Sinusitis vs Sequential Upper Respiratory Infections in Children

Children who develop acute bacterial sinusitis secondary to viral upper respiratory infections (URIs) have higher symptom severity scores and more frequent URI episodes than children who experience uncomplicated URIs, according to a study published in Clinical Infectious Diseases. Further, a new virus was detected in approximately 30% of nasal samples obtained from children on the day they were diagnosed with acute sinusitis, which suggests that some children diagnosed with sinusitis were experiencing sequential viral infections.

Researchers followed 31 patients aged 48 to 96 months for 1 year, obtaining nasal samples at visits on days 3 and 4 of URIs, on day 10, if a diagnosis of acute sinusitis was made, and on day 15 for children with uncomplicated URIs. Molecular diagnostic testing on nasal washes identified pathogenic bacteria and common respiratory viruses, and symptom severity was quantified using a standardized score.

Over the course of the year, 519 URI cases were evaluated and 37 of these met the criteria for acute sinusitis. Symptom severity scores were higher, to a statistically significant degree, on days 3, 5, 10 and 15 in patients with URIs that led to sinusitis, compared with patients who had an uncomplicated URI. Respiratory syncytial virus was detected significantly more often during URI visits that led to a diagnosis of sinusitis compared with those for uncomplicated URIs (10.8% vs 3.4%; P=.05), and new viruses were detected in 29% of samples from children who were diagnosed with sinusitis. Patients with uncomplicated URI experienced a median of 1 URI per year (range 0 to 9) compared with 3 (range 1 to 9) in patients who subsequently developed sinusitis (P <.001).

Limitations of this study included the cohort’s narrow age range, potential misrepresentation of microbial conditions due to nasal washes, and low prevalence of sinusitis.

On the basis of these results, the study investigators asserted that some children who appear to have acute sinusitis may actually be experiencing sequential viral infections. The researchers concluded that, “[the] clinical implication of this study is that sinusitis may be over-diagnosed using current guidelines. While viral [polymerase chain reaction] on nasal samples is not feasible or sufficient to exclude bacterial sinusitis at the time of clinical diagnosis, measurement of nasal cytokines (adaptable to a point-of-care assay) may reflect a host response ascribable to viral infection.”

Reference

DeMuri GP, Eickhoff JC, Gern JC, Wald ER. Clinical and virological characteristics of acute sinusitis in children [published online January 14, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz023