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Comparison of Bacterial Maxillary Sinus Cultures Between Odontogenic Sinusitis and Chronic Rhinosinusitis

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Henry Ford Health System Henry Ford Health System Scholarly Commons Infectious Diseases Articles Infectious Diseases 7-12-2020 Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis Abdulkader Yassin-Kassab Pallavi Bhargava Henry Ford Health System, [email protected] Robert J. Tibbetts Henry Ford Health System, [email protected] Zachary H. Griggs Henry Ford Health System, [email protected] Edward L. Peterson Henry Ford Health System, [email protected] See next page for additional authors Follow this and additional works at: https://scholarlycommons.henryford.com/ infectiousdiseases_articles Recommended Citation Yassin-Kassab A, Bhargava P, Tibbetts RJ, Griggs ZH, Peterson EI, and Craig JR. Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis. Int Forum Allergy Rhinol 2020. This Article is brought to you for free and open access by the Infectious Diseases at Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Infectious Diseases Articles by an authorized administrator of Henry Ford Health System Scholarly Commons. Authors Abdulkader Yassin-Kassab, Pallavi Bhargava, Robert J. Tibbetts, Zachary H. Griggs, Edward L. Peterson, and John R. Craig This article is available at Henry Ford Health System Scholarly Commons: https://scholarlycommons.henryford.com/ infectiousdiseases_articles/124 ORIGINAL ARTICLE Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis Abdulkader Yassin-Kassab, BS1, Pallavi Bhargava, MD2, Robert J. Tibbetts, PhD3, Zachary H. Griggs, DO4, Edward I. Peterson, PhD3 andJohnR.Craig,MD4 Background: Bacterial odontogenic sinusitis (ODS) is dis- sobacterium spp., Eikenella corrodens, Streptococcus tinct from other forms of rhinosinusitis. Diagnosing ODS intermedius, Streptococcus anginosus,andStreptococcus can be challenging because of nonspecific clinical presen- constellatus. Staphylococcus aureus and Pseudomonas tations and underrepresentation in the literature. The pur- aeruginosa were inversely related to ODS. There were no pose of this study was to compare maxillary sinus bacterial significant differences in cultures between the different cultures between patients with ODS and chronic rhinosi- dental pathologies. nusitis (CRS), to determine whether certain bacteria are associated with ODS. Conclusion: Certain bacteria were more likely to be as- sociated with ODS compared to CRS when purulence was Methods: This was a retrospective case-control study of cultured from the maxillary sinus. Physicians should evalu- 276 consecutive patients from August 2015 to August 2019 ate for an odontogenic source of sinusitis when these ODS- who underwent endoscopic sinus surgery (ESS) for bac- associated bacteria are identified in maxillary sinus cul- terial ODS, CRS without nasal polyps (CRSsNP), or CRS tures. C 2020 ARS-AAOA, LLC. with nasal polyps (CRSwNP). When present, pus was ster- ilely cultured from maxillary sinuses aer maxillary antros- Key Words: tomy, and aerobic and anaerobic cultures were immediately odontogenic sinusitis; unilateral sinus disease; maxillary si- sent for processing. Demographics and culture results were nusitis; chronic rhinosinusitis; endoscopic sinus surgery compared between ODS and CRS patients, and then sepa- rately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different How to Cite this Article: dental pathologies (endodontic vs oroantral fistula). Yassin-Kassab A, Bhargava P, Tibbes RJ, Griggs ZH, Pe- terson EI, Craig JR. Comparison of bacterial maxillary si- Results: The following bacteria were significantly more nus cultures between odontogenic sinusitis and chronic likely in ODS compared to CRS: mixed anaerobes, Fu- rhinosinusitis. Int Forum Allergy Rhinol. 2020;00:1-8. acterial odontogenic sinusitis (ODS) refers to max- lead to ODS, including endodontic disease, periodontitis, B illary sinusitis, with or without extension to other oroantral fistula (OAF), or dental treatment-related for- paranasal sinuses, secondary to either adjacent maxil- eign bodies in the sinus.2-9 Endodontic disease causing ODS lary dental infection or iatrogenic injury from dental or refers to apical periodontitis with or without periapical le- other oral procedures.1 A variety of dental pathologies can sions (PAL) such as abscesses, cysts, or granulomas. ODS is a distinct type of sinusitis that presents more com- monly unilaterally.5,10-15 Despite multiple studies showing 1College of Human Medicine, Michigan State University, East Lansing, ODS accounting for 45% to 75% of unilateral maxillary si- MI; 2Department of Internal Medicine, Division of Infectious Disease, nus opacification,5,10-15 its diagnosis can be elusive because Henry Ford Health System, Detroit, MI; 3Department of Public Health 4 patients have nonspecific sinonasal symptoms and mini- Services, Henry Ford Health System, Detroit, MI; Department of 8,12,14 Otolaryngology, Henry Ford Health System, Detroit, MI mal dental complaints. Additionally, because radiol- ogists and dentists frequently miss the diagnosis,8,10,12,15-18 Correspondence to: John Craig, MD, Department of Otolaryngology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202; e-mail: otolaryngologists are often responsible for recognizing [email protected] ODS. However, ODS has not been discussed in sinusitis Potential conflict of interest: J.R.C. is a consultant for Optinose USA, Inc. guidelines,12,19,20 and diagnostic protocols have not been Received: 31 March 2020; Revised: 10 May 2020; Accepted: 15 May 2020 established. It would be helpful to determine whether cer- DOI: 10.1002/alr.22627 View this article online at wileyonlinelibrary.com. tain clinical variables could help predict an odontogenic International Forum of Allergy & Rhinology, Vol. 00, No. 0, xxxx 2020 1 Yassin-Kassab et al. source of sinusitis so that ODS is not overlooked, and pa- antrostomies on the side or sides of maxillary sinus dis- tients are referred for appropriate dental evaluation. ease. All patients received a single preoperative dose of in- One possible way to distinguish ODS from other forms of travenous clindamycin, or cefazolin in clindamycin-allergic non-odontogenic rhinosinusitis could be through bacterial patients. Tissue was sent for histopathologic analysis in all sinus cultures. Multiple studies have demonstrated anaer- CRS cases, and nearly all ODS cases. Cases were defined obic bacteria and polymicrobial growth to be common in as eosinophilic if histopathological analysis revealed ࣙ10 ODS,5,21-23 but very few studies have directly compared eosinophils per high-powered field.27 culture results between ODS and rhinosinusitis patients. If purulence was identified intraoperatively in the maxil- The purpose of this study was to compare bacterial cul- lary sinus during maxillary antrostomy, it was always cul- ture results between ODS and chronic rhinosinusitis (CRS) tured. Drainage had to be thick, opaque, and colored to be patients, to determine whether certain bacteria and polymi- cultured. If pus was not identified, cultures were not taken. crobial growth were more common in ODS. Thin, clear, or eosinophilic-appearing mucin was not cul- tured. In bilateral CRS cases, cultures were only taken from 1 of the maxillary sinuses demonstrating purulence. Cul- Patients and methods tures were always obtained sterilely in the same fashion by This was a retrospective case-control study of 276 consec- using a mucus specimen trap (Covidien, Mansfield, MA) utive patients from August 2015 to August 2019 who un- attached to a sterile 2.5-mm curved olive-tip suction. The derwent endoscopic sinus surgery (ESS) for bacterial ODS, suction tip was advanced into the maxillary sinus lumen CRS without nasal polyps (CRSsNP), or CRS with nasal before turning on the suction, to minimize the possibility polyps (CRSwNP). The study was approved by Henry Ford of nasal contamination. Health System’s Institutional Review Board. All ODS and Specimens were immediately submitted to the core mi- CRS patients had sinonasal symptoms for over 3 months, crobiology laboratory for routine aerobic and anaerobic nasal endoscopic evidence of sinus inflammation or infec- culture and identification. For aerobic culture, specimens tion, and at least maxillary sinus opacification on computed were plated onto 5% sheep blood agar (BA), chocolate agar tomography (CT). Exclusion criteria included the follow- (CA), and MacConkey (Mac) agar media (Remel, Lenexa, ing: neoplasia, fungal disease, autoimmune disease, and pri- Kansas) and were incubated overnight in 5% carbon diox- mary or acquired immunodeficiency. ide at 35°C. For anaerobic culture, specimens were plated ODS was diagnosed based on a sinus CT demonstrat- onto BA, CA, Mac, and pre-reduced BA plates anaero- ing at least maxillary sinus opacification, plus confirmation bically (90% nitrogen, 5% carbon dioxide, and 5% hy- of odontogenic pathology by endodontic and periodontal drogen) at 35°C for 72 hours. After incubation, isolated testing, and cone-beam CT imaging. All dental evaluations bacterial colonies were identified either by mass spectrom- were performed either by 1 endodontist or 1 periodontist etry using the Vitek-MS Matrix Assisted Laser Desorption (see Acknowledgments). Only unilateral ODS cases were Ionization-Time of Flight (MALDI-TOF), or biochemically included. by using the Vitek-2 automated platform according to the CRSsNP and CRSwNP were diagnosed according
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  • Appendix a Bacteria

