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CONTENTS
Complications of Sinusitis
EDITORIAL BOARD
Co-Editors: Margaret C. Fisher, MD, and Gary D. Overturf, MD
Editor for this Issue: Geoffrey A. Weinberg, MD
Board Members
John S. Bradley, MD Deborah Lewinschn, MD Leonard Weiner, MD
Barbara Jantausch, MD Debra L. Palazzi, MD Charles R. Woods, MD
Leonard R. Knilov, MD Jennifer Read, MD Theoblis Zanoutis, MD
Charles T. Leach, MD Geoffrey A. Weinberg, MD
Key Words: sinusitis, complications, children, lescents.6 In nearly every survey of the com- COMPLICATIONS
orbital abscess, orbital cellulitis, periorbital plications of ABS males account for 60% to Complications of ABS may be cate-
cellulitis, subdural empyema, epidural empyema, 70% of cases. gorized as extracranial, intracranial, and
brain abscess those involving the bone of the sinus wall
(Pediatr Infect Dis J 2011;30: 701702) (osteitis). Extracranial manifestations may
PATHOGENESIS be divided into preseptal or postseptal infec-
The complications of ABS relate di- tion. The orbital septum is a connective tis-
The Concise Reviews of Pediatric Infectious Diseases (CRPIDS) topics, authors, and contents are chosen and approved indepen-
dently by the Editorial Board of CRPIDS.
The Pediatric Infectious Disease Journal Volume 30, Number 8, August 2011 www.pidj.com | 701
Concise Reviews The Pediatric Infectious Disease Journal Volume 30, Number 8, August 2011
loss or spread to intracranial structures, dis- Small orbital abscesses may be treated
tinguishing this condition from preseptal in- TABLE 1. Microbiology of the conservatively with antimicrobial agents
volvement is critical. The clinical findings of Complications of Sinusitis* alone.12,13 Surgery has 2 purposes: to provide
ophthalmoplegia and proptosis each have a microbiological data that will guide antibiotic
positive predictive value for orbital infection Gram-positive selection and to drain significant fluid collec-
of 97% and their absence a negative predic- Staphylococci tions. Prompt surgical drainage is paramount
tive value of 93%.6 If neither of these find- Staphylococcus aureus when the CNS and ocular structures are threat-
ings are detected, the chances of orbital in- Coagulase-negative staphylococci ened. Samples taken in the operating room
Streptococci
volvement are low. Streptococcus pneumoniae must be promptly transported to the laboratory,
Epidural empyema is the most com- S. anginosis and anaerobic transport media should always
mon intracranial complication of ABS fol- Group A streptococcus be used to optimize recovery of pathogens.
lowed by subdural empyema, meningitis, Group C streptococcus Outcomes depend on prompt recogni-
Other -hemolytic streptococci
brain abscess, and rarely, cavernous sinus Gram-negative tion of orbital and intracranial involvement and
thrombosis.7 Headache and fever are nearly Haemophilus influenzae early intervention. Patients should be managed
universal findings at presentation and are H. aphrophilus in consultation with the appropriate surgical
often accompanied by mental status changes, Moraxella catarrhalis subspecialties. Supportive care such as anti-
Pseudomonas aeruginosa
seizures, or focal neurologic deficits. Chil- Klebsiella pneumoniae convulsants, analgesics, and measures to re-
dren with orbital involvement may also have Moganella morganii duce intracranial pressure should be used as
intracranial complications. Importantly, pa- Serratia marcescens indicated. Since the complications of ABS are
tients with intracranial complications may not Citrobacter freundii rare, it is difficult to establish that early treat-
Anaerobes
have the diagnostic symptoms of ABS (cough, Bacteroides sp. ment in the ambulatory setting reduces com-
nasal discharge, or congestion) or may have Prevotella sp. plications. Treatment of uncomplicated ABS
them for only 5 to 7 days before presentation.8 Eikenella corrodens should follow established guidelines.
Symptoms referable to the central nervous sys- Fusobacterium sp.
Peptostreptococcus sp. REFERENCES
tem are often predominant. Porphyromonas sp.
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MANAGEMENT
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