rhinosinusitis%20-%20acute,%20bacterial
RHINOSINUSITIS - ACUTE, BACTERIAL
Acute bacterial rhinosinusitis is the mucosal inflammation of the nose and paransal sinuses caused by bacteria lasting >10 days for up to 4 weeks or symptoms worsening for 5-7 days and is <12 weeks with complete resolution of symptoms.
It is often preceded by a viral upper respiratory tract infection.
Signs and symptoms are nonspecific and typically difficult to differentiate from viral upper respiratory tract infection.
There is fever with nasal obstruction/congestion or anterior and/or posterior purulent drainage, with or without facial pressure/pain/fullness and reduction/loss of smell.
Streptococcus pneumoniae and unencapsulated strains of Haemophilus influenzae cause half of acute rhinosinusitis cases.

Definition

  • Mucosal inflammation of the nose and paranasal sinuses caused by bacteria lasting >10 days for up to 4 weeks or symptoms worsening after 5-7 days and is <12 weeks with complete resolution of symptoms
  • Often preceded by a viral upper respiratory tract infection (URTI), rhinitis or other conditions that impair local or systemic immune function (eg nonallergic rhinitis, dental infection, mechanical obstruction of the nose, cystic fibrosis, ciliary dysfunction, immunodeficiency that impair the sinus drainage)
  • Incidence in women is higher than men

Etiology

  • S pneumoniae and unencapsulated strains of H influenzae cause approximately 75% of acute rhinosinusitis cases
  • M catarrhalis account for 2-10% of the cases and is more common among children
  • 3-7% of the cases may be due to S pyogenes and anaerobic bacteria
  • S aureus and other Streptococcal sp may occasionally cause rhinosinusitis
  • Rarely Gram-negative bacilli are recovered in cases of acute rhinosinusitis
  • Microaerophilic and anaerobic bacteria may be identified and isolated if the acute bacterial rhinosinusitis (ARBS) is due to the extension of dental root infection to the sinus cavity

Pathophysiology

  • Occurs as a complication of a viral infection
    • Can be associated with rhinitis or other conditions that obstruct the nose or impair immune function (local or systemic)

Signs and Symptoms

  • Signs and symptoms are nonspecific and it is typically difficult to differentiate from viral upper respiratory tract infection (URTI)
  • There is nasal obstruction/congestion or anterior and/or posterior purulent drainage, with or without
    • Facial pressure/pain/fullness
    • Reduction/loss of smell
  • Other signs and symptoms include fever, fatigue, headache, ear pressure/discomfort, throat pain, halitosis, maxillary dental pain, facial swelling or periorbital edema, cough

Risk Factors

  • Most common predisposing factor to acute bacterial rhinosinusitis (ABRS) is viral upper respiratory tract infection (URTI)
  • Other factors:
    • Presence of medical conditions (eg allergic rhinitis, cystic fibrosis, immunodeficiency, etc)
    • Irritants (eg environmental tobacco smoke, air pollution, chlorine)
    • Anatomic (eg deviated septum, adenoidal hypertrophy, immotile cilia, polyps, tumors and foreign bodies)
    • Odontogenic sources
    • Medications (eg overuse of topical decongestants, cocaine abuse)
    • Trauma (eg dental procedure, diving)
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, 3 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 4 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
14 Sep 2019
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.