The following is a press release from Johns Hopkins about research being done to understand why some people have recurrent sinus infections, despite being given all of the current therapies and even undergoing unsuccessful surgeries. The long and short of it is that these people have reduced gene activity in the body’s nasal immune system. Hopefully this study will eventually lead to better treatments for this problem, and less colonization in the nose of the bacteria that makes us sick. Read more:
Researchers at Johns Hopkins have evidence that curbed activity from several key chemicals on the inner lining of the nose are linked to chronic sinusitis that fails to respond to the usual current treatments.
An estimated 32 million Americans know the misery of persistent inflammation of the moist tissue that lines the nose and sinus cavities. The result is clogged passages and recurring infections, according to the U.S. Centers for Disease Control and Prevention.
Because nearly one in 10 of those treated see symptoms return within weeks or months after drugs or surgery fail to keep the sinus passages open, scientists have long suspected that these resistant cases had some underlying problem with the immune system contributing to the ailment.
In a study to be described on Sept. 19 at the annual scientific sessions of the American Academy of Otolaryngology, Head and Neck Surgery, the Hopkins team found that in chronic sufferers who failed to respond to treatment, the activity of at least four genes in the body’s nasal immune defense system were severely decreased, and their production of two proteins critical to this defense was 20 to 200 times less than normal.
Comparing nasal epithelial cell samples from nine patients who benefited from surgery with nine who did not, the Hopkins team discovered suppressed levels of human beta defensin 2 (HBD2) and mannose binding lectin (MBL) in those whose symptoms returned. The proteins are naturally produced in the nose whenever the immune system detects foreign bacteria or fungi, binding to invading pathogens, inactivating them and making them easily disposed of.
An earlier study published by the same team in the March-April issue of the American Journal of Rhinology also showed that sinus tissue from people with chronic sinusitis that resisted treatment had 30 times lower than normal activity of a so-called toll-like receptor gene, TLR9.
Inside the nose, researchers say, toll-like receptor proteins (TLRs) detect invading bacteria and other pathogens in the air by attaching to their trace byproducts. Once a threat is identified, the receptors stimulate the epithelial cells to produce antibiotic proteins, such as HBD2 and MBL, to fight the invading organisms. This innate response helps prevent airborne bacteria or fungi from settling in the nose and sinus cavities, causing infection.
“Colonization with microorganisms is a common problem in patients with chronic sinusitis and polyps, but the reasons for this are incompletely understood,” says Andrew Lane, M.D., an associate professor at The Johns Hopkins University School of Medicine and director of its rhinology and sinus surgery center. “Now we are uncovering new clues as to what might be wrong and perhaps, ultimately, how it might be treated.
“The nose’s first line of defense is the epithelium, and when the local innate immune function is curtailed, infections can get a head start, which might serve to worsen the sinus inflammation.
“The potential is there to manipulate these chemical receptors and proteins to see if this makes patients more responsive to conventional therapy,” says Lane.
The study, led by Lane, was believed to be the first to determine levels of each TLR - there are 10 - by directly measuring messenger RNA expression in sinusitis patients and those more fortunate to not have it. Scientists have known for more than a year that TLRs were present in both the healthy and sinusitis-wracked nose, but not which receptors or proteins were more important than others in the condition’s chronic form. That study involved 30 men and women, mostly from the Baltimore region, who had surgery for chronic sinusitis at Hopkins. (Another 10 had no sinus problem and served as study controls.)
Those who underwent surgery did so after standard therapy using antibiotics, decongestants and steroids had failed to stop their symptoms and keep their infections from coming back. Indeed, 20 participants in the study had developed nasal polyps, which have no known cause and are especially hard to treat, researchers say. They note that polyps must often be surgically removed to allow the sinuses to drain normally.
All patients were monitored for a minimum of six months to see if any symptoms or polyps returned. Thirteen in the surgery group had recurrent inflammation within three months to one year after surgery, while the rest remained symptom free.
The Hopkins team took samples during surgery of the mucous membrane lining the nose, and using real-time polymerase chain reaction, analyzed the samples for any genetic differences between the groups.
