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Saleem M, Nawaz H, Majeed MI, Rashid N, Anjum F, Tahir M, Shahzad R, Sehar A, Sabir A, Rafiq N, Ishtiaq S, Shahid M. Surface-enhanced Raman spectroscopy (SERS) for the characterization of supernatants of bacterial cultures of bacterial strains causing sinusitis. Photodiagnosis Photodyn Ther 2023; 41:103278. [PMID: 36627069 DOI: 10.1016/j.pdpdt.2023.103278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sinusitis is defined as inflammation of the paranasal sinus mucous membrane lining caused by bacteria which usually invade the sinus by upper respiratory tract viral infections (UTI). OBJECTIVES In the present study, Surface-enhanced Raman spectroscopy (SERS) has been applied to differentiate and characterize supernatant samples, in triplicate, of three different types of bacteria which are considered leading cause of sinusitis disease. METHODS For this purpose, supernatant samples of three different strains of bacteria namely Staphylococcus aureus, Klebsiella pneumoniae and Enterococcus faecalis. The SERS has identified significant changes as a result of secretions of biomolecules by these bacteria in their supernatants which can be helpful to explore the potential of this technique for the identification and characterization of different strains of bacteria causing same disease. RESULTS These differentiating characteristic SERS spectral features including 552 cm-1 (C-S-S-C bonds), 951 cm-1 (CN stretching), 1008 cm-1 (Phenylalanine), 1032 cm-1 (In plane CH bending mode Phenylalanine), 1280 cm-1, 1320 cm-1, 1329 cm-1 (Amide III band), 1368 cm-1, 1400 cm-1, 1420 cm-1 (COO-sym. stretching and CH bending), 1583 cm-1 (Tyrosine) correspond to Proteins and 1051 cm-1 (C-C, C-O, -C-OH def.) correspond to carbohydrates contents of these three different types of bacterial secretions in their respective supernatants. Furthermore, multivariate data analysis techniques like principal component analysis (PCA) and a supervised method partial least squares-discriminant analysis (PLS-DA) were found to be useful for the identification and characterization of different bacterial supernatants. CONCLUSIONS Surface-enhanced Raman spectroscopy is proven to be a helpful approach for the characterization and discrimination of three bacterial supernatants including S. aureus, K. pneumonia and E. faecalis.
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Affiliation(s)
- Mudassar Saleem
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Haq Nawaz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan.
| | - Muhammad Irfan Majeed
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan.
| | - Nosheen Rashid
- Department of Chemistry, University of Education, Faisalabad Campus, Faisalabad 38000, Pakistan
| | - Fozia Anjum
- Department of Chemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Muhammad Tahir
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Rida Shahzad
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Aafia Sehar
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Amina Sabir
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Nighat Rafiq
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Shazra Ishtiaq
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Muhammad Shahid
- Department of Biochemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
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Clement WA, Sooby P, Doherty C, Qayyum N, Irwin G. Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature. Int J Pediatr Otorhinolaryngol 2021; 140:110492. [PMID: 33234332 DOI: 10.1016/j.ijporl.2020.110492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition. DATA SOURCES Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications. RESULTS Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported. LIMITATIONS All studies were retrospective case note reviews. CONCLUSIONS Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.
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Affiliation(s)
- W A Clement
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom.
| | - P Sooby
- Department of Paediatric Otolaryngology, Royal Hospital for Children, Glasgow, United Kingdom
| | - C Doherty
- Department of Paediatric Infectious Diseases Immunology and Allergy, Royal Hospital for Children, Glasgow, United Kingdom
| | - N Qayyum
- Department of Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - G Irwin
- Department of Paediatric Radiology, Royal Hospital for Children, Glasgow, United Kingdom
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Park S, Lee SY, Jeon YJ. Two Cases of Acute Isolated Sphenoid Sinusitis in Children. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2020.00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Acute isolated sphenoid sinusitis is a rare disease, and accounts for less than 3% of all sinusitis, especially in young children. Delayed diagnosis or misdiagnosis can occur frequently due to atypical clinical presentations. This can lead to serious complications because of the involvement of anatomically related intracranial structures. Therefore, nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools to confirm the diagnosis. We report two cases of a previously healthy 6-year-old girl and a 13-year-old boy, whose chief complaints were uncontrolled headache and high fever over 38°C. Physical examination and initial laboratory test results of blood, urine, and cerebrospinal fluid were normal. The diagnosis was made after a brain MRI revealed isolated sphenoid sinusitis. The girl was treated with third generation cephalosporins intravenously. The boy, however, had to undergo an emergent endoscopic sinus surgery as his headache and eyeball-pain symptoms did not resolve by medical treatment alone. Both cases had good outcomes, without neurological sequelae.
