Acute bacterial rhinosinusitis and it's info

ABRS

1. Acute Bacterial RhinoSinusitis BLOCK 1A GRP 3 Group members Lekha Mintu Paras Choudhary Rajkumar Renuka Sabeeha Shahith

2. introduction Acute bacterial rhinosinusitis (ABRS) is an infection and inflammation of the paranasal sinuses that occurs as a result of bacterial colonization, typically following a viral upper respiratory tract infection.
It is characterized by the presence of symptoms lasting 10 days or more, including purulent nasal congestion, drainage, facial pain, postnasal drip, hyposmia /anosmia and fever.
It can involve one or more of the sinuses, including the maxillary, frontal, ethmoid, or sphenoid sinuses. 2

3. etiology Most cases of ABRS are preceded by a viral URI The most common bacterial pathogens include: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Less commonly, the following bacteria may also be implicated: Staphylococcus aureus (including MRSA), Anaerobic bacteria. Sinus Obstruction : Any factor that obstructs sinus drainage can predispose an individual to bacterial infection such as allergic rhinitis, nasal polyp and environmental irritants(smoke, pollutants) Immunocompromised states(HIV/AIDS, chemotherapy and chronic conditions like asthma, cystic fibrosis and smoking may increase the susceptibility to ARBS. 3

4. PREVALENCE Most ARS cases are viral (90%-98%), while bacterial infections are 2%-10%. Secondary bacterial infection following viral URI occurs in 0.5%-2% of adult cases. 4

5. PREDISPOSING FACTORS Allergic/non-allergic rhinitis, nasal polyps, trauma, dental infections, immunodeficiency or other factors that lead to inflammation of the nose and paranasal sinuses. Rhinosinusitis is found more commonly in conditions like tumors, Wegener’s granulomatosis , HIV, Kartagener’s syndrome, immotile cilia syndrome, and cystic fibrosis increase risk.

6. SIGNS AND SYMPTOMS Nasal congestion. Purulent nasal discharge. Facial pain or pressure. Fever.
Cough.
Fatigue. 7.Maxillary dental pain. 8.Ear pressure or fullness. 9.Hyposmia or anosmia 10.Early morning headache due to the involvement of frontal sinuses 11.Pain with Movement of eye due to the involvement of ethmoid sinuses 6

7. Pathophysiology Predisposing factors Allergic rhinitis Anatomical abnormalities like nasal polyp, deviated septum Environmental irritants like smoking, pollution impaired the mucociliary clearance. Immunodeficiencies like diabetes, hiv , immunosuppressive drugs weakens the immune system thereby increasing the risk of infection. Microbial Invasion Viral URI impairs the normal mucus clearance providing an ideal environment for bacterial proliferation. Common pathogens include: Streptococcus pneumoniae (most common). Haemophilus influenzae . Moraxella catarrhalis (especially in children).

8. Inflammatory Cascade Bacterial colonization leads to immune cell recruitment and the release of pro-inflammatory cytokines, which causes: Mucosal edema : Further narrows sinus openings. Hypersecretion of mucus: Causes nasal discharge and blockage. Pus formation: containing dead cells(dead neutrophils, bacteria and cellular debris) causing sinus obstruction. Sinus pain and pressure: Resulting from increased intraluminal pressure leading to facial pain, headache and congestion Cycle of Stasis and Inflammation The combination of obstruction, mucus stasis, and bacterial growth perpetuates inflammation, worsening symptoms. If untreated, this can lead to complications such as orbital cellulitis, subperiosteal abscess, or intracranial extension.

9. Complications Chronic Rhinosinusitis : If untreated, ABRS may transition into chronic sinusitis (symptoms lasting >12 weeks). Severe cases: Orbital complications : Orbital cellulitis or abscess. subperiosteal abscess Intracranial complications Meningitis, brain abscess (rare) Cavernous sinus thrombosis 9

10. 10 In the first 3 to 4 days of illness, there is difficulty in differentiating a viral etiology from early-onset bacterial etiology of rhinosinusitis Persistence of symptoms for 5 to 10 days,represents the beginning stages of ABRS. During this period, a pattern of initial improvement followed by worsening characterized by new onset of fever, headache or increased nasal discharge may be observed. This pattern of “double worsening” or “double sickening” is consistent with ABRS. DIAGNOSIS OF ACUTE BACTERIAL RHINOSINUSITIS (ABRS)