“Surgically treating sinusitis is much like plumbing, in the sense that we try to restore normal sinus cavity drainage pathways,” adds study presenter Murugappan Ramanathan Jr., M.D., a resident in otolaryngology - head and neck surgery at Hopkins. “But for the intractable cases, surgery may fail because the problem is not so much about plumbing as it is inflammation, and for this we need research at the molecular level to find a solution.”
Funding for this study was provided in part by the National Institutes of Health, including the National Institute on Deafness and Other Communication Disorders, and the National Institute of Allergy and Infectious Diseases, with additional funding coming from the American Rhinologic Society.
Besides Lane and Ramanathan, other researchers involved in this research, conducted solely at Hopkins, were Quynh Ai Truong-Tran, Ph.D., and Robert Schleimer, Ph.D.
Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
bacteria, colonization, Infection Prevention, Johns Hopkins, Research and Development .gif)
42 responses so far ↓
Karen Davidson // Jan 26, 2007 at 9:14 am
I have had no less than 7 surgeries on my sinuses. I have tubes in my ears. I am a 54 year old female who has been diagnosed with MRSA of the sinuses. I was treated with vacomiacin but developed a rash so was withdrawn. My ears feel like they are full and they itch and I feel drainage run into them. My nose has had a sore in it for 5 years that won’t heal. Thick mucas and crusting are a way of life for me. On top of everything else, I am a chronic asthmatic. Have been on disability because of all this since 1992. Is there anything out there to give me relief?
Christina // Jan 26, 2007 at 9:31 am
Hi Karen, thanks for the comment. First of all, a rash is very normal from Vancomycin, it is called Red Man Syndrome. But it certainly is possible you were allergic to it, my husband was as well. There are other antibiotics available now that can treat MRSA - zyvox, cubicin and others - my advice to you is to see another doctor - apparently whomever you are seeing now is not up on the current treatments. I would HIGHLY recommend you seek and Infectious Disease specialist. And do seek one, this infection is damaging your body, and could eventually break free from your sinuses and enter your bloodstream. Take care of yourself, please!
Lisa // Jan 28, 2007 at 12:09 am
My son who is now 27 has had what we thought was severe acne on his back for a few years now. He was incarcerated at 19 for about a year and is serving time in prison now. He also has a couple of tatoos. I am wondering if he could possibly have MRSA? No one in our family has acne or any real skin problems. It has gotten much worse lately and I am very worried about him. He also has a lot of sinus type problems and headaches.
Christina // Jan 28, 2007 at 12:14 am
Hi Lisa, it certainly wouldn’t hurt to do what you can to see that he is tested. If they can culture his acne and swab his nose, it might tell you a lot. Good luck to him, let us know how it goes, and try not to worry, hopefully it is nothing major.
Kathrin // Feb 5, 2007 at 11:13 am
I have been fighting MRSA infection in my sinuses for over a year now. I’ve been on three IV drugs all of which I was allergic to. I have been on Zyvox for about eight months and it works but the infections return within one to two months. I’m learning to deal with it but my question is, can anyone tell me if I am contagious? Not even my infectionous disease doctor will really say. Good luck to everyone else dealing with terrible problem.
Lisa // Feb 5, 2007 at 7:58 pm
My son is trying to get tested soon. He thinks the acne like infection on his back and his sinus trouble may be MRSA related. If I have any helpful information to report after he is tested I will give details here. Good luck to all and God bless you with recovered health.
Christina // Feb 5, 2007 at 8:16 pm
Kathrin - certainly your fluids have MRSA that can be spread - be sure and wash your hands obsessive/compulsively, and that will help prevent spreading it more than anything. Maybe you need to consider another ID doc?
Christina // Feb 5, 2007 at 8:17 pm
Lisa, thanks for the update - please do keep in touch. I pray everything goes well for your son!
Karen Nolan // Feb 6, 2007 at 8:33 am
Dear Christina
I have been fighting sinus infections one after the other and as soon as I finish an antibiotic within a week or so another one starts. This has been going on for at least 12 years now. My doctor has no idea what to do anymore and yes I have had a few sinus surgeries too. Please give me some ideas of what to do and where to go. We live in Canada.
Thank You
Karen
Christina // Feb 6, 2007 at 8:43 am
Hi Karen, first thing I would make sure to do is to get another opinion. Probably from a specialist in Infectious Disease. All of the antibiotics you have taken have made the bacteria resistant, I would imagine, and you will probably need to try some sort of different therapy. Please do seek another opinion though, I am sure you can get rid of your problem.
