Predicting bacteria causing acute bacterial rhinosinusitis by clinical features / Predição de bactérias causadoras de rinossinusite bacteriana aguda por características clínicas

Abstract Introduction: Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics. Objective: This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria. Methods: Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference. Results: Serum C-reactive protein level elevation correlated with the bacterial species (p = 0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94). Conclusion: Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.

Resumo: Introdução: Os médicos se baseiam nas características clínicas para a escolha dos agentes terapêuticos para o tratamento da rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae são agentes comuns na rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae resistentes a antibióticos requerem medicamentos diferentes. Objetivo: Avaliar as associações entre as características clínicas da rinossinusite bacteriana aguda e bactérias patogênicas. Método: O estudo incluiu 64 pacientes com rinossinusite bacteriana aguda. Foram coletadas e registradas as características clínicas, inclusive obstrução nasal, secreção com cor alterada, dor facial, distúrbios do olfato, febre e achados laboratoriais de pacientes com rinossinusite bacteriana aguda. As culturas bacterianas obtidas por swab endoscópico do meato médio foram usadas como referência. Resultados: A elevação do nível sérico de proteína C-reativa estava correlacionada com a espécie bacteriana (p = 0,03); ela estava aumentada em 80,0% das rinossinusites por Haemophilus influenzae e em 57,1% das rinossinusites por Streptococcus pneumoniae. A proteína C-reativa elevada foi um significativo fator preditor de rinossinusite por Haemophilus influenzae, com razão de probabilidade de 18,06 (IC 95% 2,36-138,20). A sensibilidade da elevação dos níveis séricos de proteína C-reativa para o diagnóstico de rinossinusite por Haemophilus influenzae foi de 0,80 (IC 95% 0,49 ± 0,94). Conclusão: A elevação dos níveis séricos de proteína C-reativa é um preditor de rinossinusite bacteriana aguda causada por Haemophilus influenzae.

Manejo multidisciplinario de rinosinusitis bacteriana aguda posterior a elevación de seno maxilar: reporte de caso rehabilitado a tres años de seguimiento / Multidisciplinary management of acute bacterial rhinosinusitis after maxillary sinus lift: three years follow-up: case report

La cirugía de elevación de seno maxilar se considera como la técnica de aumento óseo más predecible. Sin embargo, no está exenta de complicaciones las cuales deben ser manejadas adecuadamente. Se presenta un caso clínico rehabilitado, con un seguimiento de 3 años, en el cual se realizó un manejo multidisciplinario y resolutivo de complicaciones asociadas a la técnica quirúrgica de elevación de membrana sinusal vía ventana lateral. Frente a una infección postoperatoria, como la presentada en el caso, hay que considerar iniciar un tratamiento antibiótico en el momento adecuado para impedir el agravamiento del cuadro clínico o un cambio de esquema en caso de resistencia antimicrobiana.

Maxillary sinus lift surgery is considered the most predictable bone augmentation technique. However, this procedure is not without complications, which must be handled properly. We present a rehabilitated clinical case, with a 3-year follow-up, in which a multidisciplinary and resolutive management of complications associated with the surgical technique of sinus lift procedure, using lateral window approach, was performed. In case of postoperative infection, such as the one presented in this report, it is necessary to consider starting an antibiotic treatment at the adequate moment to prevent the aggravation of the illness or change the pharmacological treatment in case of antimicrobial resistance.

Rinosinusitis fúngica invasiva aguda: actualización en pacientes adultos y pediátricos / Acute invasive fungal rhinosinusitis: update in adults and pediatric patients

RESUMEN La rinosinusitis fúngica invasiva aguda (RSFIA) es una enfermedad poco frecuente caracterizada por una infiltración fúngica de la submucosa y vasos sanguíneos de las cavidades nasal y paranasal. Afecta a pacientes con grados variables de inmunosupresión, destacando entre estas patologías subyacentes la diabetes mellitus y las neoplasias malignas hematológicas. Presenta una alta tasa de mortalidad, pudiendo reducirse significativamente si el diagnóstico y el tratamiento se realizan precozmente. Este artículo tiene por objetivo presentar una revisión actualizada de la literatura respecto a la presentación clínica, microbiología, factores de riesgos, métodos diagnósticos, tratamiento y pronóstico de la RSFIA, tanto en adultos como en niños.

