Acute bacterial sinusitis: Difference between revisions
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− | == |
+ | ==Background== |
− | * |
+ | *See also [[nosocomial sinusitis]] and [[invasive fungal sinusitis]] |
− | === |
+ | ===Microbiology=== |
− | * |
+ | *[[Streptococcus pneumoniae]] (most common; 41% in adults and children) |
− | * |
+ | *Non-typable [[Haemophilus influenzae]] (35% in adults, 27% in children) |
− | * |
+ | *[[Moraxella catarrhalis]] (4% in adults, 22% in children) |
− | * |
+ | *[[Streptococci]] (7% in adults and children) |
− | * |
+ | *[[Anaerobes]] (7% in adults) |
− | * |
+ | *[[Staphylococcus aureus]] (3% in adults) |
− | === |
+ | ===Risk Factors=== |
− | * |
+ | *Systemic factors |
− | ** |
+ | **Viral upper respiratory infection |
− | ** |
+ | **[[Allergic rhinitis]] and [[asthma]] |
− | ** |
+ | **[[Cystic fibrosis]] |
− | ** |
+ | **Immune disorders including [[agammaglobulinemia]], [[HIV]], and [[chronic granulomatous disease]] |
− | ** |
+ | **Ciliary dyskinesia |
− | ** |
+ | **Tobacco smoke |
− | * |
+ | *Mechanical factors: choanal atresia, cleft palate, deviated septum, nasal polyps, foreign body, tumour, ethmoid bullae |
− | * |
+ | *Local factors: facial trauma, swimming and diving, rhinitis medicamentosa, nasal intubation |
+ | |||
+ | == Clinical Manifestations == |
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+ | |||
+ | * May have periorbital edema with involvement of the ethmoid sinuses that must be differentiated from periorbital cellulitis |
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+ | |||
+ | === Complications === |
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+ | |||
+ | * Complications occur more commonly in sinusitis including the frontal and ethmoidsinuses |
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+ | * Intracranial: [[subdural empyema]], [[epidural abscess]], intraparenchymal [[brain abscess]], [[Bacterial meningitis|meningitis]], and [[venous sinus thrombosis]] |
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+ | ** Consider these diagnoses with fever, altered mentation, seizures, or focal neurologic deficits |
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+ | * Extracranial: [[Periorbital cellulitis|orbital cellulitis]], [[orbital abscess]], and [[subperiosteal abscess]], including [[Pott puffy tumour]] |
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+ | |||
+ | == Management == |
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+ | |||
+ | * For adults, treat with [[Is treated by::amoxicillin-clavulanic acid]] for 10 days |
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+ | * For children |
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+ | ** Treat if severe, and can either treat or watch and wait if mild to moderate |
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+ | ** Use [[Is treated by::amoxicillin]] with or without clavulanic acid |
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+ | * Alternatives include [[cefpodoxime]], [[cefixime]], [[cefdinir]], [[azithromycin]], [[clarithromycin]], [[levofloxacin]], and [[moxifloxacin]] |
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+ | * Large-volume nasal irrigation may be helpful, especially with chronic symptoms |
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− | <br /> |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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[[Category:Head and neck infections]] |
[[Category:Head and neck infections]] |
Latest revision as of 21:00, 15 August 2020
Background
- See also nosocomial sinusitis and invasive fungal sinusitis
Microbiology
- Streptococcus pneumoniae (most common; 41% in adults and children)
- Non-typable Haemophilus influenzae (35% in adults, 27% in children)
- Moraxella catarrhalis (4% in adults, 22% in children)
- Streptococci (7% in adults and children)
- Anaerobes (7% in adults)
- Staphylococcus aureus (3% in adults)
Risk Factors
- Systemic factors
- Viral upper respiratory infection
- Allergic rhinitis and asthma
- Cystic fibrosis
- Immune disorders including agammaglobulinemia, HIV, and chronic granulomatous disease
- Ciliary dyskinesia
- Tobacco smoke
- Mechanical factors: choanal atresia, cleft palate, deviated septum, nasal polyps, foreign body, tumour, ethmoid bullae
- Local factors: facial trauma, swimming and diving, rhinitis medicamentosa, nasal intubation
Clinical Manifestations
- May have periorbital edema with involvement of the ethmoid sinuses that must be differentiated from periorbital cellulitis
Complications
- Complications occur more commonly in sinusitis including the frontal and ethmoidsinuses
- Intracranial: subdural empyema, epidural abscess, intraparenchymal brain abscess, meningitis, and venous sinus thrombosis
- Consider these diagnoses with fever, altered mentation, seizures, or focal neurologic deficits
- Extracranial: orbital cellulitis, orbital abscess, and subperiosteal abscess, including Pott puffy tumour
Management
- For adults, treat with amoxicillin-clavulanic acid for 10 days
- For children
- Treat if severe, and can either treat or watch and wait if mild to moderate
- Use amoxicillin with or without clavulanic acid
- Alternatives include cefpodoxime, cefixime, cefdinir, azithromycin, clarithromycin, levofloxacin, and moxifloxacin
- Large-volume nasal irrigation may be helpful, especially with chronic symptoms