Jean Carman // Jul 5, 2007 at 12:10 pm
I have a friend who has had recurrent sinus infections since having sinus surgery several years ago. She is allergic to most abx and has to be desensitized in ICU before every round with the PIC line. She gets about 6 weeks reprieve between infections. She had surgery in Seattle to remove the front part of her skull and clear out the frontal sinuses and fill it with body fat. She had a longer reprieve but now she is sick again and for the first time, it is MRSA. Please advise…what can we do, where can we go. Desperate!!!
Jean
Kathrin // Jul 5, 2007 at 8:55 pm
Dear Jean,
I am learning that MRSA is everwhere. I’m also learning to stay away from doctor’s offices and hospitals as much as possible because they are infested! Get a reputable ID doctor and don’t let any doctor talk you into anymore surgery. That’s where people are getting infected. Harsh reality isn’t it?
Kathrin
Debby // Jul 5, 2007 at 9:48 pm
I am a 43-year-old female with chronic recurring sinus problems. I have had about 7 sinus surgeries including frontal sinus obliteration. My last sinus surgery for polyps was this month. I have had tubes in my ears for the last 2 years. I had Pseudomonas infection in my sinuses about a year ago. This cleared. Now, with the tubes in my ears being changed this month, I found out I have MRSA in my ears only, not my sinuses. I have been given Vioxx to treat my ears. Is this going to work? I see stories above where these people having been fighting this problem for years. I also have severe asthma, which at the moment is under control. But, today is the first day I have received the Vioxx and I know I have had it for over a week since the surgery. I also want to know I am contagious to other. I have a 7-month-old living with me. I am aware of proper hand washing to prevent spread. But what else can I do to ensure my grandson does not get MRSA from me?
Biopsy // Jul 8, 2007 at 4:36 pm
You guys may be interested to link to my personal blog
http://biopsy.wordpress.com/
I’m a 50-year female with a long history of chronic frontal sinus infection with multiple surgeries carried out. I contracted an MRSA infection in my skull two years ago following a repeat external- frontoethmoidectomy procedure with the insertion of a stent. I am presently recovering from a ‘Reidel’ procedure (removal of anterior bony wall of frontal sinuses bilaterally via a coronal incision) as a result of developing chronic osteomyelitis caused by MRSA.
Debbie // Jul 22, 2007 at 1:19 pm
Hi I am a 35 year old female with two young kids ages 2.5 and 5. I have been battling chronic sinus infections for at least four years. I have been on multiple types of antibiotics only to have repeated infections set in only weeks after they are done. I get little response from some antibiotics namely amoxi-clavulin. I have had two sinus surgeries, wtith the last being a success, meaning that the sinuses are open for drainage. The problem is that I am still getting infections! The ENT is questioning MRSA or other “superbug”. He said he is not able to test for this through culture until I am done my current antibiotics. The other theory from the Immunologist is immunodeficiency &/or cellular damage in my sinuses due to scarring from the past. I have yet to see an Infection Disease specialist but it is in the works. As a result of all of the difficulties I have recently started migraines which are completely debilitating.
Does anyone have any advise? How was your MRSA diagnosed?
Sincerely Debbie
Biopsy // Jul 23, 2007 at 6:32 pm
Hi Debbie
My MRSA was first diagnosed by a simple nasal swab. I’d developed cellulitis around both eyes following open surgery for an abscess in one of the frontal sinuses. I was on oral antibiotics at the time but had no active nasal discharge. The infection required intensive IV antibiotic treatment to get a lasting response.
When my MRSA recurred a year later it reappeared as a really aggressive frontal sinus infection with pus streaming from one side of my nose. A swab was taken of this pus which showed it to be a positive MRSA infection. Again I was on oral antibiotics at the time of the nasal swab but was failing to respond to them.
I’d recommend you get a nasal swab done asap.
Best of Luck!
Biopsy
Karie // Aug 14, 2007 at 12:13 am
hi I am a 40 yar old female who had surgery on my sinuses this past july 5th i have been suffering a sinus infection ever since now i have mrsa and was on bactrim and now on zyvox -very expensive.. hate that i can only eat certain foods do i go see another specialist or what i am in fear that i will never get this out of my system any help will be greatly appreciated, thanks to all and good luck to all sufferers out there .
