Aerobic bacteriology of throat swabs in adult patients with chronic rhinosinusitis in Lokoja, Kogi state, Nigeria

Abstract

Allergy, pollutants, infections, anatomical variation, and immunological factors are involved in chronic rhinosinusitis. As the bacterial flora kept changing and with frequent antibiotic resistance to the commonly used drugs, there is need for a bacteriological study to identify the causative pathogens and their antibiotic susceptibility for cost effective management of the disease. Eighty six patients with chronic rhinosinusitis and 25 well adults (control) had swab taken from their posterior nasal mucosa with the aid of a head light and angle metallic tongue depressor. Blood and MacConkey’s agar plates were used for overnight incubation at 37°C. Bacterial growth identified using colonial morphology, Gram stain results and key biochemical reactions. Kirby-Bauer’s method was used for the antimicrobial susceptibility testing for all isolates. Results showed that patients were 41males and 45female, male to female ratio was 1:1.2, mean age was 25.34±12SD years and the modal age group was 31-40years (25.6%).Of the 86 patients, 44(51.2%) were culture positive for aerobic bacteria, 2(2.3%) fungi and 40(46.5%) had no growth. Controls were 12males and 13females with a male to female ratio of 1:1.1. Eleven (44%) of the control had no growth and 14(56%) had Staphylococcus aureus only. The predominant bacterial isolate from patients was Pseudomonas aeruginosa 12(14.0%) followed by S. aureus (11.6%) and Imipenem had the highest drug susceptibility followed by ciprofloxacin.
Keywords: aerobic, bacteriology, chronic, rhinosinusitis, susceptibility

Full text

Nig. J. Pure &Appl. Sci. Vol. 30 (Issue 1, 2017)
ISSN 0794-0378
(C) 2017 Faculty of Physical Sciences and Faculty of
Life Sciences, Univ. of Ilorin, Nigeria
www.njpas.com.ng
Corresponding Author: S.A. Ogah, Department of Surgery, Federal Medical Centre P.M.B. 1001,
Lokoja, Kogi State, Nigeria. Email: stephenogah@yahoo.comMobile: +2348075224222
Page | 2965
doi: http://dx.doi.org/10.19240/njpas.2017.A10
Aerobic bacteriology of throat swabs in adult patients with chronic rhinosinusitis in
Lokoja, Kogi state, Nigeria
S.A. Ogah,1* J.I. Ogah,2 I.E. Enesi,3 D.I. Oseji3
1Consultant Oto-rhino-laryngologist, Head and Neck Surgeon, Otolaryngology Division,
Department of Surgery, Federal Medical Centre, P.M.B. 1001, Lokoja, Nigeria.
2Infectious Diseases and Environmental Health Research Group, Department of Microbiology,
Faculty of Life Sciences, University of Ilorin, Kwara State, Nigeria.
3Department of Ophthalmology, Federal Medical Centre, P.M.B. 1001, Lokoja, Nigeria.
Abstract
Allergy, pollutants, infections, anatomical variation, and immunological factors are involved in
chronic rhinosinusitis. As the bacterial flora kept changing and with frequent antibiotic
resistance to the commonly used drugs, there is need for a bacteriological study to identify the
causative pathogens and their antibiotic susceptibility for cost effective management of the
disease. Eighty six patients with chronic rhinosinusitis and 25 well adults (control) had swab
taken from their posterior nasal mucosa with the aid of a head light and angle metallic tongue
depressor. Blood and MacConkey’s agar plates were used for overnight incubation at 37°C.
Bacterial growth identified using colonial morphology, Gram stain results and key biochemical
reactions. Kirby-Bauer’s method was used for the antimicrobial susceptibility testing for all
isolates. Results showed that patients were 41males and 45female, male to female ratio was
1:1.2, mean age was 25.34±12SD years and the modal age group was 31-40years (25.6%).Of the
86 patients, 44(51.2%) were culture positive for aerobic bacteria, 2(2.3%) fungi and 40(46.5%)
had no growth. Controls were 12males and 13females with a male to female ratio of 1:1.1.
Eleven (44%) of the control had no growth and 14(56%) had Staphylococcus aureus only. The
predominant bacterial isolate from patients was Pseudomonas aeruginosa 12(14.0%) followed by
S. aureus (11.6%) and Imipenem had the highest drug susceptibility followed by ciprofloxacin.
Keywords: aerobic, bacteriology, chronic, rhinosinusitis, susceptibility.
Introduction
Rhinosinusitis is an inflammatory condition of
the nose and sinus mucosae characterized by
major and minor signs/symptoms (Benninger
et al., 2008). Major signs/symptoms include
facial pain, facial congestion, nasal
obstruction, nasal discharge, hyposmia and
fever. The minor ones include headaches,
dental pain, ear pain, ear fullness, fever,
halitosis, fatigue, and cough. Having two
major symptoms/signs or one major and two
minor symptoms/signs is enough to make the
diagnosis (Hamilos et al., 2011).