    Appendix a Bacteria

    Appendix A Complete list of 594 pathogens identified in canines categorized by the following taxonomical groups: bacteria, ectoparasites, fungi, helminths, protozoa, rickettsia and viruses. Pathogens categorized as zoonotic/sapronotic/anthroponotic have been bolded; sapronoses are specifically denoted by a ❖. If the dog is involved in transmission, maintenance or detection of the pathogen it has been further underlined. Of these, if the pathogen is reported in dogs in Canada (Tier 1) it has been denoted by an *. If the pathogen is reported in Canada but canine-specific reports are lacking (Tier 2) it is marked with a C (see also Appendix C). Finally, if the pathogen has the potential to occur in Canada (Tier 3) it is marked by a D (see also Appendix D). Bacteria Brachyspira canis Enterococcus casseliflavus Acholeplasma laidlawii Brachyspira intermedia Enterococcus faecalis C Acinetobacter baumannii Brachyspira pilosicoli C Enterococcus faecium* Actinobacillus Brachyspira pulli Enterococcus gallinarum C C Brevibacterium spp. Enterococcus hirae actinomycetemcomitans D Actinobacillus lignieresii Brucella abortus Enterococcus malodoratus Actinomyces bovis Brucella canis* Enterococcus spp.* Actinomyces bowdenii Brucella suis Erysipelothrix rhusiopathiae C Actinomyces canis Burkholderia mallei Erysipelothrix tonsillarum Actinomyces catuli Burkholderia pseudomallei❖ serovar 7 Actinomyces coleocanis Campylobacter coli* Escherichia coli (EHEC, EPEC, Actinomyces hordeovulneris Campylobacter gracilis AIEC, UPEC, NTEC, Actinomyces hyovaginalis Campylobacter