Steph // Aug 15, 2007 at 2:28 pm
Hi Karie
Sorry to hear about your troubles. Keep going on the Zyvox if you can - I know it’s a hard drug to tolerate. I was put on it long-term leading up to surgery earlier this year (having had a recurrence of MRSA) and I got the ‘all-clear’ when screened pre-operatively - so it obviously does the business! And as far as I’m aware, I’m still in the all-clear 4 months on! Make sure you get follow-up nasal swabs taken when you finish the antibiotic - you will only get peace of mind when you get the all-clear. Good luck.
Karie // Aug 19, 2007 at 11:36 pm
Steph
thanks for the information and yes I plan on staying on the zyvox until finished i just hope that this MRSA does not stay in my system i already think i have passed on and infection to my husband because he has bronchitis. is just hope that he does not have the mrsa .
Karen Nolan // Aug 20, 2007 at 10:15 am
Just a quick e-mail since last Feb. I had a cat scan on my sinuses and now I have a blockage so I am going to see a specialist next month. I hope to be able to finally get rid of these recurring sinus infections one after the other. Thanks for all the e-mails.
Karen
linda mugavero // Oct 5, 2007 at 12:58 am
i was diagnosed w/mrsa 5 years ago,battling sinus infections for years since 1998. the diagnosis was from a culture tkn during surgery.i was further put on antibiotics to cure this and the infectious disease dr cleared me without further testing.he suggested i go to a learning hospital for any further questions or diagnosis,he didnt like me asking all the questions,well how funny, this is 5 years later,2007 and i had my 4th surgery,with the same diagnosis mrsa colonization and infection in my maxillary sinus. i have contacted a specialist and new inf dis dr regarding treatment,have had no reply to my email to the hospital with the inf dis surgeon,nor any help from the new inf dis dr except to go back on meds until further surgery can be performed by a doctor who knows what hes dealing with. noone seems to know a dr who can deal with mrsa in the sinus and leading into part of my skull. in 1991, a dental surgeon removed a large tumor/cyst in my maxillary area and replaced the empty cavity with tcp and freeze dried bone, he is dead now. he noted in his chart i had a congenital crack in my jaw. my current surgeon believes that this is where the mrsa infection lies and needs to be removed,as it is leaking the infection into my sinus,creating years of infections. i have contacted a place called the skull base institute in california but the head dr wants $600 UP front for evaluation and i will be reimbursed by my ins. co. i dont have this kind of money but i want his opinion,i am frightened to death how far this infection has possibly spread into my face. this dr specifically goes through your nose for all types of surgery and never cuts open your skull from any type of skull surgery. does anyone know any mrsa special surgeons that can help me,or does anyone out there have any comments or suggestions for me,please help i am so frightened,people say this can spread very quickly,well how about since 1991 or so,i have already lost a considerable amount of weight from stress,going thru a divorce and my house went on fire shortly after my 4th surgery.does anyone know a specific website just for this mrsa bacteria?? help please. ty
Steph // Oct 5, 2007 at 10:45 am
Linda - I’m sorry to hear your story.
My immediate reaction to it is that you may be going down the wrong track in looking for an ‘MRSA special surgeon’. I don’t think there is such a thing. What you need to find is the right drug treatment for your MRSA before considering any further surgery. If you’ve not already done so, you need to get your infection properly analysed by a specialist in microbiology (possibly called an infectious disease consultant in your country?) and your sinus surgeon should refer you for this. This will accurately identify which antibiotics your strain of MRSA is particularly sensitive to so that an intensive course of antibiotics can be commenced. This sort of treatment may have to be delivered intra-venously (meaning a stay in hospital) but if it means that you can clear your system of MRSA and possibly avoid further surgery, then it’s surely worth a try.
I wish you the best of luck.
