Rhinosinusitis%20-%20acute,%20bacterial Signs and Symptoms

•  Acute rhinosinusitis (ARS) is defined as sudden onset of ≥2 of the following symptoms for <12 weeks:
  • Nasal blockage/obstruction/congestion AND
  • Facial pain/pressure OR
  • Reduced or loss of smell
• Acute bacterial rhinosinusitis (ARBS) is defined as mucosal inflammation of the nose and paranasal sinuses caused by bacteria lasting ≥10 days for up to 4 weeks with no clinical improvement, severe signs or symptoms (eg high fever [39°C], purulent nasal discharge, facial pain) of ≥3-4 consecutive days, and worsening of symptoms within 10 days after initial improvement
• 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

• 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 ARS
• Microaerophilic and anaerobic bacteria may be identified and isolated if the ABRS 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 are nonspecific and it is typically difficult to differentiate from viral URTI
• There is nasal obstruction/congestion or anterior and/or posterior purulent drainage, with or without facial pressure/pain/fullness and 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

• Most common predisposing factor to ABRS is viral URTI
• Other predisposing factors:
  
  • Presence of medical conditions (eg allergic rhinitis, vasomotor rhinitis, cystic fibrosis, immunodeficiency, Kartagener syndrome)
  • Irritants (eg environmental tobacco smoke, air pollution, chlorine)
  • Anatomic (eg deviated nasal septum, adenoidal hypertrophy, immotile cilia, polyps, tumors and foreign bodies, granulomatosis with polyangiitis)
  • Odontogenic sources
  • Medications (eg overuse of topical decongestants, cocaine abuse)
  • Trauma (eg dental procedure, diving)