Sinusitis (Rhinosinusitis)--Subacute/Chronic
Sinusitis (Rhinosinusitis)--Subacute/Chronic is a topic covered in the Johns Hopkins ABX Guide.
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PATHOGENS
- Bacteriology of chronic sinusitis less well defined than acute sinusitis [that is typically caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis].
- A multifactorial disease that aside from infection is thought to result from genetics, environmental or occupational exposures, allergy, immunodeficiencies.
- Acute exacerbations of chronic sinusitis may be caused by typical respiratory pathogens noted above.
- Polymicrobial flora typically found if sinuses are cultured
- Gram-negative organisms increased and possibly anaerobes.
- Pseudomonas aeruginosa, Staphylococcus aureus more common in nosocomial and immunocompromised infections.
- Controversy exists over the role of fungi in chronic sinusitis.
- The suggestion that fungal elements may be inciting an eosinophil-mediated immune response in sinonasal mucosa.
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