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URBÁN EDIT, GAJDÁCS MÁRIÓ, TORKOS ATTILA. The incidence of anaerobic bacteria in adult patients with chronic sinusitis: A prospective, single-centre microbiological study. Eur J Microbiol Immunol (Bp) 2020; 10:107-114. [PMID: 32590341 PMCID: PMC7391375 DOI: 10.1556/1886.2020.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Chronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. The aim of this study was to evaluate the incidence of anaerobic bacteria in chronic sinusitis in adults as a part of a prospective microbiological study. MATERIALS AND METHODS Over a one-year period, aspirations of maxillary sinus secretions and/or ethmoid cavities were derived in n = 79 adult patients with chronic sinusitis by endoscopy in a tertiary-care teaching hospital in Hungary. The qualitative and quantitative compositions of the total cultivable aerobic and anaerobic bacterial and fungal flora cultured on the samples were compared. Correct anaerobic species level identifications were carried out according to standard methods. RESULTS Bacteria were recovered for all of the 79 aspirates and the numbers of the significant cultured isolates (with colony forming units ≥103) were between 1 and 10. A total of 206 isolates, 106 anaerobic and 100 aerobic or facultative-anaerobic strains were isolated. The most common aerobic bacteria were Streptococcus pneumoniae (n = 40), Haemophilus influenzae (n = 29), Moraxella catarrhalis (n = 6), Staphylococcus aureus (n = 7) and Streptococcus pyogenes (n = 6). The anaerobic bacteria included black-pigmented Prevotella spp. and Porphyromonas spp. (n = 27), Actinomyces spp. (n = 13), Gram-positive anaerobic cocci (n = 16), Fusobacterium spp. (n = 19) and Cutibacterium acnes (n = 8). CONCLUSIONS This study illustrates the microbial dynamics in which anaerobic and aerobic bacteria prevail and highlights the importance of obtaining cultures from patients with chronic sinusitis for guidance in selection of proper antimicrobial therapy.
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Affiliation(s)
- EDIT URBÁN
- Department of Public Health, Faculty of Medicine, University of Szeged, 6720 Szeged, Dóm tér 10., Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Szigeti ut 12., Pécs, Hungary
| | - MÁRIÓ GAJDÁCS
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Eötvös utca 6., Szeged, Hungary
| | - ATTILA TORKOS
- Department of Oto-Rhino-Laryngology and Head-, Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Abstract
PURPOSE There is a high incidence of abnormal sphenoid sinus changes in patients with pituitary apoplexy (PA). Their pathophysiology is currently unexplored and may reflect an inflammatory or infective process. In this preliminary study, we characterised the microbiota of sphenoid sinus mucosa in patients with PA and compared findings to a control group of surgically treated non-functioning pituitary adenomas (NFPAs). METHODS In this prospective observational study of patients undergoing trans-sphenoidal surgery for PA or NFPA, sphenoid sinus mucosal specimens were microbiologically profiled through PCR-cloning of the 16S rRNA gene. RESULTS Ten patients (five with PA and five with NFPAs) with a mean age of 51 years (range 23-71) were included. Differences in the sphenoid sinus microbiota of the PA and NFPA groups were observed. Four PA patients harboured Enterobacteriaceae (Enterobacter spp., N = 3; Escherichia coli, N = 1). In contrast, patients with NFPAs had a sinus microbiota more representative of health, including Staphylococcus epidermidis (N = 2) or Corynebacterium spp. (N = 2). CONCLUSIONS PA may be associated with an abnormal sphenoid sinus microbiota that is similar to that seen in patients with sphenoid sinusitis.