S.A. Ogah, J.I. Ogah, I.E. Enesi, D.I. Oseji Nig. J. Pure& Appl. Sci. Vol. 30 (Issue 1, 2017)
Nig. J. Pure & Appl. Sci. Vol. 30 (Issue 1): 2965-2970
Page | 2966
The paranasal sinuses are a common site of
infection in human beings with frequent
morbidity and rare mortality (Aanan et al.,
2005). Infections in them almost always
spread into the nasal cavity hence the use of
the encompassing word rhinosinusitis. Based
on the disease duration, it is classified into
acute (1-4 weeks), sub-acute (4-12 weeks),
chronic (greater than 12 weeks) and recurrent
(4 or more episodes per year) by the
Rhinosinusitis Task Force of the American
Academy of Otolaryngology (Report of the
Rhinosinusitis Task Force Committee
Meeting. Alexandria, Virginia, August 17,
1996). Common predisposing factors include
acute upper respiratory tract viral infections,
allergic conditions, anatomical variation of the
nasal structures, obstruction of the sinus
drainage and defect in the mucocilliary
function (van Cauwenberge et al., 2006). By
reason of frequent failure in antibiotic
treatment, acute exacerbations and
recurrences, the disease usually requires many
courses of antibiotics with occasional surgical
procedures. Cost effective management of
rhinosinusitis therefore will depend on the
knowledge of causative microorganisms and
their antimicrobial sensitivity test (Ogah and
Ogah, 2016). Several hypotheses are now
available to help explain the pathophysiology
of chronic rhinosinusitis but none of them is
sufficient enough to explain the cascades of
event that are noticed in the disease course
(Mantovani et al., 2010).
Suggested four sites of effective sample
collection in chronic rhinosinusitis include (1)
from the sinus itself (via sinus puncture), (2)
from the sinus ostium at the middle meatus
with the aid of an endoscope, (3) from the
posterior nasal mucosa and (4) from the
anterior nasal mucosa based on the available
facilities. A major drawback of all the
collecting sites is frequent sample
contamination if adequate sterility measures
are not put in place during the procedure.
Varalakshmi et al. (2016) had also shown that
collected samples from the middle meatus
using an endoscopic technique is as good as
that collected from the sinus with a puncture.
Rhinosinusitis is an inflammatory condition of
the nose and paranasal sinus mucosae.
Materials and Methods
This is a hospital based prospective study
carried out in the ENT clinic of the Federal
Medical Center Lokoja between January 2014
and December 2015. One hundred and eleven
subjects were recruited for the study by
convenience sampling method. They consist
of 86 adult patients with a clinical diagnosis of
chronic rhinosinusitis and 25 well adults to
serve as control. The patients were 41males
and 45females, and the control were 12males
and 13 females with age ranging from 21-80
years. With aseptic condition strictly followed,
all subjects had a throat swab taken from their
posterior nasal mucosa with the aid of a good
head light and an angle metallic tongue
depressor. Blood and MacConkey’s agar
plates were used for overnight incubation at
37°C. Bacterial growth identified using
colonial morphology, Gram stain results and
key biochemical reactions. Kirby-Bauer’s
method was used for the antimicrobial
susceptibility testing for all isolates.
Results
The total number of patients were 86,
consisting of 41 males and 45 females and
male to female ratio was 1:1.2. Mean group

S.A. Ogah, J.I. Ogah, I.E. Enesi, D.I. Oseji Nig. J. Pure& Appl. Sci. Vol. 30 (Issue 1, 2017)
Nig. J. Pure & Appl. Sci. Vol. 30 (Issue 1): 2965-2970
Page | 2967
age of 25.34years and the modal age group
was 31-40 years (25.6%) as shown in Table 1.
Out of the 86 samples, 44(51.2%) were culture
positive for bacteria, 40(46.5%) samples had
no growth in them and 2 (2.3%) samples had
fungi as shown in Figure1 and Anaerobes
where not cultured due to lack of the facility.
The predominant bacterial isolate was
Pseudomonas aeruginosa (14.0%) followed
by Staphylococcus aureus (11.6%), E. coli
(9.3%), S. epidermidis (9.3%) and Klebsiella
spp (4.6%) as shown in Table2. Imipenem
(93.2%) had the highest susceptibility
followed by ciprofloxacin (90.9%) as shown
in Table3. For the control group, the male to
female ratio was 1:1.1, 11(44%) samples had
no growth and 14(56%) had S. aureus only.
Table1: Age and Gender distribution of patients with chronic rhinosinusitis
Age group
Number of Males (%)
Number of Females (%)
Total (%)
21-30
8(9.3)
6(7.0)
14(16.3)
31-40
10(11.6)
12(14.0)
22(25.6)
41-50
6(7.0)
9(10.4)
15(17.4)
51-60
9(10.4)
6(7.0)
15(17.4)
61-70
4(4.7)
7(8.1)
11(12.8)
71-80
4(4.7)
5(5.8)
9(10.5)
Total
41(47.7)
45(52.3)
86(100.0)
Male/female ratio=1:1.1 and group mean=25.34years
Figure1: Culture Results of adult patients with chronic Rhinosinusitis in Lokoja, Nigeria.
44
40
2
0
5
10
15
20
25
30
35
40
45
50
Bacteria No Growth Fungi

