A Systematic Review on the Association between Rhinovirus and Sinusitis

Rhinovirus (RV) infections are the most common cause of viral URIs, and in the majority of persons self-resolve. However, in others, viral URIs can progress to bacterial sinusitis and induce chronic rhinosinusitis (CRS) exacerbations. We conducted a comprehensive PRISMA review through April 2018 based on MEDLINE, Embase, Web of Science-SCI and 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) investigate the pathophysiologic mechanisms by which RV induces sinonasal inflammation, (3) study the changes that occur after experimental RV inoculation, and (4) explore the treatment options available for RV-associated sinusitis. Data regarding study design, research question, intervention, subjects, outcomes, and biases was extracted. The initial search yielded 2395 unique abstracts, of which 600 were selected for full-text review, and 147 included in the final review. We determined that (1) the prevalence of RV infections is increased in those with CRS, (2) RV-A and RV-C challenges in vitro to sinonasal epithelia produce robust cytokine responses and differential gene changes, (3) humans challenged in vivo with RV secrete local and systemic inflammatory mediators with radiographic mucosal thickening and (4) no current therapies have produced consistent and significant resolution of disease. RV 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.