Background: Bacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS).\r\nHowever their presence and relationship to disease is debated. This study used multiple detection methods to\r\ncompare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa. The utility of\r\ncontemporary detection methods is also examined.\r\nMethods: Sinonasal mucosa was analyzed from 38 CRS and 6 controls. Bacterial and fungal analysis was performed\r\nusing conventional culture, molecular diagnostics (polymerase chain reaction coupled with electrospray ionization\r\ntime-of-flight mass spectrometry) and fluorescence in situ hybridization.\r\nResults: Microbes were detected in all samples, including controls, and were often polymicrobial. 33 different\r\nbacterial species were detected in CRS, 5 in control patients, with frequent recovery of anaerobes. Staphylococcus\r\naureus and Propionibacterium acnes were the most common organisms in CRS and controls, respectively. Using a\r\nmodel organism, FISH had a sensitivity of 78%, and a specificity of 93%. Many species were detected in both CRS\r\nand controls however, microbial abundance was associated with disease manifestation.\r\nConclusions: This study highlights some cornerstones of microbial variations in healthy and diseased paranasal\r\nsinuses. Whilst the healthy sinus is clearly not sterile, it appears prevalence and abundance of organisms is critical in\r\ndetermining disease. Evidence from high-sensitivity techniques, limits the role of fungi in CRS to a small group of\r\npatients. Comparison with molecular analysis suggests that the detection threshold of FISH and culture is related to\r\norganism abundance and, furthermore, culture tends to select for rapidly growing organisms.
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