Complications to acute bacterial rhinosinusitis in children - a prospective study; bacterial cultures, virus detection, allergy sensitization and immunoglobulins.

BACKGROUND: Prospective studies of complications due to acute rhinosinusitis are lacking, bacterial cultures are hard to obtain and the role of airborne allergies, viruses and immunoglobulin levels are unclear. The aim was to investigate the role of bacteria, viruses, allergy and immunoglobulins in children hospitalized due to rhinosinusitis. METHODOLOGY: A prospective cohort study in Stockholm, Sweden, of children up to 18 years of age, hospitalized due to acute bacterial rhinosinusitis, from April 1st, 2017 to April 1st, 2020. RESULTS: Of 55 children included, 51% had a positive viral nasopharyngeal PCR and 29% had a positive allergy sensitization test. A higher percentage of middle meatus cultures were positive for bacterial growth compared to nasopharyngeal and displayed a wider array of bacteria. Dominating bacteria were S. milleri in surgical (7/12 cases), S. pyogenes in middle meatus (13/52 cases), and S. pyogenes and H. influenza in nasopharyngeal cultures (8/50 cases respectively). Nasal cultures were negative in 50% of surgical cases. An association was found between S. pyogenes and peak CRP; H. influenzae and peak CRP; S. pneumoniae and peak CRP; and possibly between M. catarrhalis and days of IV antibiotics. Further, an association between influenza A/B and S. pyogenes; a positive viral PCR and lower grade of complication and peak CRP; and a possible association between influenza virus and lower grade of complication. Allergy sensitization was possibly associated with a higher number of days with IV antibiotics. No immunoglobulin deficiencies were found. CONCLUSIONS: There seem to be differences in the patterns of bacterial growth in nasopharyngeal, middle meatus and surgical cultures in children with complications to acute bacterial rhinosinusitis. Presence of certain viruses and sensitization to airborne allergies seem to play a role in complications to acute bacterial rhinosinusitis in children.

Serious complications due to acute rhinosinusitis in children up to five years old in Stockholm, Sweden - Still a challenge in the pneumococcal conjugate vaccine era.

OBJECTIVES: The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS: This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS: A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS: Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.

Most preschool children hospitalised for acute rhinosinusitis had orbital complications, more common in the youngest and among boys.

AIM: This study established the incidence of acute rhinosinusitis and related orbital complications in tertiary care in Stockholm County and surveyed the clinical outcomes. METHODS: This was a population-based, retrospective, observational study, from July 1, 2003 to June 30, 2007, of the hospital admissions records of 213 children up to five years old, with a diagnosis of sinusitis and related complications. RESULTS: Preseptal cellulitis was present in 171 of the 213 admissions, which equated to an incidence of orbital complications due to acute rhinosinusitis of 36 per 100 000 people per year (95% confidence interval 26-49). Postseptal complications occurred in seven cases. The incidence rate ratio for hospitalisation of children less than two years old with rhinosinusitis compared with children aged 2-5 years was 2.8 (95% confidence interval 1.8-4.4). The incidence among boys was 53 per 100 000 people per year and 36 per 100 000 people per year for girls, and the incidence rate ratio was 1.5 (95% confidence interval 1.0-2.3). The most common bacterial finding was Streptococcus pneumoniae. CONCLUSION: Most children hospitalised for acute rhinosinusitis had an orbital complication, and this was more common in children under the age of two years and boys. Severe postseptal complications were rare.

Repeated exercise and redistribution thallium-201 scintigrams in patients with myocardial infarction treated with timolol or placebo.

Repeat exercise thallium-201 scintigrams were performed 2 weeks, 3 months, and 6 months in 27 patients following their first myocardial infarction. All patients were treated with timolol or matching placebo, administered intravenously starting within 5 hours of onset of chest pain. The extent of transient perfusion defects in 15 timolol-treated patients increased significantly between 2 weeks and 3 months compared to a decrease in 12 placebo-treated patients (p less than 0.05). Between 3 and 6 months the extent of transient defects did not change in the two groups, and there was no difference between the groups. The extent of permanent defects was not significantly different between the timolol- and placebo-treated patients on any occasion. However, patients in the timolol group had a decrease in permanent defects with time in contrast to patients in the placebo group (p less than 0.05). Thus, early intervention with timolol in the acute phase of myocardial infarction may have consequences for the postinfarction phase, as reflected in repeat thallium-201 scintigrams.

Stokes-Adams attacks requiring pacemaker treatment in three patients with acute nonspecific myocarditis.

Three patients, aged 16--44 years, with complete heart block in acute myocarditis are reported. The diagnosis of myocarditis was based on the development of transitory repolarization disturbances on the ECG in association with clinical signs of acute infectious disease. All patients were brought to hospital due to repeated Stokes-Adams attacks and demonstrated ventricular asystoles for up to 25 sec. The patients were all successfully treated with temporary intracardiac pacing but one of them later turned out to require a permanent pacemaker. The possibility of differences in localization and in prognostic importance of conduction disturbances between infectious and ischemic myocardial disease is discussed.

Early work load tests for evaluation of long-term prognosis of acute myocardial infarction.

Exercise tests performed 3 and 9 weeks after acute myocardial infarction in 205 patients were found to give prognostic information on the survival during a follow-up period of 2 to 5 years. The appearance of tachycardia, major ventricular arrhythmias, or anginal complaints during these early exercise tests was thus accompanied by a significantly increased mortality during the observation period. Ventricular arrhythmias disclosed by exercise proved to be of higher prognostic significance than those recorded at rest on the same occasions. The usefulness of early exercise tests in the evaluation of the response to antiarrhythmic treatment after acute myocardial infarction as well as of the prognostic importance of the effects was documented in a smaller series of patients.