S.A. Ogah, J.I. Ogah, I.E. Enesi, D.I. Oseji Nig. J. Pure& Appl. Sci. Vol. 30 (Issue 1, 2017)
Nig. J. Pure & Appl. Sci. Vol. 30 (Issue 1): 2965-2970
Page | 2968
Table2: Aerobic bacteria found in adult patients with chronic rhinosinusitis in Lokoja, Nigeria.
Table3: Drug sensitivity pattern in patients with chronic rhinosinusitis in Lokoja, Nigeria.
Tested Isolate
N
Drugs in microgram/disc
P. aeruginosa
S. aereus
E. coli
S. epidermidis
Klebsiella spp
Total
AMP(10)
AUG(30)
CRO(30)
OB(5)
CN(10)
IPM(10)
CIP(5)
OFX(5)
12
0(0.0)
8(18.2)
7(15.9)
6(13.6)
10(22.7)
11(25.0)
10(22.7)
8(18.2)
10
5(11.4)
6(13.6)
5(11.4)
4(9.1)
8(18.2)
9(20.5)
10(22.7)
8(18.2)
8
3(6.8)
5(11.4)
5(11.4)
3(6.8)
7(15.9)
8(18.2)
7(15.9)
6(13.6)
8
2(4.6)
4(9.1)
3(6.8)
4(9.1)
6(13.6)
7(15.9)
8(18.2)
5(11.4)
6
2(4.6)
4(9.1)
4(9.1)
3(6.8)
6(13.6)
6(13.6)
5(11.4)
4(9.1)
44
12(27.4)
27(61.4)
24(54.6)
20(45.4)
37(84.0)
41(93.2)
40(90.9)
31(70.5)
N=Number of isolate tested, AUG = amoxicillin – clavulanate; CIP = ciprofloxacin; OFX =
ofloxacin. CRO = ceftriaxone; OB = cloxcillin; CN=gentamicin; AMX = amoxicillin; IPM =
Imipenem. Figures in parenthesis are in percentages
Discussion
In our study chronic rhinosinusitis was
found commonest in the 31-40 (25.6%) age
group and this is different from another
study in which it was more in the younger
age group of 21-30years (Incorvaia et al.,
2010). A little more than half (51.2%) of our
patients had aerobic bacteria being the
aetiologic agents of their diseases. This
study appears to be in support of an earlier
study that showed chronic rhinosinusitis is a
disease caused essentially by aerobic
bacteria and a few facultative anaerobes
(Araujo et al., 2003). It is therefore not out
of place to do an aerobic bacterial study to
aid the treatment of our patients especially
when facilities for identifying anaerobic
organisms were not available as noticed in
our study. A large proportion of our patients
had negative culture results which may
probably be due to their previous antibiotic
usage or that the culture period was not long
enough to allow the growth of some
pathogenic organisms. The two fungi
cultured in this study may either be due to
some contamination of the samples or that
the involved patients have depressed
immunity that should be further
investigated. The commonest aerobic
bacterium found in this study was
pseudomonas aeruginosa which is a gram
negative organism, followed by S. aureus
Bacteria isolate
Number of Patients (%)
Pseudomonas aeruginosa
12(14.0%)
Staphylococcus aereus
10(11.6%)
Escherichia coli
8(9.3%)
Staph. epidermidis
8(9.3%)
Klebsiella
6(7.0%)
Total
44(51.2%)

S.A. Ogah, J.I. Ogah, I.E. Enesi, D.I. Oseji Nig. J. Pure& Appl. Sci. Vol. 30 (Issue 1, 2017)
Nig. J. Pure & Appl. Sci. Vol. 30 (Issue 1): 2965-2970
Page | 2969
and S. pneumonia. This is similar to some
studies in the past that found more of Gram
Negatives in chronic rhinosinusitis in adults
(Tantilipikorn et al., 2002; Rombaux et al.,
2002). It may be necessary to say that Gram
negatives organisms are increasingly gaining
ground in this disease entity and that effort
should be made to always identify them
during treatment. Half of our well subjects
also had S. aureus cultured and this raises
the question whether S. aureus should be
regarded as a pathogen in chronic
rhinosinusitis. Ciprofloxacin should be
consider in patients with chronic
rhinosinusitis who cannot afford the high
cost of imipenem which is the drug of
choice in this study.
Conclusion
The isolation, identification and
antimicrobial agent susceptibility/resistance
pattern of the aetiologic microbiological
agents in chronic adult rhinosinusitis will
assist the attending Physician in cost
effective management of the patient with
this chronic debilitating disease.
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