How To Cure Your Sinus Infection
A 51-yr-old woman with neurofibromatosis was seen in the emergency room for symptoms of sinus congestion, productive cough, nausea with emesis, and malaise. She appeared flushed and was found to be profoundly orthostatic by both pulse and blood pressure. Her symptoms, physical exam, and sinus computed tomography (CT) films were all consistent with a diagnosis of sinusitis, and she was therefore admitted for intravenous hydration and antibiotics.
Haemophilus influenzae is a small gram-negative bacterium whose natural host is the human upper respiratory tract, in which it can cause mucosal infections, otitis, sinusitis, and meningitis, particularly in young children. Its genome consists of a single circular chromosome 1.83 million base pairs long, which is relatively small compared with the genome of its cousin, E. coli, which exceeds 4.3 million base pairs. Its small genome and the therapeutic interest of this bacterium as a target made H. influenzae the candidate of choice for the first complete automated genome sequencing project, carried out in 1995 at TIGR (The Institute of Genome Research), in the United States.
Sinusitis is well recognised as a common cause of headache and the patient with headache should be questioned about recent upper respiratory tract infections or a previous history of sinus disease. Tenderness over the affected sinus is an important sign. The headache tends to begin after rising in the morning and reaches a
Cystic fibrosis can be associated with headaches and facial pain caused by sinusitis or coughing paroxysms (81,82). Migraine and tension headaches are the most common types of pediatric headaches. By age 15 years, 5.3 of children have migraines, 15.7 have frequent nonmigrainous headaches, and 54 have infrequent nonmigrainous headaches. More than 82 of children by late adolescence experienced some type of headache (83).
Orbital cellulitis is characterized by the typical triad of exophthalmos, eyelid swelling, and limited ocular motility. The latter feature distinguishes orbital cellulitis from the more limited case of cellulitis of the lid, in which the eye's movements are unrestricted, and the prominence of the eye is confined to the tissues external to the orbital septum. This can be difficult to judge when the lid swelling is so pronounced that the eye cannot be seen. There is usually an associated fever, a leukocytosis, and history of repeated bouts of bacterial sinusitis. Such cases must be managed quickly and aggressively with hospitalization, intravenous antibiotics, and surgical incision and decompression of the swollen orbital tissues.
P. carinii (now considered to be a fungus) occasionally caused pneumonia in CLL patients prior to the introduction of fludarabine therapy, but most cases of Pneumocystis pneumonia have occurred in patients who were treated with fludarabine plus prednisone (46,58). The association of this infection with adrenocorticosteroid therapy is well recognized hence, the role of fludarabine is less certain. Systemic Candida infections have been reported in patients receiving fludarabine, as well as sporadic cases of infection caused by Aspergillus species, Fusarium species, Histoplasma capsulatum, and Onchocronis species (59). It is somewhat surprising that superficial Candida infections and Aspergillus sinusitis have not been reported more frequently, the former infections being associated with low CD4+ lymphocyte counts and the latter with neutropenia and adrenal corticosteroid therapy.
A substantial proportion of bacterial infections occurring in CLL patients involve the respiratory tract and are caused by S. pneumoniae and H. influenzae (40). The propensity for these infections relates to several factors including decreased production of secretory and serum immu-noglobulins, impaired complement binding to organisms, and deficiencies in neutrophils and CD4+ lymphocytes. The most common respiratory infections are acute and chronic sinusitis, otitis media, and pneumonia. In the past most pneumonias were caused by S. pneumoniae, but with current chemotherapeutic regimens, the spectrum of pathogens includes Gram-negative bacilli, Nocardia species, Legionella species, and P. carinii. In a study from the 1980s, the estimated frequency of pneumococcal bacteremia was 10.8 episodes 1000 patients (54). The lung was the site of origin of 75 of cases and even when treated with appropriate antibiotics, the fatality rate was 20 . The increasing proportion of penicillin-resistant...
Antibiotics are medications that are prescribed for people with bacterial infections. When you were a child and had an ear infection, your parents probably gave you spoonfuls of the pink medicine (Figure E11.1), and now when you have a sinus infection your doctor prescribes other antibiotics. These infections are easily treated and require fairly little inconvenience besides a trip to the doctor and pharmacy. Unfortunately, the days of easily treatable bacterial infections may soon be over because the bacteria that cause many diseases including tuberculosis, malaria, ear infections, and gonorrhea have become resistant to the antibiotics developed to cure them.
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