Complications to acute bacterial rhinosinusitis in children - a prospective study; bacterial cultures, virus detection, allergy sensitization and immunoglobulins.

BACKGROUND: Prospective studies of complications due to acute rhinosinusitis are lacking, bacterial cultures are hard to obtain and the role of airborne allergies, viruses and immunoglobulin levels are unclear. The aim was to investigate the role of bacteria, viruses, allergy and immunoglobulins in children hospitalized due to rhinosinusitis. METHODOLOGY: A prospective cohort study in Stockholm, Sweden, of children up to 18 years of age, hospitalized due to acute bacterial rhinosinusitis, from April 1st, 2017 to April 1st, 2020. RESULTS: Of 55 children included, 51% had a positive viral nasopharyngeal PCR and 29% had a positive allergy sensitization test. A higher percentage of middle meatus cultures were positive for bacterial growth compared to nasopharyngeal and displayed a wider array of bacteria. Dominating bacteria were S. milleri in surgical (7/12 cases), S. pyogenes in middle meatus (13/52 cases), and S. pyogenes and H. influenza in nasopharyngeal cultures (8/50 cases respectively). Nasal cultures were negative in 50% of surgical cases. An association was found between S. pyogenes and peak CRP; H. influenzae and peak CRP; S. pneumoniae and peak CRP; and possibly between M. catarrhalis and days of IV antibiotics. Further, an association between influenza A/B and S. pyogenes; a positive viral PCR and lower grade of complication and peak CRP; and a possible association between influenza virus and lower grade of complication. Allergy sensitization was possibly associated with a higher number of days with IV antibiotics. No immunoglobulin deficiencies were found. CONCLUSIONS: There seem to be differences in the patterns of bacterial growth in nasopharyngeal, middle meatus and surgical cultures in children with complications to acute bacterial rhinosinusitis. Presence of certain viruses and sensitization to airborne allergies seem to play a role in complications to acute bacterial rhinosinusitis in children.

A Swedish population-based study of complications due to acute rhinosinusitis in children 5-18 years old.

BACKGROUND: There are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. METHODS: This was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. RESULTS: Incidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe - postseptal orbital, intracranial or osseous - complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. CONCLUSIONS: There is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis.

Most preschool children hospitalised for acute rhinosinusitis had orbital complications, more common in the youngest and among boys.

AIM: This study established the incidence of acute rhinosinusitis and related orbital complications in tertiary care in Stockholm County and surveyed the clinical outcomes. METHODS: This was a population-based, retrospective, observational study, from July 1, 2003 to June 30, 2007, of the hospital admissions records of 213 children up to five years old, with a diagnosis of sinusitis and related complications. RESULTS: Preseptal cellulitis was present in 171 of the 213 admissions, which equated to an incidence of orbital complications due to acute rhinosinusitis of 36 per 100 000 people per year (95% confidence interval 26-49). Postseptal complications occurred in seven cases. The incidence rate ratio for hospitalisation of children less than two years old with rhinosinusitis compared with children aged 2-5 years was 2.8 (95% confidence interval 1.8-4.4). The incidence among boys was 53 per 100 000 people per year and 36 per 100 000 people per year for girls, and the incidence rate ratio was 1.5 (95% confidence interval 1.0-2.3). The most common bacterial finding was Streptococcus pneumoniae. CONCLUSION: Most children hospitalised for acute rhinosinusitis had an orbital complication, and this was more common in children under the age of two years and boys. Severe postseptal complications were rare.