Abstract
Mycoplasmal infection is a frequent cause of chronic respiratory tract disease in domestic animals and fowls; and in man one of the causes of colds and aggravation of chronic infection of the respiratory tract. Recent interest in this infection prompted this study of its effects or pathogenicity in chronic rhino-sinusitis. Mycoplasma has also been found in the discharge from respiratory tract mucosa over relatively long periods and is considered a possible factor contributing to the chronicity of infections of the respiratory tract.
Methods:(1) A culture, employing standard rabbit serum, was prepared using specimens obtained from the maxillary sinuses and middle nasal meatus of healthy persons, of patients operated for chronic sinusitis, and of patients with acute exacerbation of chronic sinusitis and isolation and identification of mycoplasma made.
(2) Sero-immunological examination was performed with complement fixation and indirect hemagglutination tests to determine the titer of antibodies to M. pneumoniae.
Results and Summary:(1) In patients operated for with chronic sinusitis, non-pathogenic M. salivarium and M. orale type I, were isolated from the middle nasal meatus in 4 of 98 patients (4.1%) and from the maxillary sinus mucosa in 1 of 40 patients (2.1%).
(2) M. salivarium and M. orale type I were isolated from the middle nasal meatus in 7 of 106 patients (6.5%) with acute exacerbation of chronic sinusitis. Pathogenic M. pneumoniae was not found in any of the patients. As the same species of mycoplasma were isolated from the mucous membrane of the oropharynx in all 7 patients, it appeared that the mycoplasmal infection of the chronically inflammed sinus mucosa was due to contamination from the oropharynx.
(3) No mycoplasma was observed in the middle nasal meatus of 168 healthy persons without respiratory tract infection. Thus, mycoplasma does not appear to be present in the normal fl ora of healthy paranasal sinuses.
(4) Although M. salivarium and M. orale type I are considered non-pathogenic, various toxic phenomena suggestive of a low virulence were observed. With reduced local resistance to infection or the use of antibiotics, the possibility of opportunistic mycoplasmal infection by these species is therefore possible.
(5) In 1969 a significantly higher number of patients with acute exacerbation of chronic sinusitis (11.5%) showed a high titer of complement-fixing antibodies, as compared with healthy individuals (4.1%) (chi-square test, p =0.05). In the same year a higher titer of indirect hemagglutinating antibodies was found in the sinusitis group than in the control group (chi-square test, p=0.01).
(6) No significant difierence in age distribution of healthy individuals with antibodies to M. pneumoniae was observed. As high titers of antibodies were present in healthy individuals only in 1969 and not in 1971, it is surmised that an endemic outbreak of infection by M. pneumoniae occurred in the Tokyo area in that year.
(7) The significance of mycoplasmal infection as one of the principal factors responsible for exacerbation of chronic sinusitis in endemic areas of infection by M. pneumoniae is suggested by the results of the sero-immunological studies.
