Discussion:
Microbiology of Sinusitis (The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.)
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Oliver Crangle
2014-08-05 07:28:08 UTC
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Re: Microbiology of Sinusitis (The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.)

From: pautrey23x <***@xxxxxxxxx>
Date: Sun, 29 Jul 2012 20:17:13 -0700 (PDT)
On Jul 29, 8:49 pm, pautrey23x <***@xxxxxxxxx> wrote:
Microbiology of Sinusitis
Authors
Itzhak Brook1
1Georgetown University School of Medicine, Washington DC
Correspondence and requests for reprints should be addressed to Itzhak
Brook, M.D., M.Sc., 4431 Albemarle Street, NW, Washington DC 20016. E-
mail: ***@xxxxxxxxxxxxxx
Abstract

Most sinus infections are viral, and only a small proportion develops
a secondary bacterial infection. Rhinoviruses, influenza viruses, and
parainfluenza viruses are the most common causes of sinusitis. The
most common bacteria isolated from pediatric and adult patients with
community-acquired acute purulent sinusitis are Streptococcus
pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and
Streptococcus pyogenes. Staphylococcus aureus and anaerobic bacteria
(Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus
spp.) are the main isolates in chronic sinusitis. Pseudomonas
aeruginosa and other aerobic and facultative gram-negative rods are
commonly isolated from patients with nosocomial sinusitis, the
immunocompromised host, those with HIV infection, and in cystic
fibrosis. Fungi and Pseudomonas aeruginosa are the most common
isolates in neutropenic patients. The microbiology of sinusitis is
influenced by the previous antimicrobial therapy, vaccinations, and
the presence of normal flora capable of interfering with the growth of
pathogens.
sinusitis bacteria Streptococcus pneumoniae Staphylococcus aureus
anaerobes
The upper respiratory tract, including the nasopharynx, serves as the
reservoir for pathogens capable of causing respiratory tract
infections, including sinusitis (1). Potential pathogens can relocate
during a viral respiratory infection from the nasopharynx into the
sinus cavity, causing sinusitis (2). Establishment of the microbiology
of all forms of sinusitis is of primary importance as it can serve as
a guide for choosing the adequate antimicrobial therapy. This review
presents the microbiology of all forms of sinusitis.
NASAL FLORA

The origin of organisms that are introduced into the sinuses and may
eventually cause sinusitis is the nasal cavity. The normal flora of
that site includes Staphylococcus aureus, Staphylococcus epidermidis,
α- and γ-streptococci, Propionibacterium acnes, and aerobic
diphtheroid (3–5). Potential sinus pathogens have been infrequently
isolated from healthy nasal cavities. These included Streptococcus
pneumoniae (0.5–15%), Haemophilus influenzae (0–6%), Moraxella
catarrhalis (0–4%), Streptococcus pyogenes (0–1%), and anaerobic
bacteria (Peptostreptococcus spp. [7–16%] and Prevotella spp. [6–8%])
(3–5).
The nasal cavity flora of patients with sinusitis is different from
healthy flora. Although the recovery of Staphylococcus spp. and
diphtheroids is reduced, the isolation of pathogens increases: S.
pneumoniae was found in 36% of patients, H. influenzae in more than
50%, S. pyogenes in 6%, and M. catarrhalis in 4% (6–10).
In many studies of the nasal bacterial flora in sinusitis a
simultaneous sinus aspirate was not taken (8, 9). Some studies found
the correlation between the floras to be poor (8, 11), whereas others
illustrated good correlation (9, 6, 11). In one study (6) in which the
sinus aspirate culture yielded a presumed sinus pathogen, the same
organism was found in the nasal cavity sample in 91% of the 185
patients. The predictive value of a pathogen-positive nasal finding
was high for S. pyogenes (94%), H. influenzae (78%), and S. pneumoniae
(69%), but was low for M. catarrhalis (20%).
Hsin and colleagues (12) demonstrated that when performed in pediatric
patients, the correlation between endoscopic middle meatal culture and
maxillary sinus puncture was only in 78%. The authors concluded that
endoscopic sampling is not as favorable in children as in the case of
adult patients.
Despite these encouraging data, nasopharyngeal culture is not an
acceptable alternative to culture through aspiration.
NORMAL SINUS FLORA

