Rinossinusite nosocomial em unidade de terapia intensiva: estudo microbiológico

Background Rhinosinusitis is a common condition which may present with complications commonly involving the orbit and the intracranial space. Loss of vision in the absence of clinical or radiological signs of involvement of the orbit and intracranium is rare and carries a high morbidity rate. Streptococcus equi subspecies zooepidemicus is not a well-documented cause of paranasal sinus infection. Case presentation We present a case of a 16 year old female patient who had unilateral loss of vision with signs of retrobulbar optic neuritis and no other neurological signs. We isolated an unusual organism- Streptococcus equi subspecies zooepidemicus from the maxillary sinus. Emergency endoscopic sinus surgery and antibiotic treatment resulted in complete reversal of the loss of vision. Conclusion The presence of paranasal sinus disease in association with loss of vision even in the absence of a clear link between the two should be treated as an emergency with surgical drainage and or appropriate antibiotic therapy. In patients presenting with suspected inflammatory orbital involvement, imaging of the orbit and paranasal sinuses should be considered early.

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Papel da punção do seio maxilar no diagnóstico e no tratamento de pacientes com rinossinusite hospitalar

Neto¹,

Guerreiro²,

Hirai³

et al. 2012

Braz. j. otorhinolaryngol.

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Rhi nosinusitis 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. Braz J Otorhinolaryngol. 2012;78(4):35-41. BJORL ORIGINAL ARTICLE

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Rinossinusite nosocomial em unidade de terapia intensiva: estudo microbiológico

Cited by 4 publications

References 25 publications

Microbiology of Pediatric Sinusitis

Microbiology of Pediatric Sinusitis

Streptococcus equi subsp. zooepidemicus and ‘Neighbourhood syndrome’ –extra-orbitocranial rhinosinusitis with reversible sudden loss of vision- a case report

Papel da punção do seio maxilar no diagnóstico e no tratamento de pacientes com rinossinusite hospitalar

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