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Affiliation(s)
- Gavin J Humphreys
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Mueez Waqar
- Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Andrew J McBain
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kanna K Gnanalingham
- Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK.
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
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Humphreys GJ, Kumar N, McBain AJ. Low incidence of coaggregation amongst bacteria isolated from the upper respiratory tract in health and disease. J Med Microbiol 2017; 66:1338-1341. [PMID: 28857734 DOI: 10.1099/jmm.0.000567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The nasal cavity harbours a commensal microbiota that reportedly provides colonization resistance against respiratory pathogens. Following the onset of chronic rhinosinusitis (CRS), a change in sinus microbiota composition is frequently reported in which atypical anaerobic and/or Gram-negative bacteria predominate. We have investigated pairwise interactions between respiratory bacteria isolated from healthy adults (n=3) and individuals exhibiting CRS (n=3). Antagonism was determined using a spot plate methodology and coaggregation scores were determined using a quantitative spectrophotometric assay. Obligate anaerobes were isolated from all CRS samples and exhibited inter-host growth inhibition of commensal nasal bacteria, including Corynebacterium spp. and Staphylococcus spp. Antagonism between bacteria isolated from healthy individuals was limited to corynebacterial-mediated inhibition of the staphylococci. The frequency of coaggregation was low overall (2/153 pairwise interactions). Antagonism of the nasal microbiota by respiratory pathogens may represent a competitive strategy in the sinus and warrants further investigation.
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Affiliation(s)
- Gavin J Humphreys
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, M13 9PT, UK
| | - Nirmal Kumar
- Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, WN1 2NN, UK
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, M13 9PT, UK
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Brook I. The role of antibiotics in pediatric chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2017; 2:104-108. [PMID: 28894828 PMCID: PMC5527363 DOI: 10.1002/lio2.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 01/05/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology. Data source Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis. Results Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta‐lactamase producing aerobic and anaerobic organisms, amoxicillin‐clavulanate is the first‐line regimen for most patients. Clindamycin is adequate for penicillin‐allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy. Conclusions Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. Level of Evidence 7.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics Georgetown University School of Medicine Washington D.C. U.S.A
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Abstract
Chronic sphenoid rhinosinusitis is a spectrum of inflammatory diseases in isolated sphenoid sinus which may persist over a period of 12 weeks. It is a different entity from other types of rhinosinusitis because clinical presentations include headache, visual loss or diplopia, and patients may or may not have nasal obstruction or nasal discharge. Nasal endoscopic examination is useful, and computed tomography is mandatory. The disease requires comprehensive knowledge and appropriate imaging technique for diagnosis. To treat patients with chronic sphenoid rhinosinusitis, surgical treatment with endoscopic transnasal sphenoidotomy is often required. As there are no recent updated reviews of chronic sphenoid rhinosinusitis, in this article, we review the anatomy of the sphenoid sinus and its clinical relationship with the clinical signs and symptoms of the disease, the imaging findings of each diagnosis and the comprehensive surgical techniques.
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Affiliation(s)
- Natamon Charakorn
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Microbiology of chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis 2016; 35:1059-68. [DOI: 10.1007/s10096-016-2640-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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10
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Posterior orbital cellulitis: case report and literature review. The Journal of Laryngology & Otology 2013; 127:1148-51. [DOI: 10.1017/s0022215113002181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:It is rare for isolated sphenoid sinusitis to cause orbital cellulitis. We present a rare case of posterior orbital cellulitis, so caused, together with a review of the relevant literature.Case report:A 29-year-old woman presented with a 6-week history of progressive, unilateral, retro-orbital and periorbital right eye pain. On examination, the only finding was reduced visual acuity in the right eye. A computed tomography scan demonstrated right frontal and sphenoid sinus opacification. Sphenoidotomy and frontal sinus trephination were subsequently performed, following failure to respond to intravenous antibiotics. After surgery, the patient's vision returned to normal.Conclusion:Isolated sphenoid sinusitis is rare but can cause significant visual disturbance and permanent loss of vision. Vague symptoms unsupported by clinical signs at presentation are a feature of posterior orbital cellulitis. The presented case highlights the problem, and the need for a high index of clinical suspicion even in the absence of firm clinical signs, in order to prevent permanent visual loss.