ABSTRACT Acute invasive fungal rhinosinusitis (AIFS) is a rare disease characterized by fungal infiltration of the submucosa and blood vessels of the nasal y paranasal cavities. It affects almost exclusively patients with different degrees of immunosuppression, with underlying pathologies such as diabetes mellitus and hematological malignancies. AIFS has a high mortality rate, but it can be significantly reduced if the diagnosis and treatment are carried out early in the course of disease. This article aims to present an updated literature review regarding clinical presentation, microbiology, risk factors, diagnostic methods, treatment and prognosis of AIFS, both in adults and children.

Antibiotic sensitivity pattern of bacterial isolates in patients with chronic rhinosinusitis in Kaduna, Nigeria

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)

Evaluation of the ability of an experimental model to induce bacterial rhinosinusitis in rabbits, / Avaliação da capacidade de um modelo experimental para indução de rinossinusite bacteriana em coelhos,

Introduction: For decades, animals have been used in sinonasal experimental models, and the practice has increased substantially in the last few years. This study aimed to assess the pathogenesis of infectious process and medication efficiency to treat rhinosinusitis. Objective: To evaluate the efficiency of the proposed experimental model to induce an acute bacterial sinonasal infectious process through histological analysis and sinus secretion cultures. Methods: This was an experimental study with 22 New Zealand rabbits, divided into: group A (six rabbits), group B (seven rabbits), group C (seven rabbits), and group D (control group with two rabbits). Rhinosinusitis was induced by the insertion of a synthetic sponge into the right nasal cavity of 20 animals (study groups), followed by the instillation of bacterial strains (50% Staphylococcus sp. and 50% Streptococcus sp.). The groups were euthanized within 10 days (group A), 17 days (group B), and 30 days (groups C and D). Results: All the rabbits of the study group developed acute bacterial rhinosinusitis, which was diagnosed through macroscopic evaluation, histological analysis, and sinus secretion culture. Conclusion: The proposed model is technically simple to perform, it is similar to the rhinogenic model in human beings, and it is highly efficient to reproduce an acute bacterial sinus infection. .

Introdução: A realização de modelos experimentais nasossinusais em animais vem sendo realizada há décadas, com substancial aumento nos últimos anos. Tem como objetivos identificar as alterações fisiopatológicas ocasionadas pelo processo infeccioso sinusal e avaliar a eficácia de medicamentos no tratamento da rinossinusite. Objetivo: Avaliar a eficácia do modelo experimental proposto para a indução de um processo infeccioso nasossinusal agudo bacteriano, utilizando parâmetros histopatológicos e cultura da secreção sinusal. Método: Estudo experimental com 22 coelhos da raça Nova Zelândia, divididos em: grupo A (6 coelhos), grupo B (7 coelhos), grupo C (7 coelhos) e grupo D (controle com 2 coelhos).Induzido quadro de rinossinusite através da inserção de esponja sintética nas fossas nasais direita dos 20 coelhos (grupos de estudo), seguido por instilação de toxoide bacteriano (50% estreptocócico, 50% estafilocócico). Os grupos foram sacrificados com 10 dias (grupo A), 17 dias (grupo B) e 30 dias (grupos C e D). Resultados: Todos os coelhos do grupo de estudo apresentaram quadro de rinossinusite aguda bacteriana, através da identificação macroscópica, análise histológica e cultura das secreções. Conclusão: O modelo proposto apresenta simplicidade técnica para sua execução, similaridade ao quadro rinogênico que acomete os humanos e é altamente eficaz na produção de um quadro infeccioso bacteriano agudo sinusal. .