Regards, Steph
Joey // Oct 18, 2007 at 3:50 pm
I have recently had my 4 th sinus sx, like many of you all that have posted on this site. The surgery culture showed MRSA for the first time. I have been put on Bactrum DS for 20 days but no mention of IV antibiotics as of yet. Does anyone know if this seems long enough? I know the culture showed that this strain of MRSA is sensitive to Bactrim. Is this really something that can spread quickly? I have read a million conflicting reports. thanks for the advise if any,
Joey
Steph // Oct 18, 2007 at 5:28 pm
Hi Joey
If the culture showed up a sensitivity to Bactrim then your prescription should work. However I am not in a position to advise you on your concern as to whether the dosage will be enough to stamp out the MRSA infection for good. I suggest you ask your surgeon or general practitioner for more ‘up front’ information.
Best of luck! Steph
anomnymous // Oct 31, 2007 at 3:15 am
Linda can you please email me i have this in my sinuses too but feel like it is spreading to my face nd jaw area. kyfillie06@yahoo.com thats azero in the email address. i feel like im getting no where with this infection also.
Tammy // Nov 11, 2007 at 2:09 pm
Hello,
I am currently being treated for MRSA.I have sarcoidosis of the sinuses and this has posed great trouble for me. My sinuses are really set up for infections and have been chronic since 1999. I have been on ABX since Sept, all Staph…but the last one came back as MRSA. I have been referred to an Infectious Control MD, but am not able to get in to see him til the end of Jan! I am a nurse also, and being positive for active respiratory MRSA, has put work at a stand still and have been told not to work til my cultures are clear. Understandably, I comply. This is very difficult and has put a financial strain on the household. In the past and now, I have been very careful and followed all precautions needed. Sadly, I know all are not so careful and puts us all at risk.I am off work until at least Dec14th after my ABX TX ends and culture is taken. My frustration is the continual battle with this. We had my husband cultured to see if he was a carrier…no symptoms, so he can be treated also if need be.We should have results this Monday. Well, thanks for allowing me to vent. Hopeful til the end!
Tammy
anomnymous // Nov 11, 2007 at 4:03 pm
Tammy could you please tell me what sarcoidosis
anomnymous // Nov 11, 2007 at 4:04 pm
Tammy could you please tell me what sarcoidosis is of the sinuses?
Mac Miller // Nov 12, 2007 at 3:15 pm
My husband has had a sinus inf since July.He had sinus surg in Sept. He is feeling worse.His post op CT is worse than pre op. C&S showed bug bactrim ds sensitive.He has been on for a week and feels worse. What is the next step,second opinion from ENT or ID doc?
Tammy // Nov 12, 2007 at 4:12 pm
Hello Anonymous,
To answer your question about Sarcoidosis……Sarcoidosis is an Autoimmune disease that can affect any organ of the body. Usually, it affects the lungs, but I am without symptoms there. I have had 3 sinus SX to open up pathways that the sarcoid tissues closed. Sarcoid produces granulous tissue in unwanted places. They have linked this disease now to cell-wall difficient bacteria which affects those that are susceptable to this. Most people can fight off the germs, my body makes a home for them in the granulous tissue. I am being treated non-traditionally to fight this. Traditionally steroids and other meds are used. If you have any other questions concerning this, you can find more info at www.marshallprotocol.com. Hope this helped.
Lynn // Feb 3, 2008 at 3:22 pm
I am about at the end of my rope. I have had 12 sinus surgeries and been on IV antibiotics for MRSA 7 times. I thought I had it licked because I did not get an infection for almost a year, but after having a recent sinus infection and swab, it came back MRSA again. I have been to ENT, Infectious Disease, Epidemiologist, Dermatologist, etc. It keeps coming back. I am 52 and been fighting these infections since I was in my 30s. I try to exercise and be healthy, but no matter what I do, nothing works. Any ideas from anyone?
steph // Feb 3, 2008 at 4:43 pm
Hello Lynn
Poor you! I’m sorry to hear what you’re going through. Having been there myself, I can totally empathise in how soul destroying it is to have recurrent MRSA sinus infections. A positive MRSA swab means little to the medics but it can be devastating news to the patient. It means that all the previous treatment has failed and must now be faced all over again with no guarantee of success.
I thought I’d never get the all-clear from MRSA but after extensive surgery 10 months ago, I haven’t tested positive since. I am however still colonised by Staph A and have found it difficult to rid myself of this.