11. 1.The diagnosis of ABRS is based on the following criteria: Acute onset of some or all of the following symptoms: nasal congestion,purulent nasal discharge, (anterior/posterior nasal drip) with or without facial pain/ pressuredental pain and ear pressure/fullness, fever, cough, fatigue, hyposmia /anosmia that fail to improve after 10 days Symptoms worsening within 5-10 days after an initial improvement (i.e. double worsening) Symptoms not lasting beyond 4 weeks Grade D Recommendation, Level 5 Evidence DIAGNOSING AbrS

12. DIAGNOSING AbrS 2. Physical Examination Includes inspection, palpation of maxillary and frontal sinuses, and rhinoscopy . Provides information on the chronicity and severity of the patient’s ABRS. Nasal decongestion and suctioning of excess secretions may aid diagnosis. Grade D Recommendation, Level 5 Evidence. Nasal Endoscopy Safe, radiation-free, cost-effective office procedure
Used to identify purulent discharge, anatomical abnormalities, and collect microbiological samples through endoscopy guidance Grade C Recommendation, Level 4 Evidence.

13. 4.Imaging Studies NOT recommended for the routine diagnosis of ABRS. Reserved for: Persistent or recurrent symptoms. Suspected complications (e.g., orbital, intracranial, or soft tissue involvement). Co-morbidities that predispose to complications, including diabetes, an immune-compromised state, or a history of facial trauma or surgery. CT imaging is preferred for complications or surgical planning. Grade A(-) Recommendation, Level 1A Evidence DIAGNOSING AbrS

14. TREATMENT FOR ABRS 1.Primary Treatment: Empiric Antibiotic Therapy First-Line Regimen for Low-Risk Patients: Amoxicillin-Clavulanic Acid: 625 mg every 8 hours or 1 g every 12 hours. Amoxicillin: 500 mg every 8 hours or 1 g every 12 hours. Treatment duration: 7-10 days. Low-risk patients: <65 years, no recent antibiotics (30 days), no hospitalization (5 days), no co-morbidities, not immunocompromised. For Penicillin-Allergic Patients: Doxycycline 100 mg every 12 hours. Levofloxacin 500 mg once daily or Moxifloxacin 400 mg once daily. Macrolides (e.g., erythromycin): Use only where resistance rates are low.

15. 2.Second-Line Antimicrobial Therapy Considered for: High-risk patients of antimicrobial resistance All patients with worsening or no improvement of symptoms after 5-7 days Regimens: Amoxicillin-Clavulanic Acid 2 g every 12 hours. Doxycycline 100 mg every 12 hours. Levofloxacin 500 mg once daily or Moxifloxacin 400 mg once daily. TREATMENT FOR ABRS

16. TREATMENT FOR ABRS 3.Patients unresponsive to second-line therapy require further evaluation, including: CT scan of the Paranasal Sinuses. Sinus or middle meatal cultures. Immune system studies. 4. Watchful Waiting An option for uncomplicated ABRS (e.g., mild symptoms, no extra-sinus complications).Temperature <38.3 C, no extra-sinus complications), provided that there is good follow-up Start antibiotics if symptoms fail to improve after 7 days or worsen ("double worsening"). Grade A Recommendation, Level 1A Evidence.

17. 17 ADJUNCTIVE AND SYMPTOMATIC TREATMENT 1. Nasal Saline Irrigation (NS )-Hypertonic saline is particularly beneficial Safe, effective for mucociliary clearance and reducing inflammation. Grade A Recommendation, Level 1A Evidence. Intranasal Corticosteroid Sprays (INCS) Effective as monotherapy or combined with antibiotics for symptom relief. Found to significantly improve symptom resolution. Topical Nasal Steroids can be used alone or in combination with oral antibiotics for symptomatic relief of ABRS Grade A Recommendation, Level 1A Evidence.

18. ADJUNCTIVE AND SYMPTOMATIC TREATMENT 3.Decongestants/Antihistamines
Lack evidence for efficacy.
Symptomatic management should focus on hydration, analgesics, antipyretics, saline irrigation and INCS
Grade D Recommendation, Level 5 Evidence. 4.Patient Education Avoid inciting factors like allergens, irritants, or self-medication with antibiotics. Educate on judicious antibiotic use to reduce antimicrobial resistance

19. 19 THANK YOU !!!