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

Papel da punção do seio maxilar no diagnóstico e no tratamento de pacientes com rinossinusite hospitalar / The role of maxillary sinus puncture on the diagnosis and treatment of patients with hospital-acquired rhinosinusitis

A rinossinusite é uma das principais causas de febre em pacientes críticos e deve ser sistematicamente pesquisada. OBJETIVO: Avaliar o impacto da punção do seio maxilar à beira leito, no diagnóstico e no tratamento dos pacientes com rinossinusite infecciosa internados em Unidade de Terapia Intensiva de um hospital universitário de alta complexidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que avaliou os pacientes em ventilação mecânica com febre de origem indeterminada e sinais tomográficos de rinossinusite submetidos à punção do seio maxilar pelo meato inferior. RESULTADOS: A amostra total do estudo consistiu de 27 pacientes (70,3% do sexo masculino com média de idade 45,3 anos). Os diagnósticos de admissão mais frequentes na Unidade de Terapia Intensiva foram Trauma Crânio Encefálico e Acidente Vascular Cerebral. No exame tomográfico, os seios paranasais mais acometidos foram o maxilar, em 85,2%, e esfenoidal, em 74,1%. A secreção purulenta foi visualizada no meato médio em 30,7% das fossas nasais. Os microrganismos mais frequentes nos aspirados dos seios foram Pseudomonas aeruginosa e Acinetobacter baumannii. CONCLUSÃO: A punção do seio maxilar à beira leito demonstrou-se uma importante ferramenta diagnóstica e terapêutica nos pacientes de UTI com rinossinusite hospitalar, submetidos à ventilação mecânica invasiva.

Rhinosinusitis is one of the most commom causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and theraupetic tool for critically ill patients.

Cirugía endoscópica en niños y adolescentes con rinosinusitis: perfil inmunológico y bacteriológico / Endoscopic sinus surgery in children and adolescent with rhino sinusitis: immunologic and bacteriologic profile

Introducción: La rinosinusitis, corresponde a un grupo de desórdenes que se caracteriza por la inflamación de la mucosa tanto de cavidades paranasales (CPN) como de fosas nasales. Está determinada por factores del huésped y ambientales que interactúan causando un estado inflamatorio persistente que produce remodelación de la mucosa. Entre éstos se destacan la alergia y otras alteraciones inmunológicas junto con la colonización por agentes infecciosos. Objetivo: Determinar las características demográficas, clínicas, inmunológicas y agentes infecciosos involucrados en la rinosinusitis crónica (RSC) y rinosinusitis aguda (RSA) recurrente de niños y adolescentes sometidos a cirugía endoscópica funcional (CEF). Establecer las posibles asociaciones de estas características con la necesidad de reoperación y la recurrencia de la enfermedad. Material y método: Estudio retrospectivo observacional en que se evalúan 28 niños y adolescentes sometidos a CEF en el servicio de ORL de Clínica Las Condes durante los años 2000 a 2009. Todos los pacientes contaban con estudio inmunológico y test cutáneo preoperatorio más biopsia de mucosa de CPN y cultivos intraoperatorios de secreción de CPN. Los análisis estadísticos se realizaron con test de Anova para los análisis descriptivos y para el análisis de grupos el test de Fisher. Considerando como significativo un p <0,05. Resultados: Se analizaron 28 pacientes; el 89,2 por ciento tuvo test cutáneo positivo y biopsia inflamatoria crónica eosinofílica (53,6(0) por ciento). El 17 por ciento presentó algún tipo de deficiencia inmunológica. Se obtuvo cultivos positivos intraoperatorios en el 71 por ciento de las muestras, en su mayoría agentes aeróbicos (57,1 por ciento), con 14,2 por ciento de anaerobios y sin presencia de hongos. Veinte y siete pacientes tuvieron seguimiento posoperatorio de 5 años. Cuatro de ellos (14 por ciento) debió ser reoperado...

