Microbiological Aspects of Acute and Chronic Pediatric Rhinosinusitis

Abstract

The microbiology of acute and chronic rhinosinusitis has been extensively studied, but there are still some differences of view concerning the etiology of the former, and many disagreements regarding the microbiology of the latter. Establishing the concomitant distribution of the causative micro-organisms in cases that involve multiple sinuses is scientifically and practically important. The main problems are the variety of aerobes and anaerobes that may be involved, and the fact that different tracts of the sinuses of the same patient may be simultaneously affected. Rhinosinusitis may also involve the formation of biofilm, which may play a significant role in its pathogenesis and persistence. Biofilms have a number of advantages in terms of bacterial survival, and their perpetuation can create a certain degree of instability in host-bacteria interactions. Sinonasal microflora may further complicate pathogenesis and the identification of the pathogen(s) involved. Furthermore, the concentration, uniformity, and type/number of strains of nasal microbiota may vary from one site to another. The relative and total micro-organism counts can also be affected by various factors, and microbiota can modulate the course of both acute and chronic rhinosinusitis.

Pediatric Chronic Rhinosinusitis: Unmet Needs

“…In large part the antibiotic regimen recommended for pediatric infections CRS has been circumscriptive, but stable for 25 years, as previously summarized [1]. Historically (prior century), the antibiotics selected were directed at the recognized or suspected microbiological overgrowth [1,19]. Bio-filming added to the complexity [18], and information about the sinus microbiome with a disruptive disease dybiosis could provide future therapeutic directives [19,20], but is not yet part of the current pediatric CRS landscape.…”

Some Features of Clinical Laboratory and Instrumental Research in Chronic Inflammatory Diseases of the Nose and Paranasal Sinuses in Patients with Myocarditis

“…Over the past 10-20 years, the incidence of myocarditis and pericarditis has increased significantly [18]. Non-coronarogenic myocardial diseases account for 7-9% of all diseases of the cardiovascular system [10,21]. It has been proven that there is a direct connection between influenza and acute respiratory infections with subsequently developing chronic therapeutic pathology and serious somatic complications [22].…”

“…To detail the nature of the lesion of the nasal cavity and paranasal sinuses allow special examination methods, which have been included in the arsenal of ENT specialists in recent years. This is an instrumental endoscopic study, with which you can objectively assess the degree of violation of nasal breathing [6,7,8,10].…”

Modern approaches to the treatment of chronic polypous rhinosinusitis

“…In other cases, the treatment is usually started with a symptomatic therapy, since there is no consensus about an antibiotic therapy in childhood (Klimek et al 2019). This is due to the fact that in some patients with CPR, the pathogen of infection is not detected and that a long-term use of antibacterial drugs can lead to dysbiosis, allergies and other side effects (Drago et al 2019).…”