BACTERIAL SINUSITIS - CASE DISCUSSION

Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa

1. SINUSITIS – CASE DISCUSSION Dr. S P Srinivas Nayak Assistant Professor, SUCP Hyderabad, Telangana , India.

2. Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa . The paranasal sinuses are air-filled spaces located within the bones of the skull and facial bones. They are centered on the nasal cavity and have various functions, including.. 1. lightening the weight of the head, 2. humidifying and heating inhaled air, 3. increasing the resonance of speech, and 4. serving as a crumple zone to protect vital structures in the event of facial trauma.   Four sets of paired sinuses are recognized: maxillary, frontal, sphenoid, and ethmoid

3. Even though the majority of these infections are viral in origin, antimicrobials are prescribed frequently. It is thus important to differentiate between viral and bacterial sinusitis to aid in optimizing treatment decisions. Viral sinusitis and bacterial sinusitis are difficult to differentiate because their clinical presentations are similar . Viral infections, however, tend to resolve by 7 to 10 days. Persistence of symptoms beyond this time or worsening of symptoms likely indicates a bacterial infection. ACUCTE sinusitis lasts less than 30 days, and CHRONIC for more than 3 months

4. ETIO-PATHOPHYSIOLOGY Main cause: Bacterial, Viral infections Viruses are responsible for most cases of acute sinusitis; however, when symptoms are persistent (≥7 days) or severe, bacteria may be a primary cause. Other factors that can be associated with sinus disease include allergic inflammation , systemic diseases , trauma , environmental exposures , and anatomic abnormalities . Complications include: osteitis , orbital cellulitis , meningitis, and brain abscess, but are extremely rare.

5. ORGANISMS S. pneumoniae and H. influenzae are responsible for approximately 70% of bacterial causes of acute sinusitis in both adults and children. Moraxella catarrhalis is also frequently implicated in children (approximately 25%) S. pyogenes , S. aureus , fungi, and anaerobes are associated less frequently with acute sinusitis

6. Acute bacterial sinusitis usually preceded by a viral respiratory tract infection that causes mucosal inflammation. This can lead to obstruction of the sinus ostia , the pathways that drain the sinuses . Mucosal secretions become trapped, local defenses are impaired, and bacteria from adjacent surfaces begin to proliferate

7. Signs and symptoms In Acute Adults Nasal discharge/congestion Maxillary tooth pain, facial or sinus pain that may radiate (unilateral in particular) Children Nasal discharge and cough for greater than 10 to 14 days or severe signs and symptoms such as temperature above 39°C (102.2°F) or facial swelling or pain are indications for antimicrobial therapy Chronic Symptoms are similar to acute sinusitis but more nonspecific Rhinorrhea is associated with acute exacerbations Chronic unproductive cough, laryngitis, and headache may occur Chronic/recurrent infections occur three to four times a year and are unresponsive to steam and decongestants

8. Uncomplicated Sinusitis - Amoxicillin Uncomplicated sinusitis with penicillin allergic patient Non–immediate-type hypersensitivity: cefuroxime , cefixime Immediate-type hypersensitivity: Clarithromycin or azithromycin or trimethoprim-sulfamethoxazole or doxycycline or respiratory fluoroquinolone

9. Treatment failure or prior antibiotic therapy in past 4 to 6 weeks: High-dose amoxicillin with clavulanate or β- lactamase –stable cephalosporin Second choice: respiratory fluoroquinolone ( levofloxacin ) High suspicion of penicillin-resistant Streptococcus pneumoniae : High-dose amoxicillin or clindamycin Second choice: respiratory fluoroquinolone

10. CASE DISCUSSION A 40-year-old woman presents to her GP with a 2-week history of rhinorrhoea , nose block, headache for a week. She is normally fit and well and has had no other symptoms other than some lethargy . She has fever for last 3days Question: What is likely her diagnosis? What drug would you suggest?

11. ANSWER: Most likely the patient has Bacterial Sinusitis So, Treatment would be as follows Rx Tab. Paracetamol 650mg SOS Tab. Amoxiclav 625mg BID 3days Supportive symptomatic therapy like antihistamine, nasal decongestent etc which ever required.

12. Thank you