lastname: Koskela
authors.forename: Petri
authors.initials: P
authors.lastname: Koivunen
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Alho
mesh_terms: D000208:Acute Disease; D001431:Bacteriological Techniques; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D018450:Disease Progression; D004724:Endoscopy; D005387:Finland; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000175:diagnosis / Q000382:microbiology; D006193:Haemophilus influenzae / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology; D008889:Military Personnel; D060885:Multiplex Polymerase Chain Reaction; D009297:Nasal Mucosa / Q000382:microbiology; D009305:Nasopharynx / Q000382:microbiology; D011446:Prospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000382:microbiology*; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology*; D013223:Statistics as Topic; D014774:Virulence; D014777:Virus Diseases / Q000175:diagnosis / Q000382:microbiology; D055815:Young Adult
keywords: Acute rhinosinusitis; pathogenic bacteria; pathophysiology; sinus; virus
references.citation: Clin Infect Dis. 2004 Jan 15;38(2):227-33
references.pmid: 14699455
references.citation: J Med Microbiol. 2003 Jul;52(Pt 7):591-597
references.pmid: 12808082
references.citation: Pediatrics. 2003 May;111(5 Pt 1):e586-9
references.pmid: 12728114
references.citation: Clin Infect Dis. 2012 Apr;54(8):e72-e112
references.pmid: 22438350
references.citation: Am J Rhinol. 2004 Nov-Dec;18(6):349-55
references.pmid: 15706980
references.citation: J Clin Microbiol. 1988 Oct;26(10):1919-25
references.pmid: 3182986
references.citation: J Clin Microbiol. 1989 Dec;27(12):2736-43
references.pmid: 2592539
references.citation: Emerg Infect Dis. 2002 Feb;8(2):188-94
references.pmid: 11897072
references.citation: Clin Infect Dis. 2005 Aug 15;41(4):490-7
references.pmid: 16028157
references.citation: Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31
references.pmid: 17761281
references.citation: Allergy. 2003 Aug;58(8):767-71
references.pmid: 12859556
references.citation: J Virol Methods. 2012 Jun;182(1-2):82-6
references.pmid: 22465255
references.citation: J Clin Microbiol. 1998 Aug;36(8):2205-9
references.pmid: 9665992
references.citation: Am J Rhinol Allergy. 2013 Jan;27(1):39-42
references.pmid: 23406599
references.citation: Lancet. 1996 Jun 1;347(9014):1507-10
references.pmid: 8684101
references.citation: Rhinology. 1986 Sep;24(3):223-5
references.pmid: 3775189
references.citation: Ann Otol Rhinol Laryngol Suppl. 1995 Oct;167:17-21
references.pmid: 7574265
references.citation: Pediatr Infect Dis J. 2006 Feb;25(2):108-12
references.pmid: 16462285
references.citation: Laryngoscope. 2012 Feb;122(2):467-72
references.pmid: 22253013
references.citation: Rhinol Suppl. 2012 Mar;23:3 p preceding table of contents, 1-298
references.pmid: 22764607
references.citation: Clin Infect Dis. 2007 Nov 15;45(10):e121-7
references.pmid: 17968816
references.citation: N Engl J Med. 1994 Jan 6;330(1):25-30
references.pmid: 8259141
references.citation: Laryngoscope. 2009 Jul;119(7):1406-11
references.pmid: 19434681
references.citation: Scand J Prim Health Care. 2009;27(1):18-24
references.pmid: 19085427
references.citation: Postgrad Med J. 2007 Jun;83(980):402-8
references.pmid: 17551072
references.citation: Lancet. 2003 Jan 4;361(9351):51-9
references.pmid: 12517470
references.citation: Medscape J Med. 2008 Apr 29;10(4):105
references.pmid: 18504478
references.citation: AJNR Am J Neuroradiol. 2012 Dec;33(11):2038-42
references.pmid: 22700752
references.citation: Vital Health Stat 10. 2009 Dec;(242):1-157
references.pmid: 20821903
references.citation: Arthritis Rheum. 1998 Mar;41(3):535-43
references.pmid: 9506582