Introduction: Rhino sinusitis is a group of disorders characterized by inflammation of the mucosa of both sinuses and nostrils. It is determined by environmental and host factors that interact causing a persistent inflammatory condition that causes remodeling of the mucosa. Chief among these are allergy and other immune disorders with colonization by infectious agents. Aim: To determine the demographic, clinical, immunologic and infectious agents involved in chronic Rhino sinusitis (CRS) and Recurrent Acute Rhino sinusitis (RAR) in children and adolescents undergoing functional endoscopic sinus surgery (FESS). Establish the possible associations of these characteristics with the need for re operation and recurrence of the disease. Material and method: Retrospective observational study that evaluated 28 children and adolescents involved in the ENT department at Clínica Las Condes, Santiago, Chile during the years 2000 to 2009. All study patients had preoperative Prick test, immune workout and intraoperative Para nasal mucosal biopsy and cultures of Para nasal secretion. Statistical analysis was performed using ANOVA test for descriptive analysis and cluster analysis with Fisher Exact test. Results were considered significant with p <0.05 Results: We analyzed 28 patients, 89.2 percent had positive Prick test and 53.6 percent showed biopsy with eosinophilic inflammatory disease. 17 percent had some type of immune deficiency. Positive intraoperative cultures were obtained in 71 percent of the samples, mostly aerobic agents (57.1 percent), with 14.2 percent anaerobes and negatives cultures for fungi. Twenty seven patients had postoperative follow-up of 5 years. Four of them (14 percent) had to be re-operated. During the monitoring period, 22 percent developed RAR. It was considered a poor surgical outcome the need for re-operation or recurrence of RAR. We couldn't find association of variables with a poor outcome after surgery...

Microbiology of rhinosinusitis in immunosupressed patients from the university hospital / Microbiologia das rinossinusites nos imunossuprimidos do hospital de clínicas

Immunosuppressed patients are often susceptible to upper airway infections, especially those of the paranasal sinuses. These can sometimes jeopardize treatment success and even lead to a fatal outcome. OBJECTIVE: To study the paranasal microbiology of immunosuppressed patients with clinical evidence of rhinosinusitis, and compare it with that from immunocompetent patients. MATERIAL AND METHOD: Retrospective study, in which 42 immunosuppressed and 16 immunocompetent patients were selected. All had clinically evident acute or recurrent rhinosinusitis and were submitted to ethmoidal or sphenoid sinusectomy or maxillary sinus puncture to gather material for microbiological cultures. RESULTS: There were 92 percent positive cultures, and 21 percent were negative. Of the positive cultures, 38 percent were bacterial, with P. aeruginosa being the most frequent agent; 64 percent were fungal, which occurred in the most immunocompromised patients. In the immunocompetent group, there were 62. 5 percent positive cultures and 37. 5 percent negative ones. All the positive ones were bacterial, with no fungi. CONCLUSIONS: Transplant recipients were prone to develop bacterial rhinosinusitis by Gram positive and Gram negative agents, the most common of the latter being Pseudomonas aeruginosa. Fungal infections occurred in the severely immunosuppressed, and it was absent in immunocompetent patients.

Os pacientes imunossuprimidos têm maior risco de infecções de vias aéreas superiores, principalmente seios paranasais. Estas podem ter evolução fatal ou impedir a recuperação e o tratamento das doenças iniciais. OBJETIVO: Verificar a microbiologia dos seios paranasais dos pacientes imunossuprimidos com rinossinusite, em nosso serviço, e comparar com a microbiologia de pacientes imunocompetentes. MATERIAL E MÉTODO: Estudo retrospectivo, no qual foram selecionados 42 pacientes imunossuprimidos e 16 pacientes imunocompetentes. Todos tinham diagnóstico de rinossinusite aguda ou recorrente e foram submetidos à punção de seio maxilar ou sinusectomia etmoidal ou esfenoidal para coleta de secreção para cultura. RESULTADOS: Obteve-se 92 por cento de cultura positiva e 21 por cento negativa nos imunossuprimidos. Dos positivos, 38 por cento foram bacterianos e 64 por cento, fúngicos, sendo a bactéria mais frequente a P. aeruginosa. Os fungos apareceram nos pacientes com imunossupressão grave. Nos imunocompetentes, obteve-se cultura positiva em 62,5 por cento dos pacientes, e negativa em 37,5 por cento deles, com 100 por cento de positividade para bactérias e ausência de fungos. CONCLUSÃO: Pacientes imunossuprimidos adquirem rinossinusites por bactérias Gram positivas, Gram negativas das mais diversas espécies, sendo Pseudomonas aeruginosa a mais frequente. As infecções fúngicas são mais frequentes em pacientes imunossuprimidos graves e ausentes em imunocompetentes.

Sequence of oral manifestations in rhino-maxillary mucormycosis.