The question of whether normal bacterial flora in the sinuses exists
is controversial. The communication of the sinuses with the nasal
cavity through the ostia could enable organisms that reside in the
nasopharynx to spread into the sinus. After closure of the ostium,
these bacteria can become involved in the inflammation. Organisms have
been isolated from uninflamed sinuses in several studies (13–16). The
bacterial flora of noninflamed sinuses were studied for aerobic and
anaerobic bacteria in 12 adults who underwent corrective surgery for
septal deviation (13). Organisms were found in all aspirates with an
average of four isolates per sinus aspirate. The predominant anaerobic
isolates were Prevotella, Porphyromonas, Fusobacterium, and
Peptostreptococcus spp. The most common aerobic bacteria were S.
pyogenes, S. aureus, S. pneumoniae, and H. influenzae.
In another study, specimens were processed for aerobic bacteria only,
and Staphylococcus spp. and α-hemolytic streptococci were isolated
(14). Organisms were isolated in 20% of maxillary sinuses of patients
who underwent surgical repositioning of the maxilla (15). In contrast,
another report of aspirates of 12 volunteers with no sinus disease
showed no bacterial growth (16).
Jiang and colleagues (17) evaluated endoscopically the bacteriology of
normal maxillary sinuses. Organisms were recovered from 14 of 30 (47%)
swab specimens and 7 of 17 (41%) mucosal specimens.
Gordts and colleagues (18) reported the microbiology of the middle
meatus in healthy adults and children. Fifty-two (75%) adults had
bacterial isolates present, mostly S. epidermidis (35%),
Corynebacterium spp. (23%), and S. aureus (8%). In children, the most
common organisms were H. influenzae (40%), M. catarrhalis (34%), and
S. pneumoniae (50%).
INTERFERING FLORA

The nasopharynx of healthy individuals is generally colonized by
relatively nonpathogenic aerobic and anaerobic organisms (19, 20),
some of which are able to interfere with the growth of potential
pathogens (21). This phenomenon is called bacterial interference.
These organisms include the aerobic α-hemolytic streptococci (mostly
Streptococcus mitis and Streptococcus sanguis) (22) and anaerobic
bacteria (Prevotella melaninogenica and Peptostreptococcus anaerobius)
(23). Many interfering bacteria produce bacteriocins, which are
bactericidal proteins.
Nasopharyngeal carriage of upper respiratory tract pathogens, such as
S. pneumoniae, H. influenzae, and M. catarrhalis, can, however, occur
in healthy individuals and increases significantly in young children
during respiratory illness (23, 24) and in those prone to sinusitis
(25). The absence of interfering organisms can explain the higher
recovery of pathogens in these children. Colonization with interfering
organisms may play a role in preventing colonization by pathogens and
the development of upper respiratory infections, including sinusitis.
Exposure to direct and indirect smoking can increase oral colonization
with pathogenic bacteria and decrease the number of organisms that
interfere with their growth. The flora of smokers contained fewer
aerobic and anaerobic organisms with interfering capability and more
potential pathogens as compared with nonsmokers (26). The high number
of pathogens and the low number of interfering organisms found in the
nasopharynx of smokers reverts to normal levels after complete
cessation of smoking (27). The oral flora of smoking parents contains
more potential pathogens that are similar to the one recovered from
their otitis media–prone children and fewer interfering organisms as
compared with nonsmoking parents (28). Because smoking parents harbor
more potential pathogens and fewer interfering organisms, they may
serve as a source of pathogens that can colonize and/or infect their
children. These colonization patterns may place smokers and their
children at greater risk of acquiring respiratory infections,
including sinusitis.
Administration of antimicrobials can influence the composition of
nasopharyngeal flora (29, 30). Therapy with oral second- or third-
generation cephalosporins does not eliminate organisms with
interfering capabilities, as does amoxicillin (31) or amoxicillin–
clavulanate.
MICROBIOLOGY OF SINUSITIS

The pattern of many upper respiratory infections, including sinusitis,
evolves in several phases (Figure 1). The early stage often is a viral
infection that generally lasts up to 10 days, and complete recovery
occurs in most individuals (7). However, in a small number of patients
with viral sinusitis (estimated at 0.5%) a secondary acute bacterial
infection may develop. This is generally caused by facultative aerobic
bacteria (i.e., S. pneumoniae, H. influenzae, and M. catarrhalis). If
resolution does not occur, anaerobic bacteria of oral flora origin
become predominant over time. The dynamic of these bacterial changes
were recently demonstrated by performing serial culture in patients
with maxillary sinusitis (32).

View larger version:
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Figure 1.
The dynamics and changes over time in the microbiology of bacterial
sinusitis.
Viral Infections
Viral illness is the most common cause for upper respiratory tract
infections, including sinusitis (33). Rhinovirus, influenza virus, and
parainfluenza virus are the most common causes of sinusitis (34, 35).
It is not known for certain whether the viral infection only precedes
or is also concurrent with the bacterial infection. The actual
mechanisms by which a virus causes sinus disease are unknown. The
proposed mechanism by which viruses predispose to sinusitis involve
microbial synergy, induction of local inflammation that blocks the
sinus ostia, increase of bacterial attachment to the epithelial cells,
and disruption of the local immune defense (Figure 1).

