Sandbox Maliha: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(75 intermediate revisions by the same user not shown)
Line 1: Line 1:
__NOTOC__
{{CMG}}
==Heading==
===Heading2===
====Heading3====
=====Heading4=====


*Example
====Acute Sinusitis====
:*Example2
[[Acute (medical)|Acute]] sinusitis is usually precipitated by an earlier [[upper respiratory tract infection]], generally of [[virus|viral]] origin.
::*Example3
Virally damaged surface tissues are then colonized by [[bacteria]], most commonly ''[[Haemophilus influenzae]]'', ''[[Streptococcus pneumoniae]]'', ''[[Moraxella catarrhalis]]'' and ''[[Staphylococcus aureus]]''. Other [[bacterial]] [[pathogen]]s include other [[streptococci]] [[species]], [[Anaerobic organism|anaerobic bacteria]] and, less commonly, [[gram negative]] bacteria.
Another possible cause of sinusitis can be dental problems that affect the maxillary sinus.
[[Acute (medical)|Acute]] episodes of sinusitis can also result from [[fungus|fungal]] invasion.
These [[infection]]s are most often seen in [[patient]]s with [[diabetes]] or other [[immunodeficiency|immune deficiencies]] (such as [[AIDS]] or [[transplant]] [[patient]]s on anti-rejection medications) and can be life threatening. In type I diabetes, ketoacidosis causes sinusitis by [[Mucormycosis]].


*[[Hepatitis]]


==Treatment==
====Chronic Sinusitis====
===Overview===Empiric antimicrobial therapy for Mycotic Aneurysm include intravenous [[Vancomycin]] and either [[Ceftriaxone]], [[Piperacillin-Tazobactam]] or [[Ciprofloxacin]] for 6 weeks.  Alternative regimens include [[Cefepime[[, [[Imipenem-Cilastatin]], [[Meropenem]], or [[Ertapenem]] for Gram-negative bacteria.  
Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common. The causes are multifactorial and may include allergy, environmental factors such as dust or pollution, bacterial infection, and/or fungus (either allergic, infective or reactive). Non allergic factors such as [[Vasomotor rhinitis]] can also cause chronic sinus problems.  


===Antimicrobial Regimen===
Symptoms include: [[Nasal congestion]]; facial pain; [[headache]]; [[fever]]; general [[malaise]]; thick green or yellow [[Rhinorrhea|discharge]]; feeling of facial 'fullness' worsening on bending over; aching teeth. 


* '''Empiric antimicrobial therapy'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
Very rarely, chronic sinusitis can lead to [[anosmia]], the inability to [[olfaction|smell]] or detect odors.
:* Preferred regimen: [[Vancomycin]] 2 g/day IV divided q6-12h targeting trough concentration of 15-20 μg/mL for 6 weeks (for critically ill patient, start with a loading dose of 25 mg/kg followed by 15 mg/kg q12h) {{and}} ([[Ceftriaxone]] 2 g IV q24h for 6 weeks {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 6 weeks {{or}} [[Ciprofloxacin]] 400 mg IV q12h for 6 weeks)
 
:* Alternative regimen: Consider substituting [[Daptomycin]] for Vancomycin. Consider [[Cefepime]], [[Imipenem-Cilastatin]], [[Meropenem]], or [[Ertapenem]] for Gram-negative bacteria.
In a small number of cases, chronic [[maxillary]] sinusitis can also be brought on by the spreading of bacteria from a dental infection.  
The treatment for chronic fibrosing mediastinitis is somewhat controversial, and may include either steroids or surgical decompression of the affected vessels.
 
Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. A task force for the American Academy of Otolaryngology - Head and Neck Surgery / Foundation along with the Sinus and Allergy Health Partnership broke Chronic Sinusitis into two main divisions, Chronic Sinusitis without polyps and Chronic Sinusitis with polyps (also often referred to as Chronic Hyperplastic Sinusitis). Recent studies which have sought to further determine and characterize a common pathologic progression of disease have resulted in an expansion of proposed subtypes. Many patients have demonstrated the presence of [[Eosinophil granulocyte|eosinophils]] in the mucous lining of the nose and paranasal sinuses. As such the name Eosinophilic Mucin RhinoSinusitis (EMRS) has come into being. Cases of EMRS may be related to an allergic response, but allergy is often not documentable, resulting in further subcategorization of allergic and non-allergic EMRS.
 
A more recent, and still debated, development in chronic sinusitis is the role that [[fungus]] may play. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a definite factor in the development of chronic sinusitis and if it is, what the difference may be between those who develop the disease and those who do not.

Latest revision as of 20:41, 8 March 2016

Acute Sinusitis

Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection, generally of viral origin. Virally damaged surface tissues are then colonized by bacteria, most commonly Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. Other bacterial pathogens include other streptococci species, anaerobic bacteria and, less commonly, gram negative bacteria. Another possible cause of sinusitis can be dental problems that affect the maxillary sinus. Acute episodes of sinusitis can also result from fungal invasion. These infections are most often seen in patients with diabetes or other immune deficiencies (such as AIDS or transplant patients on anti-rejection medications) and can be life threatening. In type I diabetes, ketoacidosis causes sinusitis by Mucormycosis.


Chronic Sinusitis

Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common. The causes are multifactorial and may include allergy, environmental factors such as dust or pollution, bacterial infection, and/or fungus (either allergic, infective or reactive). Non allergic factors such as Vasomotor rhinitis can also cause chronic sinus problems.

Symptoms include: Nasal congestion; facial pain; headache; fever; general malaise; thick green or yellow discharge; feeling of facial 'fullness' worsening on bending over; aching teeth.

Very rarely, chronic sinusitis can lead to anosmia, the inability to smell or detect odors.

In a small number of cases, chronic maxillary sinusitis can also be brought on by the spreading of bacteria from a dental infection.

Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. A task force for the American Academy of Otolaryngology - Head and Neck Surgery / Foundation along with the Sinus and Allergy Health Partnership broke Chronic Sinusitis into two main divisions, Chronic Sinusitis without polyps and Chronic Sinusitis with polyps (also often referred to as Chronic Hyperplastic Sinusitis). Recent studies which have sought to further determine and characterize a common pathologic progression of disease have resulted in an expansion of proposed subtypes. Many patients have demonstrated the presence of eosinophils in the mucous lining of the nose and paranasal sinuses. As such the name Eosinophilic Mucin RhinoSinusitis (EMRS) has come into being. Cases of EMRS may be related to an allergic response, but allergy is often not documentable, resulting in further subcategorization of allergic and non-allergic EMRS.

A more recent, and still debated, development in chronic sinusitis is the role that fungus may play. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a definite factor in the development of chronic sinusitis and if it is, what the difference may be between those who develop the disease and those who do not.