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Bacterial densities of S. pneumoniae, H. influenzae increase during sinusitis
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SAN DIEGO — Bacterial densities of Streptococcus pneumoniae and Haemophilus influenzae increased during episodes of acute bacterial sinusitis, according to data presented at the Pediatric Academic Societies Annual Meeting.
In an effort to characterize viral infections that lead to sinusitis following upper respiratory infection, Gregory P. DeMuri, MD, of the University of Wisconsin, and colleagues assessed 202 children who exhibited symptoms of upper respiratory infection between 2012 and 2014. Nasal washes were conducted at onset of infection and during recovery.
Gregory P. DeMuri
Overall, the researchers observed 22 episodes of sinusitis (9%).
PCR testing indicated rhinovirus in 31% of sinusitis samples, RSV in 17%, coronavirus in14%, adenovirus in 10%, influenza virus 7%, human bocavirus in 4% and metapneumovirus in 4%.
In samples taken during upper respiratory infections, detected virus included rhinovirus (48%), coronavirus (10%), parainfluenza (6%), metapneumovirus (5%), influenza (4%), RSV (4%), enterovirus (3%), adenovirus (2%) and human bocavirus (2%).
Adenovirus (OR = 22.8; 95% CI, 6.6-678; P = .001) and RSV (OR = 15; 95% CI, 2.3-102; P = .02) were more frequently detected in sinusitis samples vs. upper respiratory infection samples.
Bacterial density in nasal washed increased among 86% of patients’.
Mean bacterial density was significantly higher for S. pneumoniae in sinusitis samples (P = .02) and was notably higher for H. influenzae (P = .07).
“We conclude that adenovirus, rotavirus, influenza virus and RSV were detected more frequently from nasal washes from sinusitis. In addition, RSV was detected more frequently from nasal washes from sinusitis visits than [upper respiratory infection] visits,” DeMuri said during a presentation. “We also conclude that bacterial densities in nasal washes were higher in [upper respiratory infection] samples vs. surveillance samples for S. pneumoniae, H. influenzae and M. catarrhalis. Seventy-eight percent of nasal washes from sinusitis samples had an increase in bacterial density of at least one sinus pathogen vs. surveillance samples.” – by Amanda Oldt
Reference:
DeMuri G, et al. Abstract #1180.4. Presented at: Pediatric Academic Societies 2015; April 25-28, 2015; San Diego.
Disclosure: DeMuri reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Kathryn M. Edwards, MD
In a recent study presented at the PAS meeting in San Diego, investigators at the University of Wisconsin assessed the role of viral and bacterial infections in acute sinusitis in children.
Over 200 children between the ages of 4 and 7 years were followed over a two year period and were seen with each episode of upper respiratory infection.
Nearly 10% of the episodes were associated with the diagnosis of acute sinusitis.
Only adenovirus and respiratory syncytial viruses were detected at significantly higher rates in sinusitis cases when compared with uncomplicated URI episodes. Bacterial density in nasal washes increased in 19 of 22(86%) patients with sinusitis when compared to healthy surveillance samples, particularly for S. pneumoniae.
This study supports the hypothesis that at least some viruses contribute to the pathogenesis of acute sinusitis, likely by facilitating the growth of bacterial pathogens.
In the abstract the authors did not correlate the impact of the detection of adenovirus and RSV on bacterial density, and this assessment should be included in further analyses.
In addition the impact of the pneumococcal conjugate vaccines on the pneumococcal density and the serotype distribution of the strains detected in the patients with sinusitis should be reported. These additional studies would further our understanding of the pathogenesis of acute sinusitis.
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