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Acute monocular visual loss in an elderly woman: a neuro-ophthalmologic emergency. J Neuroophthalmol 2013; 33:390-3. [PMID: 23792880 DOI: 10.1097/wno.0b013e318298facb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Acute rhinosinusitis is a common illness in children. Viral upper respiratory tract infection is the most common presentation of rhinosinusitis. Most children resolve the infection spontaneously and only a small proportion develops a secondary bacterial infection. The proper choice of antibiotic therapy depends on the likely infecting pathogens, bacterial antibiotic resistance, and pharmacologic profiles of antibiotics. Amoxicillin-clavulanate is currently recommended as the empiric treatment in those requiring antimicrobial therapy. Isolation of the causative agents should be considered in those who failed the initial treatment. In addition to antibiotics, adjuvant therapies and surgery may be used in the management of acute bacterial rhinosinusitis.
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Caimmi D, Caimmi S, Labò E, Marseglia A, Pagella F, Castellazzi AM, Marseglia GL. Acute isolated sphenoid sinusitis in children. Am J Rhinol Allergy 2012; 25:e200-2. [PMID: 22185724 DOI: 10.2500/ajra.2011.25.3690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Isolated pediatric sphenoidal sinusitis is an uncommon disorder with sphenoiditis more commonly found as part of pansinusitis. Recognizing the condition on history and examination alone is difficult and delayed diagnosis many occur in many cases. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are essential adjuncts to confirm diagnosis. This study was designed to confirm the clinical features and diagnostic difficulties associated with isolated sphenoidal sinusitis in children. METHODS A 16-year review was performed of cases diagnosed and treated in a tertiary teaching hospital. RESULTS Two different groups of patients were identified. One group presented with fever and headache, frequently associated with neurological complications. Swimming and/or diving could be identified as possible causative agents. The second group presented with headache alone and a less severe clinical presentation. CONCLUSION Isolated pediatric sphenoidal sinusitis may be more prevalent than was previously thought with CT/MRI helping establish the diagnosis in many cases. Pediatricians should be aware of this unusual but still potentially devastating condition. A nasal endoscopy is a useful diagnostic tool in this patient group, being noninvasive and well tolerated in children and adolescents.
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Affiliation(s)
- Davide Caimmi
- Department of Pediatrics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Microbiology of sinusitis: does allergy or endoscopic sinus surgery affect the microbiologic flora? Curr Opin Otolaryngol Head Neck Surg 2011; 19:199-203. [DOI: 10.1097/moo.0b013e328344f67a] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marple BF, Stankiewicz JA, Baroody FM, Chow JM, Conley DB, Corey JP, Ferguson BJ, Kern RC, Lusk RP, Naclerio RM, Orlandi RR, Parker MJ. Diagnosis and management of chronic rhinosinusitis in adults. Postgrad Med 2010; 121:121-39. [PMID: 19940423 DOI: 10.3810/pgm.2009.11.2081] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.
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Affiliation(s)
- Bradley F Marple
- UT-Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX 75390-7208, USA.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington, DC, USA.
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Current management of isolated sphenoiditis. Eur Arch Otorhinolaryngol 2008; 266:987-92. [PMID: 19052765 DOI: 10.1007/s00405-008-0873-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
Isolated sphenoiditis (IS) is a relatively rare clinical entity which might present with serious complications. The clinical records of ten patients with IS were reviewed. The presenting symptoms, the findings, and the treatments given were noted. Eight patients were female and two were male, and their age varied between 9 and 65 years (mean 31 years). The main presenting symptom was headache in five patients, diplopia in four patients, and postnasal drainage in one patient. The duration of the symptoms ranged between 48 h and 1 year. The diagnosis was accomplished by history, nasal endoscopy and radiological examination (computed tomography and/or magnetic resonance imaging). Two patients had fungus ball. One patient was a scuba diver as a possible predisposing factor. All of the patients underwent medical treatment consisting of intravenous antibiotics or oral antibiotics, and endoscopic sinusotomy was performed in nine patients additionally. Complete resolution was obtained for all patients except one who had diplopia for one year. IS may present with headache and orbital symptoms. Timely diagnosis and treatment are substantial in order to avoid serious complications, and to obtain a complete recovery. Medical treatment does not avoid surgery in majority of cases. Surgery is indicated from the very beginning specifically for the cases starting with diplopia which might be suggestive of a progression of the infection. Currently the most frequently used approach is endoscopic transnasal sphenoidotomy. This technique seems to be effective and less traumatic compared to other approaches.
