Comparative characteristics of the microbial landscape of the maxillary sinus in patients with chronic dacryocystitis and chronic sinusitis

Chronic rhinosinusitis (CRS) and chronic dacriocystitis (CDC) are often accompanied by the formation of chronic infection focus, that emphasizes the importance of understanding their etiology in rational therapy selection. Objective. To perform the comparative analysis of the microbial landscape of the mucous membrane of the paranasal sinuses (PNSs) in patients with CRS, the lacrimal sac (LS) in patients with CDC and the mucous membrane of the PNSs and LS in patients with combined CRS and CDC, as well as the antimicrobial susceptibility of the isolated microbial strains for development of effective methods for treatment and prevention of these diseases. Material and methods. The results of domestic and foreign studies (PubMed, Scopus, eLIBRARY) on microbiota content in CRS and CDC were analyzed. The results of our own studies in 120 patients aged 40—80 years with a follow-up period of 2 years divided into 3 groups of equal number were presented. The first group consisted of 40 patients (24 women and 16 men) with exudative purulent chronic maxillary sinusitis (CMS). The second group included 40 patients (38 women and 2 men) with CDC. The third group consisted of 40 patients (34 women and 6 men) with a combination of CDC and CMS. Bacteriological and molecular genetic research methods, allowing to determine a wide range of pathogens that cause the inflammatory process, were used in order to identify microorganisms. Results. It has been found in all groups of patients that the structure of the isolated microbiota was characterized by pronounced polymorphism and included both obligate aerobic and facultative and obligate anaerobic microorganisms. The most common etiologically significant microorganisms in CMS were Streptococcus pneumoniae — 19 (47.5%) cases, Staphylococcus aureus — 14 (35%), Haemophilus influenzae — 7 (17.5%), Moraxella catarrhalis — 7 (17.5%), Pseudomonas aeruginosa — 4 (10%), Bacteroides spp. — 3 (7.5%) and Klebsiella spp. — 3 (7.5%). Staphylococcus genus bacteria prevailed in the microbiota structure of patients with CDC, presenting in 20 cases (50% of the entire population of isolated microorganisms). Neisseria spp. have been identified in 8 (20%) cases, Streptococcus spp. — in 4 (10%). The study of pathological discharge from the maxillary sinus of patients with combination of CMS and CDC has revealed the following: microorganisms of the Staphylococcus spp. were the most common pathogens — 22 cases (55% of the total number of isolated microorganisms), bacteria of the Enterobacteriaceae family were detected in 8 (20%) cases, Streptococcus spp. — in 8 (20%), Neisseria spp. and Rothia mucilaginosa were less common — in 2 (5%) and in 2 (5%) cases, respectively. The most common pathogens isolated from the LS of patients with combination of CMS and CDC were Staphylococcus spp. — 24 cases (60% of the total number of microorganisms), bacteria of the Enterobacteriaceae family — 10 (25%) and Streptococcus spp. — 6 (15%). Conclusion. The study results allow to conclude that there is no clear relationship between the microbiota structure in patients with CRS and CDC and that further investigation of this problem is needed.