Mucormycosis, caused by saprophytic fungi of the order Mucorales of the class Zygomycetes, is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. These fungi are ubiquitous, found in soil, bread molds, decaying fruits and vegetables. The most common form of mucormycosis is rhinocerebral and is usually seen in uncontrolled diabetes mellitus or in immunocompromised patients. This fungus invades the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. We report a case of palatal perforation by rhino-maxillary mucormycosis in an immunocompromised patient. The aim of this article is to draw attention to the clinical presentation and pathogenesis of mucormycosis and to emphasize the need for high degree of suspicion in its diagnosis and management.

Comparação entre diferentes métodos de coleta para avaliação microbiológica de pacientes com rinossinusite crônica / Comparing different methods used to collect material for a microbiological evaluation of patients with chronic rhinosinusitis

There is still controversy on which is the best method to collect the secretion directly from the middle meatus or maxillary sinus in patients with chronic rhinosinusitis. AIM: To evaluate the prevalence of bacteria in patients with chronic rhinosinusitis and compare the suction trap collector to direct aspiration attached to a syringe for the microbiological analysis of these secretions. MATERIALS AND METHODS: Prospective study involving 31 patients who underwent endoscopically guided maxillary secretion aspiration by two different methods (aspiration with the collector tube "suction trap" and aspiration with the use of a catheter connected to a syringe), to determine the microbiological diagnosis and to compare the two methods used. RESULTS: microorganisms grew samples collected from 55 percent of the 31 patients. The most frequent bacteria were S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria. The results from cultures were similar between the two methods in 71 percent of patients. CONCLUSION: S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria make up the main flora in the maxillary sinus of the patients. There was good correlation between the microbiological results obtained by using a catheter attached to a syringe and the "suction trap" nasal collector.

Atualmente existe controvérsia sobre qual a melhor forma de se coletar secreção do meato médio ou seio maxilar em pacientes com rinossinusite crônica. OBJETIVO: Avaliar a prevalência de bactérias em pacientes com rinossinusite crônica e comparar o método de aspiração direta com seringa e coletor estéril como forma de análise microbiológica desses pacientes. MATERIAIS E MÉTODOS: Estudo prospectivo em 31 pacientes submetidos à coleta de secreção do seio maxilar sob visão endoscópica por dois métodos diferentes (aspiração com coletor estéril de secreção nasal "suction trap" e aspiração usando cateter com seringa acoplada), para determinação do diagnóstico microbiológico e comparação dos métodos utilizados. RESULTADOS: Dos 31 pacientes estudados, o crescimento de microrganismos foi observado em apenas 55 por cento das amostras cultivadas. Os microorganismos mais frequentes foram Staphylococcus aureus, Pseudomonas aeruginosa e outras bactérias aeróbicas Gram-negativas. Os resultados das culturas foram coincidentes entre os dois métodos em 71 por cento dos pacientes. CONCLUSÃO: Staphylococcus aureus, Pseudomonas aeruginosa e outras bactérias aeróbicas Gram-negativas constituem a flora predominante em pacientes com rinossinusite crônica. Houve correlação satisfatória entre os achados microbiológicos obtidos pelo uso de cateter acoplado à seringa com o do coletor nasal do tipo "suction trap".

Biofilme em rinossinusite crônica com polipose nasossinusal: estudo piloto / Biofilm in chronic sinusitis with nasal polyps: pilot study

Apatogenia da rinossinusite crônica não está completamente estabelecida e existem algumas explicações para essa doença, como a osteíte, os superantígenos, a hipersensibilidade mediada por fungos e, mais recentemente, o biofilme. Não existem publicações na língua portuguesa sobre biofilmes na rinossinusite crônica. Objetivo: Reproduzir um método para evidenciar a presença de biofilmes em pacientes com rinossinusite crônica com polipose nasossinusal. Material e método: Amostras de bula etmoidal de nove pacientes com rinossinusite crônica com polipose nasossinusal sem resposta ao tratamento clínico submetidos à cirurgia foram analisadas com microscopia eletrônica de varredura para evidenciar o biofilme. Desenho do estudo: Estudo de coorte contemporânea com corte transversal. Resultados: Observamos o biofilme em 55,56 por cento (5/9) dos pacientes, através da visualização da estrutura tridimensional, de estruturas esféricas envolvidas por uma matriz amorfa e dos canais de água. Conclusão: Reproduzimos um método de visualização de biofilme bacteriano através da microscopia eletrônica de varredura e evidenciamos a sua presença nos pacientes com rinossinusite crônica com polipose nasossinusal.