If you would like to, you can read more about my sinus history and problems with MRSA at
http://biopsy.wordpress.com/
or just click on Steph above.
Then click on ‘MRSA’ in the tag cloud on right hand side of site. You can leave a comment for me on the blog if you wish.
I wish I could give you some reason for hope, Lynn. All I can tell is that you’re not alone in your experience. The very best of luck.
mary // Feb 3, 2008 at 6:24 pm
hi lynn sorry you can get rid of this i cant either and some other girls i know. if you would like to email me please feel free were here if you need to talk.
Diana // Feb 19, 2008 at 11:44 pm
Does MRSA cause watering of the eyes and vision problems?
mary // Feb 20, 2008 at 12:45 pm
it has with me
Pat // Feb 23, 2008 at 5:43 pm
4 weeks ago I had sinus surgery. This week Dr took a culture, possible MRSA. question : How do I keep from spreading it to others? I work in the health field.
mary // Feb 23, 2008 at 7:07 pm
KYFILLIE06@YAHOO.COM EMAIL ME YOUR NOT ALONE THERES SEVERAL OF US THT HAVE THIS IN SINUSES. YOU MY NEED TO WEAR MASK ALONG WITH GOOD HANDWASHING IF POSSIBLE
Pat // Feb 25, 2008 at 8:11 pm
Mary Thank you for your support. My culture just came back. Negative for MRSA
Laura // Mar 1, 2008 at 9:19 am
I have chronic sinusitis, which I always thought was due to allergies. About 2 months ago, I had a sinus lift with bone graft done by an oral surgeon in preparation for a dental implant. At the time of the surgery I had a sinus infection for which I was prescribed Amocicillin. I asked whether the surgery should be postponed due to theinfection ,but was told that the infection would not interfere with the surgery. Stupidly, I believed what my dentist and surgeon told me and went ahead with the surgery. The surgeon kept me on the Amoxicillin post surgery. A few days after the procedure I started experiencing intense pain at the incision site as well as in my sinuses. On exam, the oral surgeon told me that I had developed a “little infection,” which he drained. He also told me that I had developed an oral-nasal fistula, which explained why liquids I held in my mouth would start pouring our of my nose alon with foul smelling green puss. He also took me off Amoxicillin and put me on Flagel for one week. After that week, the pain got worse, so I went to another oral surgeon, who immediately put me on Augmenten XR, took a Catscan of my head and did a culture. He also told me that he thought I would need surgery to remove the bone graft and clean-out my sinuses. At the time, the culture showed that I had strep and “rare” MRSA. After one week on the Augmenten, I continued to feel sick and elected to have the surgery last Sunday. During surgery another, more robust, culture was taken. This one should moderate MRSA. At that point and ID specialist was called in. He put me on minocyin, but ever since the operation I have been having intense debilitating headaches and feel even sicker than before. Yesterday, I couldn’t stand it anymore, so I called the ID doctor, who has now switched me to iv cubicin. Last night, I had the same horrible headache and sick feeling all night. I’ve been taking Vicodin and Rx Ibuprofen for the pain, but it doesn”t seem to help. Any idea why I keep having the pain and headaches that start in the late afternoon and last all night? thanks for reading this. L
Becky // Mar 8, 2008 at 9:59 pm
I have had several surgeries; and been treated for MRSA with IV drugs; and had constant sinus infections for the past 15 years. I had a spontenous fistula leak and spinal fluid leaked through my skull and out my nose. My MRSA has never gone away. Now my jaws hurt all the time. Could this be related?
m // Mar 9, 2008 at 10:58 pm
hi i have this pin also in my jaws you can email mr if you like kyfillie06@yahoo.com
mAtt // Mar 23, 2008 at 1:06 am
I recommend that you guys suffering from Sinus issues check out The Grossan Hydropulse a true lifesaver and if you can up your B-12 but only sub lingual tablets. Additionally you can check out Aerosol Science Laboratories in Calabasas, California get a referral to a doc in your area. Those guys are the bomb!!! lucky for me I had Murray Grossan Md in Los Angeles. He is a very good doctor and a kind man. He prescribed liquid Mupiricin via a nebulizer and the Hydropulse it really helped. ASl labs did it all after prescription they rock! They have a web site as well. i wish you all luck it is a horrible road to travel. I know!
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