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Berlucchi M, Rossini M, Bondioni MP, Nicolai P. Isolated acute sphenoiditis with visual loss: A rare disorder in pediatric patients. INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY EXTRA 2008; 3:132-135. [DOI: 10.1016/j.pedex.2008.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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21
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Occipital Headache and Septicemia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e318162a95b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Thaler E, Kennedy DW. Microbiology and Immunology of Rhinosinusitis. RHINOSINUSITIS 2008. [PMCID: PMC7169636 DOI: 10.1007/978-0-387-73062-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - David W. Kennedy
- Health System, University of Pennsylvania, Spruce Street 3400, Philadelphia, 19104-4283 U.S.A
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Abstract
Sinusitis is one of the most common complaints resulting in physician visits in the United States. An antecedent viral infection of the upper respiratory tract is the most common presentation. Despite its prevalence, most cases resolve spontaneously. Only a small proportion develops a secondary bacterial infection that will benefit from antimicrobial therapy. This article discusses the microbiology and pathogenesis of acute and chronic bacterial sinusitis. The role anaerobic bacterial in chronic and recurrent sinusitis is emphasized, and appropriate antimicrobial regimens are discussed.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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Babiński D, Brzoznowski W, Skorek A, Ostrowska A, Stankiewicz C. Zapalenie zatoki klinowej. Otolaryngol Pol 2007; 61:452-7. [DOI: 10.1016/s0030-6657(07)70460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marseglia GL, Pagella F, Licari A, Scaramuzza C, Marseglia A, Leone M, Ciprandi G. Acute isolated sphenoid sinusitis in children. Int J Pediatr Otorhinolaryngol 2006; 70:2027-31. [PMID: 16930730 DOI: 10.1016/j.ijporl.2006.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 07/14/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acute infection of the sphenoid sinus usually affects both pre-adolescent and adolescent subjects and is associated with infections of the other paranasal sinuses. Acute isolated sphenoiditis, though uncommon, is frequently misdiagnosed as symptoms are vague and there are few clinical findings. Indeed, it is not usually diagnosed until the patient develops neurological complications. The aim of this report is to discuss our cases of acute isolated sphenoiditis and compare them with those reported in the International literature. METHODS We reviewed our 10-year records of paediatric patients affected by acute isolated sphenoid sinusitis, as confirmed by nasal endoscopy and/or CT scan, and compared them with paediatric cases of sphenoid sinusitis reported in literature. In particular, we focused on clinical findings, associated risk factors, diagnostic approach, and treatment. RESULTS As previously stated at the Brussels Consensus Meeting, patients can be separated into two groups on the basis of clinical findings: the first including patients affected by severe acute sphenoiditis presenting fever and headache, and frequently associated with neurological symptoms, with swimming and diving as possible predisposing factors. The second group includes patients with non-severe acute sphenoiditis, mainly associated with headache, allergic rhinitis being a possible predisposing factor. CONCLUSIONS Acute isolated sphenoid sinusitis appears to be difficult to diagnose, and there are few reports in peer-reviewed paediatric journals. We wish to alert paediatricians and ENT specialists of the importance of this rare but still potentially devastating disorder.
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Affiliation(s)
- Gian Luigi Marseglia
- Dipartimento di Scienze Pediatriche, IRCCS Policlinico San Matteo, Università di Pavia, Italy.
