Microbiology of rhinosinusitis in immunosupressed patients from the university hospital

Abstract

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% positive cultures, and 21% were negative. Of the positive cultures, 38% were bacterial, with P. aeruginosa being the most frequent agent; 64% were fungal, which occurred in the most immunocompromised patients. In the immunocompetent group, there were 62.5% positive cultures and 37.5% negative ones. All the positive ones were bacterial, with no fungi. Conclusion: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. Braz J Otorhinolaryngol. 2011;77(4):522-5. ORIGINAL ARTICLE BJORL

Management of non‐invasive rhinosinusitis in the immunosuppressed patient population

“…[7][8][9] A Brazilian group confirmed the importance of Pseudomonas as an opportunistic pathogen in transplant patients. 13 Milgrim et al found Listeria monocytogenes and Candida albicans to be pathogenic species in HIV patients. 10 Even with this information available for over a decade regarding the prevalence and distinct additional pathogens involved in these immunocompromised patients, there has never been clinical research dedicated to the standardization and optimization of rhinosinusitis management for this patient population.…”

“…In 1999, Porter et al reported that 66% of HIV patients surveyed had experienced at least one episode of sinusitis within the previous 6 months, and in 2001, Tarp et al published on the presence and possible reactivation of Herpes virus type 1 to 8 in sinus aspirates of HIV‐infected individuals . Twenty years ago, first O'Donnell et al and then Fried et al noted Pseudomonas to be an organism more likely found in transplant and other immunocompromised patients, and in 1996 cytomegalovirus was implicated in sinusitis in HIV patients by Marks et al A Brazilian group confirmed the importance of Pseudomonas as an opportunistic pathogen in transplant patients . Milgrim et al found Listeria monocytogenes and Candida albicans to be pathogenic species in HIV patients .…”

Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

“…11 In contrast to solid organ transplant recipients, bone marrow transplant recipients have a considerably higher rate of invasive fungal infections (up to 68%). 13,14 These patients are much more susceptible to fungal infections, as they are commonly severely neutropenic for prolonged periods of time. 15,16 In neutropenic patients, defects in phagocytic cell activity enable invasive fungal infection.…”

Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes: Table 1

“…The last recorded outbreak of Scarlet Fever in the UK was in Lancashire in 2009 also with no cases of orbital cellulitis 19. Prior to the introduction of the Haemophilus influenzae type B (Hib) vaccine, Hib was the most common organism causing orbital cellulitis 1 2 9 11. This particular species was extremely virulent and often spread to cause meningitis, cavernous sinus thrombosis and high mortatlity 9.…”