Rhinosinusitis%20-%20acute,%20bacterial%20(pediatric) Signs and Symptoms

• Acute rhinosinusitis is defined as sudden onset of ≥2 of the following symptoms for <12 weeks:
  • Nasal blockage/obstruction/congestion
  • Discolored nasal discharge
  • Daytime and night-time cough
• Acute bacterial rhinosinusitis is defined as mucosal inflammation of the nose and paranasal sinuses caused by bacteria lasting >10 days for up to 4 weeks symptoms resolve completely and may either be persistent or severe
• Often preceded by a viral upper respiratory tract infection (URTI)
  • It is a common complication of viral URTI or allergic inflammation

• Streptococcus pneumoniae is the most common cause followed by nontypeable Haemophilus influenzae
• 3rd most common pathogen is Moraxella catarrhalis
• Streptococcus pyogenes, respiratory anaerobes, Staphylococcus aureus are less common bacterial causes

• Signs and symptoms are nonspecific and it is typically difficult to differentiate from viral upper respiratory infection (URTI)
• Major symptoms include anterior and/or posterior mucopurulent drainage, nasal obstruction, facial pressure/pain/fullness, hyposmia/anosmia, and fever
• Less common signs and symptoms include fatigue, headache, ear pressure/discomfort, halitosis, cough, and maxillary dental pain

• Most common predisposing factors are viral upper respiratory tract infection (URTI) and allergic inflammation
• Other predisposing factors
  • Anatomic (eg nasal foreign bodies, septal deviation, tumor, trauma)
  • Inflammatory [eg gastroesophageal reflux disease (GERD), allergic rhinitis, vasomotor rhinitis, granulomatosis with polyangiitis]
  • Systemic (eg cystic fibrosis, immunodeficiencies, primary ciliary dyskinesia, Kartagener syndrome)
  • Iatrogenic (eg sinus surgery, nasogastric tubes, nasal packing, mechanical ventilation)
  • Other factor (eg exposure to cigarette smoking)

 Recent Antibiotic Use

• Recent antibiotic use (<90 days) is a major risk factor associated with increased risk of carriage and infection due to resistant pathogens

Other Risk Factors For Resistant Pathogens

• Age <2 years
• Attendance in daycare centers