Are rhinoviruses implicated in the pathogenesis of sinusitis and chronic rhinosinusitis exacerbations? A comprehensive review

Abstract

BackgroundRhinovirus (RV) infections are the most common cause of viral upper respiratory infections (URIs), and in the majority of persons they are self‐limiting. However, in others, viral URIs can progress to bacterial sinusitis and induce chronic rhinosinusitis (CRS) exacerbations.MethodsWe conducted a comprehensive Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) review through April 2018 based on MEDLINE, EMBASE, Web of Science–Science Citation Index (SCI), and Conference Proceedings Citation Index‐ Science (CPCI‐S) using keywords: RV, respiratory virus, sinusitis, and airway epithelial cells. The goal of this systematic review was to: (1) determine the prevalence between RV and CRS, (2) study the changes that occur after experimental RV inoculation, (3) investigate the pathophysiologic mechanisms by which RV induces sinonasal inflammation, and (4) explore the treatment options available for RV‐associated sinusitis. Data regarding study design, research question, intervention, subjects, outcomes, and biases was extracted.ResultsThe initial search yielded 2395 unique abstracts, of which 614 were selected for full‐text review; 147 were included in the final review. We determined that (1) the prevalence of RV infections is increased in those with CRS, (2) humans challenged in vivo with RV secrete local inflammatory mediators with radiographic mucosal thickening, (3) RV species RV‐A and RV‐C challenges in vitro to sinonasal epithelia produce robust cytokine responses and differential gene changes, and (4) no current therapies have produced consistent and significant resolution of disease.ConclusionRV infections are common in persons with CRS, and incite inflammatory reactions that may result in CRS exacerbations and progression of disease. Further studies assessing RV species, and the host‐virome response are required to develop new strategies targeting RV‐induced CRS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Among the epidemiologic studies which showed differential viral recovery in CRS vs control patients, 753,754,1006,1007 a consistent finding was that RV is either the most prevalent or one of the most prevalent viruses. A recent systematic review 1014 identified 5 studies that met a multi‐component quality review for potential bias. Three studies reported an association between RV and CRS, 1006,1015,1016 while 2 studies reported no association 1009,1010 .…”

The Expression of ephrinA1/ephA2 Receptor Increases in Chronic Rhinosinusitis and ephrinA1/ephA2 Signaling Affects Rhinovirus-Induced Innate Immunity in Human Sinonasal Epithelial Cells

“…Chronic rhinosinusitis (CRS) is a heterogenous mucosal inflammation of the nasal cavity and paranasal sinuses ( 1 ). Although the pathophysiological causes of CRS remain unclear, accumulating evidence suggests that abnormal immune response of sinonasal mucosa to respiratory viral infection can progress to secondary bacterial infection and induce the exacerbation of CRS ( 2 – 6 ).…”

“…Rhinovirus (RV) infections are the most common cause of viral upper airway infections ( 4 , 7 , 8 ). However, it is unclear why they are self-limiting in the majority of persons, but in others can advance to bacterial sinusitis and enhance CRS exacerbations ( 2 – 6 ). A deeper understanding of host defense factors that contribute to effective protection against respiratory viral infection may aid in the prevention of disease progression and in the development of new therapeutic target.…”

Current Understanding of the Acute Exacerbation of Chronic Rhinosinusitis

“…A recent systematic review by Basharat et al showed that the prevalence of rhinovirus infections is increased in patients with CRS. Furthermore, rhinovirus infections incite inflammatory reactions that may result in CRS exacerbations and progression of disease (Basharat et al, 2019). Human bocavirus and metapneumovirus (hMPV) are also found in the nasal washes of CRS during flare-ups (Tan et al, 2017).…”