Chronic rhinosinusitis pathogenesis is not completely established and there are some explanations for this disease, such as osteitis, superantigens, fungal-mediated hypersensitivity and, more recently, biofilms. There are no reports in Portuguese about biofilms in chronic rhinosinusitis. AIM: To reproduce a method for visualization of biofilms in patients with chronic rhinosinusitis and nasal polyps. Patients and methods: Samples of ethmoid bulla of nine patients with chronic rhinosinusitis with nasal polyps without response to clinical treatment who underwent surgery were analyzed with scanning electron microscopy to evidence bacterial biofilms. Study design: A contemporary cross-sectional cohort study Results: In 55.56 percent (5/9) of the patients we observed biofilms by seeing three-dimensional structures, spherical structures surrounded by an amorphous matrix and water-channels. Conclusion: We reproduced a method for visualization of bacterial biofilms by scanning electron microscopy and evidenced its presence in chronic rhinosinusitis with nasal polyps.

Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente / Scedosporium apiospermum rhinosinusal infection in an immunocompetent host

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.

Implications of bacterial biofilms in chronic rhinosinusitis

The recognition of sessile form of bacteria with particular features, known as biofilm, has given new insights to the understanding of pathogenesis of several chronic diseases, including Chronic Rhinosinusitis (CRS). In this article we review the main characteristics of biofilms, describe the current methods used to demonstrate biofilms in chronic rhinosinusitis and discuss the future directions of research in the field.

Bacteriología de las exacerbaciones agudas de rinisonusitis crónica en pacientes operados por cirugía endoscópica de cavidades paranasales / Bacteriology of chronic rhinosinusitis in patients that had paranasal sinuses endoscopio surgery

Introducción: La rinosinusitis crónica (RSC) es un cuadro inflamatorio en el que las bacterias juegan un rol importante. Las exacerbaciones agudas de rinosinusitis crónica (EARSC) en pacientes posoperados no son infrecuentes. Sin embargo, su manejo es complejo debido a la aparición de nuevos agentes y el aumento de la resistencia a antibióticos. Objetivo: Desarrollar una técnica de toma de muestra en cavidades paranasales, que permita caracterizar a los agentes involucrados en EARSC en pacientes posoperados. Material y método: Se recluta ron 32 pacientes posoperados. Se realizó aspirado de seno maxilar bajo visión endoscópica. Las muestras fueron cultivadas para aerobios, anaerobios y hongos. Resultados: Se enviaron 50 muestras a cultivo, en 46 de ellas se aislaron gérmenes (92%), de los cuales 44 fueron aerobios. En 7 de las muestras se aislaron anaerobios, y en 2 se obtuvo cultivo positivo para hongos. La resistencia a betalactámicos fue de 48,2%, observándose 36% de resistencia a lo menos a dos familias de antibióticos. Discusión y conclusiones: Nuestro estudio es el primero a nivel nacional en caracterizar a los agentes involucrados en EARSC en pacientes poscirugía endoscópica nasal. Los resultados obtenidos, posicionan a los cultivos endoscópicos como una excelente herramienta clínica para estudiar las EARSC.

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition where bacteria play an important role. Acute exacerbations of chronic sinusitis (AECS) in patients who underwent endoscopic sinus surgery (EES) are not infrequent. Treatment of these exacerbations is complex due to the emergence of new agents and to an increase in bacterial resistance. Therefore, it is important to develop methods to culture and identify these agents and their antimicrobial resistance and sensibilities. Aim: To develop a technique for recovery of pathogens in the paranasal sinuses of patients with AECS after EES. Material and Method: 32 patients that had undergone EES were recruited. Aspiration of the maxillary sinus under direct endoscopic vision was performed. Samples obtained were sent for aerobic, anaerobia and fungal cultures. Results: Of the 50 samples collected, 46 were positive. Of these, 44 cultured aerobes, 7 cultured anaerobes, and 2 cultured fungi. The resistance to betalactamic antibiotics was 48.2% with at least 36% resistance to two different types of antibiotics. Conclusion: This is the first report in Chile of the microorganisms involved in AECS after EES. The results suggest that the sampling method described here is a useful tool for the study of patients with AECS.

Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem / Evaluation of acute bacterial rhinosinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

OBJETIVO: Avaliar os seios paranasais em pacientes com asma estável ou asma aguda para determinar a prevalência de rinossinusite bacteriana aguda. MÉTODOS: Estudo transversal incluindo 30 pacientes com asma aguda (73 por cento do sexo feminino) tratados na sala de emergência e 30 pacientes com asma estável (80 por cento do sexo feminino) regularmente acompanhados em ambulatório. Todos os pacientes responderam a um questionário sobre sinais e sintomas respiratórios e foram submetidos a exame otorrinolaringológico e a radiograma e tomografia computadorizada de seios paranasais. RESULTADOS: Com base no diagnóstico clínico, a prevalência de rinossinusite bacteriana aguda foi de 40 por cento nos pacientes com asma aguda e de 3 por cento nos com asma estável. O exame otorrinolaringológico e os exames de imagem isoladamente não foram úteis para a confirmação diagnóstica. CONCLUSÕES: O exame otorrinolaringológico e o radiograma e a tomografia de seios paranasais por si só não foram úteis para o diagnóstico de rinossinusite bacteriana aguda. Nossos resultados confirmam a evidência de que o diagnóstico clínico de rinossinusite aguda deve ser dado com cautela.

OBJECTIVE: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. METHODS: A cross-sectional study including 30 patients with acute asthma (73 percent females) treated in the emergency room and 30 patients with stable asthma (80 percent females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. RESULTS: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40 percent in the patients with acute asthma and 3 percent in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. CONCLUSIONS: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.

Complicaciones de rinosinusitis aguda en niños del Hospital Sótero del Río / Complications of acute rhinosinusitis in children at Sótero del Río Hospital

Introducción: La rinosonusitis aguda (RSA) es frecuente en niños, respondiendo bien a tratamiento médico en la mayoría de los casos. Sin embargo puede presentar complicaciones graves a nivel orbitario e intracerebral. Objetivo: Evaluaria frecuencia, describirias características clínicas, evaluare! tratamiento y evolución de la rinosinusitis aguda complicada, en niños del Hospital Sótero del Río. Material y método: Estudio retrospectivo-descriptivo realizado en el Hospital Sótero del Río, utilizando fichas clínicas de pacientes ingresados desde enero de 2002 hasta julio de 2007, con diagnóstico de RSA complicada. Resultados: Se incluyeron 27 pacientes con diagnóstico presuntivo de RSA complicada: 30 por ciento con celulitis preseptal aislada, 36 por ciento celulitis postseptal, 26 por ciento absceso subperióstico y 8 por ciento complicaciones intracraneales. La edad promedio fue 4.53 años (4 meses-13 años); 56 por ciento sexo masculino y 44 por ciento sexo femenino; promedio de días hospitalizados 7,24 días (2-19 días); total de días con tratamiento antibiótico 20,2 días (9-38 días); el cultivo microbiológico fue positivo en 25 por ciento de los pacientes con tratamiento quirúrgico (Staphylococcus epidermidis). No existió compromiso visual al alta en ninguno de los pacientes. Conclusión: La complicación más frecuente de RSA fue la orbitaria (92 por ciento) similar a lo descrito en la literatura. El seno etmoidal, maxilar y frontal fueron frecuentemente comprometidos. La edad de presentación de complicación de RSA fue levemente menor a lo descrito en la literatura. Se encontró predominio del género masculino, aunque en los abscesos subperiósticos predominó el sexo femenino. No se encontró relación directa entre la gravedad de RSA y los valores de proteína C reactiva (PCR) y leucocitosis. La mayoría de los abscesos subperiósticos se manejaron médicamente, teniendo la mitad de ellos más de 9 años. Sólo un paciente presentó complicación orbitaria y encefálica...

