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Acute Bacterial Sinusitis (s/sx (AOM (after a viral URI, hold/rub/tub ear,…
Acute Bacterial Sinusitis
s/sx
AOM
after a viral URI, hold/rub/tub ear, infants cry and have difficulty sleeping, bulging tympanic membrane, otorrhea, otalgia, fever
ABRS
purulent nasal discharge, nasal congestion/obstruction, facial congestion/fullness, facial pain and pressure, fever, headache, ear pain and pressure, halitosis, dental pain, cough fatigue
Acute Pharyngitis
sore throat, pain while swallowing, fever, headache, NV, abdominal pain, inflammation of tonsils and pharynx, enlarged tender lymph nodes, red swollen uvula, petechiae on soft palate, scalariform rash, cough, congestion
ABRS
Bacterial differentiation:
persistent s/sx lasting > 10 days without evidence of improvement
Severe s/sx of high fever and purulent nasal discharge or facial pain for 3-4 days at the beginning of illness
Worsening s/sx characterized by new-onset fever, headache. "double sickening"
Purulent anterior nasal discharge
purulent or discolored posterior nasal discharge
facial congestion or fullness
fever, headache, ear pain/pressure/ fullness
halitosis, dental pain, cough, fatigue
AOM
Abrupt onset of the following signs and symptoms:
complains of ear pain
pulling/tugging of the ear
irritability
failure to respond to sounds
otorrhea
fever
vomiting or poor eating
Pharyngitis
Bacterial:
fever
absence of cough
headache
exudate on tonsils
tender cervical lymphadenopathy
uvula may be red and swollen
Viral: SLOW onset and less severe throat pain
acute rhinitis
hoarseness
cough
diarrhea
conjuctivitis
anterior stomatitis
diagnosis
ABRS
Distinguish that it is bacterial
No accurate diagnostic test - utilize clinical findings
Gold standard is sinus puncture w/ recovered bacteria BUT invasive and costly
Pathophysiology/Etiology
ABRS
Pathogens: S pneumoniae & H. influenzae
Sometimes M. catarrhalis
Usually viral RTI first then bacterial infection after
Mucosal inflammation leads to obstruction of the sinus ostia--local defenses impaired and bacteria proliferate
AOM