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Friedman A, Batra PS, Fakhri S, Citardi MJ, Lanza DC. Isolated sphenoid sinus disease: etiology and management. Otolaryngol Head Neck Surg 2006; 133:544-50. [PMID: 16213927 DOI: 10.1016/j.otohns.2005.04.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 04/28/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the diagnosis and management of isolated sphenoid sinus disease by using the current rhinologic standard of care. STUDY DESIGN Retrospective chart review. RESULTS Fifty sequential, symptomatic patients were studied. Presenting symptoms included headache or facial pain (88%), rhinorrhea (46%), and nasal congestion (26%). All patients underwent CT imaging, demonstrating bony changes or dehiscences (42%), a mass (24%), or complete opacification of the sphenoid sinus (22%). Eighty percent required surgical intervention. The most frequent diagnoses were as follows: sinusitis (38%), fungal ball (20%), neoplasm (16%), and mucocele (12%). Treatment resulted in clinical or endoscopic improvement or resolution in 87% of the patients. CONCLUSION The presenting symptoms of isolated sphenoid sinus disease can be nonspecific and may result in an inordinate delay in diagnosis. Nasal endoscopy and radiologic imaging are central to making an accurate and timely diagnosis. Medical treatment or minimally invasive surgical techniques can successfully manage the majority of patients with persistent or refractory symptoms.
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Affiliation(s)
- Aaron Friedman
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest 2006; 129:63S-71S. [PMID: 16428694 DOI: 10.1378/chest.129.1_suppl.63s] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To review the literature on postnasal drip syndrome (PNDS)-induced cough and the various causes of PNDS. Hereafter, PNDS will be referred to as upper airway cough syndrome (UACS). METHODS MEDLINE search (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," "etiology of cough," "postnasal drip," "allergic rhinitis," "vasomotor rhinitis," and "chronic sinusitis." Case series and prospective descriptive clinical trials were selected for review. Also, any references from these studies that were pertinent to the topic were obtained. RESULTS In multiple prospective, descriptive studies of adults, PNDS due to a variety of upper respiratory conditions has been shown either singly or in combination with other conditions, to be the most common cause of chronic cough. The symptoms and signs of PNDS are nonspecific, and a definitive diagnosis of PND-induced cough cannot be made from the medical history and physical examination findings alone. Furthermore, the absence of any of the usual clinical findings does not rule out a response to treatment that is usually effective for PND-induced cough. The differential diagnosis of PNDS-induced cough includes allergic rhinitis, perennial nonallergic rhinitis, postinfectious rhinitis, bacterial sinusitis, allergic fungal sinusitis, rhinitis due to anatomic abnormalities, rhinitis due to physical or chemical irritants, occupational rhinitis, rhinitis medicamentosa, and rhinitis of pregnancy. Because of a high prevalence of upper respiratory symptoms associated with gastroesophageal reflux disease (GERD), GERD may occasionally mimic PNDS. A crucial unanswered question is whether the conditions listed above actually produce cough through a final common pathway of PND or whether, in fact, in some circumstances they cause irritation or inflammation of upper airway structures that directly stimulate cough receptors and produce cough independently of or in addition to any associated PND. CONCLUSION PNDS (ie, UACS) secondary to a variety of rhinosinus conditions is the most common cause of chronic cough. Because it is unclear whether the mechanisms of cough are the PND itself or the direct irritation or inflammation of the cough receptors located in the upper airway, the guideline committee has decided that, pending further data that address this difficult question, the committee unanimously recommends that the term upper airway cough syndrome be used in preference to postnasal drip syndrome when discussing cough associated with upper airway conditions.
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Abstract
Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are S. pneumoniae, H. influenzae, and M. catarrhalis, while anaerobic bacteria and S. aureus predominant in CRS.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle Street Northwest, Washington, DC 20016, USA.
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Brook I. Chronic sinusitis in children and adults: role of bacteria and antimicrobial management. Curr Allergy Asthma Rep 2006; 5:482-90. [PMID: 16216174 DOI: 10.1007/s11882-005-0030-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The nasopharynx serves as the reservoir for anaerobic bacteria as well as pathogenic bacteria that can cause respiratory infections including sinusitis. Some of these organisms possess the ability to interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may result from the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus. Anaerobes were identified in chronic sinusitis in adults and children whenever techniques for their cultivation were employed. The predominant isolates were pigmented Prevotella, Fusobacterium, and Peptostreptococcus spp. The choice of antimicrobial agent in chronic sinusitis should provide coverage for the usual pathogens in acute sinusitis as well as beta-lactamase-producing aerobic and anaerobic organisms.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.