Introduction: Acute rhinosinusitis (RSA) is frequent in children. Although in most cases responds well to medical treatment, it could result in serious orbital and intracranial complications. Aim: To assess the frequency, describe the clinical characteristics and evaluate treatment and evolution of acute rhinosinusitis in children at Sótero del Rio hospital. Material and Method: Retrospective - descriptive study of clinical data from Sótero del Rio hospital between Jan 2002 and July 2007, involving patients with a diagnosis of complicated RSA. Results: Data from 27 patients were included in this study, all with presumptive RSA complications: 30 percent had isolated preseptal cellulitis, 36 percent had postseptal cellulitis, 26 percent had subperiostal abscesses, and 8 percent had intracranial complications. The average age of patients was 4,53 years (4 months-13 years old); 56 percent were males and 44 percent were females; hospitalization was in average 7,24 days (2 -19 days), the average number of days on antibiotic treatment was 20,2 (9 -38 days); microbiologic culture was positive in 25 percent of patients with surgical treatment (Staphylococcus epidermidis). None of the patients had visual complications when they were discharged from the hospital. Conclusion: The most frequent RSA complication was orbital (92 percent of complications), similar to what is reported in the literature. Ethmoidal, maxilar and frontal sinuses were more often involved. RSA complications presented at a slightly younger age than reported in the literature. More often males were affected, but subperiostal abscesses were more common in females. There was no direct relation between RSA seriousness and C-reactive protein or leukocitosis. Most subperiostal abscesses were medically treated; more than half of these patients were older than 9 years old. Only one patient presented both orbital and intracranial complications

role of aspergilus in patients with chronic allergic rhinosinusitis

Allergic Rhinosinusitis is one of the most common problems that make people refer to rhinolaryngology clinics, spending a lot of money for the treatment. The antigens from the growth of fungi in sinus cavity causes allergic manifestation and resistance to the treatment. The objective of this study was to evaluate any relationship between chronic rhinosinositis and the allergic symptoms concerning certain fungi. This is a sectional case-control study on 60 patients who referred to the rhinolaryngology clinics of Bahman 22nd and Imam Reza hospitals. 30 patients with chronic rhinosinositis and allergic symptoms like rhinorea, sneezing, nasal itching were selected for the study as the case group and the other 30 patients with chronic rhinosinousitis without the allergic symptoms as the control group After CT scan evaluation, all the patients were sent to the Endoscopic Department Of Imam Reza Hospital. The endoscopic samples obtained under general or local anesthesia were prepared from maxillary sinuses and were sent for culturing [Saboro Agar] and pathologic evaluations. Positive fungal culture was found in 26.7% of the subjects with both chronic sinusitis and allergy. The frequency rate of such finding was significantly more than that of the control group [4.7%]. The most frequent fungus was found to be aspergilus. There was a significant correlation between the fungi and the allergic symptoms in certain seasons [e.g. 44% positive culture in summer]. The frequency of asthma in the subjects with positive culture for aspergilus was 60% that was significantly more than the control group. The number of the subjects that showed palor of Mucosa during the endoscopy [25%] revealed fungal involvement which was significantly more than the control group [4.17%]. Based on the findings of this study, fungi are one of the causes of chronic allergic rhinosinusitis. Therefore, an evaluation of fungal infection in all of the patients with chronic rhinosinusitis and allergic symptoms is recommended

Microbiologia do meato médio na rinossinusite crônica / Microbiology of middle meatus in chronic rhinosinusitis

Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC) e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31 por cento das amostras, e o Staphylococcus coagulase-negativo (SCN) em 23 por cento. Gram-negativos ou facultativos foram isolados em 37 por cento das amostras, anaeróbios em 12 por cento, e fungos em 14 por cento. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74 por cento das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40 por cento das amostras e o Staphylococcus aureus em 18 por cento. Em 12 por cento dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.

This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31 percent), coagulase-negative Staphylococcus (CNS) (23 percent). Gram-negative or facultative microorganisms were isolated in 37 percent of the samples, anaerobes in 12 percent and fungi in 14 percent. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76 percent of cultures were positive for aerobes and 12 percent for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40 percent), Staphylococcus aureus (18 percent). CONCLUSION: The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.