Sinusitis aguda y su manejo, Diapositivas de Medicina

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ACUTE

RHINOSINUSITIS

DR. LUIS VELÁZQUEZ VILLASEÑOR

Respiratory Infections Are the # 1 Reason for Office Visits

Common cold Increase in symptoms after 5 days Persistent symptoms after 10 days 0 5 10 15 Days Symptoms Definition of Acute Bacterial Rhinosinusitis 12 Weeks Increase in symptoms after 5 days or persistent symptoms after 10 days with less than 12 weeks duration

ABRS: Definition and Diagnosis

• ABRS is a bacterial infection of the mucosa of the nose and paranasal sinuses characterized by:
  • Sudden onset of symptomatic sinus infection
  • Symptom duration > 7 days
  • Length of episode < 4 weeks
  • Major symptoms (PODS)
    • Facial P ain/Pressure/fullness
    • Nasal O bstruction
    • Nasal purulence/discoloured postnasal D ischarge
    • Hyposmia/anosmia ( S mell)
• Diagnosis requires the presence of > 2 PODS , one of which is either O or D and symptom duration of > 7 days without improvement.

ABRS: Microbiology

• Main causative bacteria:
  • Streptococcus pneumoniae - Haemophilus influenzae
• Minor causative bacteria:
  • Moraxella catarrhalis - Streptococcus pyogenes - Staphylococcus aureus - Gram-negative bacilli
  • Oral anaerobes

ABRS  Bacterial overinfection after AVURI (rhinovirus, coronavirus, parainfluenza virus, adenovirus, influenza virus)  Factors in normal physiology of sinuses:

 Ostium permeability

 Mucociliary clearance

 Quality of secretions

ABRS: pathogenesis

 Retained sinus secretions from:

 Ostium obstruction

 Decrease in function or number of cilia

 Mucus overproduction or thick secretions

 Ostium obstruction:

 Mucosal inflammation

 Mechanical obstruction

Health y Rhinosinusitis Inflammation Is Responsible for Cardinal Symptoms of Acute Rhinosinusitis

Underlying

inflammation leads

to…

…increased vascular

permeability and mucosal

oedema

…increased mucus

production

…impaired mucociliary

function

ABRS mechanical obstruction

ABRS pathogenesis

 Cilia suffer citotoxic effects from viruses or

genetical defects that alter its motility, number,

and morphoogy promoting bacterial infection

 Increased mucus thickness like in asthma and

cystic fibrosis pro, como en asma y fibrosis

quística promueven sobreinfección.

ABRS: other predisposing factors

 HIV

 Chemotherapy

 Post transplant immunedeficency

 Diabetes mellitus

 Conective tissu diseases

 Intensive care unit patients (NG tube, O2)

Diagnosis

Physical Examination