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30
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Brook I. The role of anaerobic bacteria in sinusitis. Anaerobe 2005; 12:5-12. [PMID: 16701606 DOI: 10.1016/j.anaerobe.2005.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 08/16/2005] [Accepted: 08/23/2005] [Indexed: 01/12/2023]
Abstract
The normal oropharyngeal flora contained aerobic and anaerobic bacteria that can cause respiratory infections including sinusitis. Some of these bacteria can interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may be the result of the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development over time of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus cavity. Anaerobes were isolated in acute maxillary sinusitis of odontogenic origin and in over half of the patients with chronic sinusitis whenever proper techniques for their cultivation were employed. These organisms were also recovered in acute sinusitis that was associated with dental infections. The predominant isolates were pigmented Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: An evidence-based review. Crit Care Med 2004; 32:S513-26. [PMID: 15542959 DOI: 10.1097/01.ccm.0000143119.41916.5d] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for source control in the management of severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis. DESIGN The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. METHODS The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. CONCLUSION Source control represents a key component of success in therapy of sepsis. It includes drainage of infected fluids, debridement of infected soft tissues, removal of infected devices or foreign bodies, and finally, definite measures to correct anatomic derangement resulting in ongoing microbial contamination and to restore optimal function. Although highly logical, since source control is the best way to reduce quickly the bacterial inoculum, most recommendations are, however, graded as D or E due to the difficulty to perform appropriate randomized clinical trials in this respect. Appropriate source control should be part of the systematic checklist we have to keep in mind in setting up the therapeutic strategy in sepsis.
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Affiliation(s)
- John C Marshall
- From the Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Abstract
The growing resistance to antimicrobial agents of all respiratory tract bacterial pathogens has made the management of sinusitis more difficult. The upper respiratory tract including the nasopharynx serves as the reservoir for pathogenic bacteria that can cause respiratory infections including sinusitis. During a viral respiratory infection, potential pathogens can relocate from the nasopharynx into the sinus cavity, causing sinusitis. Establishment of the correct microbiology of all forms of sinusitis is of primary importance, because it can serve as a guide for choosing the adequate antimicrobial therapy. This article summarizes the current information regarding the microbiology of all forms of sinusitis and approaches to antimicrobial therapy.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.
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Tanner SB, Fowler KC. Intravenous antibiotics for chronic rhinosinusitis: are they effective? Curr Opin Otolaryngol Head Neck Surg 2004; 12:3-8. [PMID: 14712111 DOI: 10.1097/00020840-200402000-00003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Antibiotics have been used commonly in chronic rhinosinusitis, often because chronic rhinosinusitis has features of a prolonged bacterial sinusitis, including abnormal CT findings and positive bacterial cultures. The advent of peripherally inserted central catheters has enabled outpatient parenteral antibiotic therapy to become a convenient means of delivering potent antibiotics for various conditions when oral antibiotics may not be effective or appropriate. Chronic rhinosinusitis has been included as a condition that may benefit from outpatient parenteral antibiotic therapy; however, there are few studies that document its success and, furthermore, chronic rhinosinusitis may not always be an infectious process. RECENT FINDINGS Three recent uncontrolled retrospective studies examined outpatient parenteral antibiotic therapy in chronic rhinosinusitis. In one series outpatient parenteral antibiotic therapy was used as an adjunct to sinus surgery, in another it was used as an alternative to sinus surgery in the pediatric population, and in the third it was used as temporary resolution for adult patients who had failed other therapies including sinus surgery. Short-term success rates were reported in the range of 29 to 89%, but relapse rates were as high as 89%. Complication rates in theses studies ranged from 14 to 26%, including medication reactions and intravenous line problems. SUMMARY The role of outpatient parenteral antibiotic therapy in the treatment of chronic rhinosinusitis has not been universally established. Although outpatient parenteral antibiotic therapy may have a role in avoiding sinus surgery in select pediatric populations, the contribution to a lasting resolution in adult patients is less clear and there are possible complications. Recognizing subsets of chronic rhinosinusitis patients for whom outpatient parenteral antibiotic therapy is appropriate will be the challenge for the future.
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