Stefano Bassetti, MD; Robert J. Sherertz, MD; Michael A. Pfaller, MD
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Bassetti S., Sherertz R., Pfaller M.; Airborne Dispersal of Staphylococcus aureus Associated with Symptomatic Rhinitis Allergica. Ann Intern Med. 2003;139:W-60. doi: 10.7326/0003-4819-139-3-200308050-00021-w1
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Published: Ann Intern Med. 2003;139(3):W-60.
TO THE EDITOR:
Airborne transmission of Staphylococcus aureus is considered rare (1). However, previous studies showed that a viral infection can drastically increase the dispersion of S. aureus into the air by nasal S. aureus carriers (2-4). We investigated airborne S. aureus dispersal by a nasal S. aureus carrier with allergic rhinitis. The carrier was asymptomatic while receiving an antihistamine. Air cultures were performed in a chamber with high-efficiency particulate air (HEPA) filtration using four Andersen air samplers and settle plates (Thermo Andersen Corp., Franklin, Massachusetts) (4). During each study day, the cultures were done with the volunteer sitting in the chamber for three periods of 20 minutes, wearing, respectively, street clothes, sterile garb, and sterile garb with a surgical mask. The number of sneezing and coughing episodes was recorded. Allergic rhinitis symptoms were assessed by using a score (5), by counting the tissues used, and by determining the weight of the nasal mucus expelled. The volunteer was studied for 2 days while asymptomatic (baseline). He then interrupted his therapy. Seven days later, he was symptomatic and was studied for a further 10 days. The peak airborne S. aureus count increased significantly above the mean count at baseline while the volunteer was wearing clothes (from 0.5 colony-forming unit [CFU] to 19 CFUs; P = 0.006) and sterile garb (from 0 CFU to 20 CFUs; P = 0.032), but not while he was wearing sterile garb and mask (from 0 CFU to 2 CFUs; P = 0.164) (Figure). Ninety-five percent of the airborne S. aureus typed by pulsed-field gel electrophoresis was identical with the S. aureus in the volunteer's nose. Independent predictors of increased airborne dispersal of S. aureus were sneezing (P < 0.001) and number of tissues used (P = 0.007). The quantity of mucus and coughing both correlated with decreased airborne dispersal of S. aureus. In this nasal carrier, symptomatic rhinitis allergica caused a significant increase in airborne dispersal of S. aureus.
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