Sinusitis in HIV-1 infection

The advent of protease inhibitors, which enhances the survival rate of HIV-infected individuals, leads patients to search for otorhinolaryngologists, as 40-70% of them may present some sort of otorhinolaryngological disorder. Aim: We aimed at comparing the CT scan findings and the nasosinusal complaints of HIV-infected and AIDS patients with clinical diagnosis of chronic rhinosinusitis. The literature on the subject is revised and discussed. Study design: clinical prospective with transversal cohort. Material and Methods: Prospectively, 39 patients with chronic rhinosinusitis, in use of antiretroviral therapy, were included in the present study and divided into two groups: patients with diagnosis of AIDS (group I) and those infected by HIV (group II). Clinical and laboratorial assessments, with CD4+ cell count and CT evaluation, were performed and compared among groups I and II. Results: Group I and II presented mean CD4+ cell count of 118 cells/10-9l and 377 cells/10-9l, respectively. Comparison of the tomographic findings by the Lund-Mackay staging system presented a score of 12 for group I and 5.63 (pd"0.001) for group II. Fever and postnasal discharge were more prevalent in group I (pd"0.001). Conclusions: In our Service, prevalence of chronic rhinosinusitis in HIVinfected patients was 12%. AIDS patients had a higher incidence of fever and postnasal discharge than those of group II. Moreover, extensive radiological findings were prevalent in patients with AIDS (group I) than in HIVinfected individuals (group II).

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“…The most common findings were purulent rhinorrhea, nasal obstruction and headache, respectively, which is in accordance with Zurlo et al 9 .…”

Section: Discussionsupporting

confidence: 91%

Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica

Miziara

Filho²,

Cortina³

et al. 2005

Rev. Bras. Otorrinolaringol.

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“…It is frequently asymptomatic or may be recurrent and refractory to medical management [42]. Declining immune function manifested by decreasing CD4 cell counts is associated with an increased incidence of sinus disease [40,42,43].…”

Section: Sinusitis and Hiv-infected Patientsmentioning

confidence: 99%

Sinusitis in the immunocompromised host

Decker

1999

Curr Infect Dis Rep

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Sinusitis occurs in a wide range of immunocompromised hosts, including neutropenic patients, diabetic patients, patients in critical care units, and patients with HIV infection. Reversal of underlying risk factors, such as neutropenia or diabetic ketoacidosis, is essential in the treatment of fungal rhinosinusitis. Aggressive surveillance, high clinical suspicion, and early diagnosis and treatment are all critical aspects of sinusitis management. Sinusitis is increasingly recognized as the cause of occult cases of fever in critical care patients. Sinusitis in HIV-infected patients becomes more prevalent as immunosuppression worsens.

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“…7,8 However, symptoms and signs may be nonspecific or absent, particularly in patients with CD4 counts under 200/mm. 3 In the review by Godofsky et al of 72 cases of sinusitis, 10 patients (14%) presented with fever and headache as their only symptoms.…”

Section: Sinusitismentioning

confidence: 99%

“…7 Of the 75 patients with sinusitis that Zurlo et al studied, 19 patients (25%) with radiographic evidence of active sinusitis were asymptomatic. 8 When patients do not respond to antibiotics targeted at common pathogens such as Streptococcus pneumonia, Viridans streptococcus , and Haemophilus influenzae, Pseudomonas aeruginosa should be considered. Although Pseudomonas aeruginosa rarely causes sinusitis in HIV-seronegative individuals, it may account for 16% to 18% of cases of sinusitis in HIV-infected individuals and is associated with a high rate of recurrent disease.…”

Section: Sinusitismentioning

confidence: 99%

Diagnosing HIV-Related disease

Jung

Paauw

1998

J Gen Intern Med

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OBJECTIVE: To summarize current information on the relation between CD4 counts and the risk of different HIV-related diseases. MEASUREMENTS AND MAIN RESULTS: MEDLINE search ofEnglish language articles between 1985 and 1996 using the medical subject heading (MeSH) term "CD4 lymphocyte count" and searches using key words of multiple HIV-related diseases were conducted. Some HIV-related diseases can be stratified to different CD4 count levels. Regardless of their CD4 count, HIV-infected patients are susceptible to sinusitis, Kaposi's sarcoma, community-acquired pneumonia, and oral hairy leukoplakia. In advanced HIV, when CD4 is below 200/ mm 3 , Pneumocystis carinii pneumonia, toxoplasmosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex, molluscum contagiosum, and bacillary angiomatosis all increase in incidence. In very advanced HIV disease, when CD4 counts are below 50/mm 3 , patients are at risk of pseudomonas pneumonia, cytomegalovirus retinitis, central nervous system lymphoma, aspergillosis, and disseminated histoplasmosis.KEY WORDS: CD4 count; HIV-related disease; risk stratification. J GEN INTERN MED 1998;13:131-136.

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Sinusitis in HIV-1 infection

Cited by 81 publications

References 10 publications

Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica

Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica

Sinusitis in the immunocompromised host

Diagnosing HIV-Related disease

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