Read More:http://m.pats.atsjournals.org/content/8/1/90.full


-----------------------


Sinus Drainage Methods

USE AT YOUR OWN RISK


This is an edited post that has appeared in various places on the web.
These methods are effective for sinusitis, colds, flu, mcs, etc. The q-
tip method and electrode placement instructions are at the bottom of
this post. Paul Sinus Drainage Methods I used a Beck blood
electrifier(BE-thumper) with adjustable frequency control the first
time I discovered the area I mentioned applying the q-tips to(Original
Post Below). I do not use the BE in the intended manner and I built my
own. I use 12 gauge silver wire electrodes with wetted cotton flannel
sleeves. I used both 4hz and about 60hz (preferred-frequency where the
optic nerve/eye quits flashing) and started with the lowest current
setting working my way up to a tingling sensation. Apply the
electrodes to the same area as the q- tips but instead of moving them
around vigorously, find a sensitive area and leave them for 15-20
seconds before moving them again. Repeat this interval and/or move
slowly around in the mentioned area. It may take up to 4-5 minutes to
start a violent sneezing attack coupled with the drainage. Be
prepared, I voided what tasted like a virus and it actually gave me
slight cold/flu symptoms while performing this procedure. Keep on
slowly stimulating the area until you quit sneezing. I had a violent
sneezing attack that lasted about 4 minutes before it quit. The first
time I probably voided about a 1/5 cup of salty virus tasting mucus
and I got instant relief. I found doing it several times(2-3) daily
was the best approach. It took about 2 weeks for the virus taste to go
away and the mucus expelled was far less than at the beginning. I
didn't have sinusitis again for several years and I didn't give it
time to set in before attacking it. Two cautions: 1)The drainage may
be contagious, so be careful(CS,GSE,H2O2);2)On a few occasions a small
amount of blood would come out with the mucus but I never had a
running nose bleed and I never worried about it. Clean every thing you
sneeze/sling mucus on. You will probably get your shirt wet with
mucus. Be careful! Don't spread infection!!! I have posted my favorite
electronic method(BK) along with the Beck method on the Google
sinusitis group under the subject, "Sinus Drainage Methods". This
works much better, much faster, you don't need to use it as often or
as long to get the job done, and you can't feel anything. I use a BK
4011A Function Generator(standard electronic test instrument) with the
same electrodes and placement used with the Beck. The settings are:
315Khz and 320Khz(start with one frequency for 5 minutes then go to
the other for same - be patient, sometimes you think it's not going to
work and it takes you by suprise), -20db attenuation(down 20db output-
very important), full positive DC offset, square wave, and full output
level(but down 20db; if you don't do this the output is very
uncomfortable). This is probably more than you wanted to know. The BK
can be ordered from electronics parts houses and probably costs about
$350.00. You can get a Beck schematic off of the internet to build
your own. Most parts can be bought at Radio Shack. You can also find
new and complete Beck units($50.00-$100.00) on the internet. I made my
own electrodes with 12 gauge silver wire and they are about 1.25
inches long. Use cotton cloth covers for the electrodes. I wet the
electrodes with colloidal silver or distilled water. You can find
silver wire on the internet. Good Luck, Paul > Paul, > > Thanks for
the info. What is the electronic method you mentioned? > > Thanks > >
___________________________________________ > Reply to: > > > -----
Original Message ---- > From: rpautrey2 > To: > Sent: > Subject:
Sinusitis/MCS (Sinus Drainage Methods) > >I made a mistake. I have
posted these sinus drainage methods > in several groups but this is
not one of them. For quick sinus relief > try the following: Slide
your finger down the ridge of your nose > until you come to the
junction where bone becomes cartilage. Directly > under your finger at
this junction, on the ceiling of each nostril > are two very sensitive
areas about 3/4" in diameter. Take two wet q- > tips and insert one
into each nostril. Massage the sensitive areas > simultaneously, and
vigorously but gently. Within a few minutes you > will experience a
violent sneezing attack followed by sinus cavity > drainage. Continue
to massage until you get relief. Do this > frequently. I cured my
sinusitis using a similar method (electronic). > It's a good idea to
gargle and rinse your nasal passages with an > alternative antibiotic
like cs or gse to prevent the introduction of > drained infection into
your throat, lungs, etc. Also clean anything > you sneezed on. Paul >



http://curezone.com/forums/am.asp?i=1066454

.

References:
Microbiology of Sinusitis (The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.)
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Microbiology of Sinusitis (The microbiology of sinusitis is influenced by the previous antimicrobial
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