A prospective longitudinal study assessing the impact of rhinovirus and bacterial infections in acute exacerbations of chronic rhinosinusitis.

IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY International Forum of Allergy & Rhinology Pub Date : 2024-09-03 DOI:10.1002/alr.23431
Nirushan Narendran, Sophia Volpe, Ibrahim Ramadan, Jacob Ryan Herbert, Bonnie LaFleur, Shireen Samargandy, Christopher H Le, Eugene H Chang
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Abstract

Background: Acute exacerbations of chronic rhinosinusitis (AECRS) are thought to arise from common viral infections progressing to secondary bacterial infections. However, the pathophysiology of AECRS remains poorly understood due to a lack of prospective longitudinal studies.

Methods: We conducted a one-year prospective longitudinal study involving chronic rhinosinusitis (CRS) adults. At baseline, we assessed subjective symptom scores using a validated upper respiratory infection questionnaire (WURSS), sinonasal outcome testing scores (SNOT-22), and endoscopic scores (modified Lund-Kennedy score). Every 2 weeks, we contacted subjects to collect WURSS and SNOT-22 scores. If WURSS scores were ≥1 and SNOT-22 scores were ≥ 8.9 compared with baseline, subjects underwent an AECRS assessment. We identified rhinovirus (RV) incidence through viral nasal brushings at each visit and bacterial infection through bacterial swabs if mucus scores were ≥1.

Results: Thiry-five of 80 CRS subjects reported at least one AECRS episode during the year, predominantly occurring in the fall and winter seasons. RV infections were detected in 8 of 35 cases, bacterial infections in 17 of 35, and co-occurring infections in 7 of 35. All subjects with AECRS visits exhibited significantly higher endoscopic scores compared with baseline. Subjects with co-occurring RV and bacterial infections demonstrated higher disease severity compared with those with either RV or bacterial infection, or no infection.

Conclusions: In a one-year prospective longitudinal study involving CRS adults, we identified significant risk factors for AECRS including seasonality and the presence of RV and bacterial infections. These data suggest a standard definition of AECRS and the need to target RV and bacterial infections if we are to help reduce disease severity.

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一项前瞻性纵向研究,评估鼻病毒和细菌感染对慢性鼻炎急性加重的影响。
背景:慢性鼻炎急性加重(AECRS)被认为是由普通病毒感染继发细菌感染引起的。然而,由于缺乏前瞻性纵向研究,人们对 AECRS 的病理生理学仍然知之甚少:我们开展了一项为期一年的前瞻性纵向研究,研究对象为慢性鼻炎(CRS)成人。基线时,我们使用有效的上呼吸道感染问卷(WURSS)评估主观症状评分、鼻窦结果测试评分(SNOT-22)和内窥镜评分(改良的伦德-肯尼迪评分)。我们每两周联系一次受试者,收集 WURSS 和 SNOT-22 评分。如果与基线相比,WURSS评分≥1分,SNOT-22评分≥8.9分,受试者将接受AECRS评估。我们在每次就诊时通过病毒性鼻刷子确定鼻病毒(RV)的发病率,如果粘液评分≥1,则通过细菌拭子确定细菌感染情况:在80名CRS受试者中,有35人报告在一年中至少发生过一次AECRS,主要发生在秋冬季节。在 35 例病例中,8 例检测到 RV 感染,17 例检测到细菌感染,7 例检测到并发感染。与基线相比,所有接受过 AECRS 检查的受试者的内窥镜评分都明显提高。与RV或细菌感染或无感染的受试者相比,同时患有RV和细菌感染的受试者疾病严重程度更高:在一项为期一年、涉及 CRS 成人的前瞻性纵向研究中,我们发现了 AECRS 的重要风险因素,包括季节性、RV 感染和细菌感染。这些数据表明了 AECRS 的标准定义,以及如果我们要帮助降低疾病的严重程度,就需要针对 RV 和细菌感染进行治疗。
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来源期刊
CiteScore
11.70
自引率
10.90%
发文量
185
审稿时长
6-12 weeks
期刊介绍: International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.
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