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Thursday, September 15, 2016

A 27 Year Old Male Presenting with Nasal Discharge, Congestion and Headache

A 27 year old male presents to his doctor with symptoms of nasal discharge. nasal congestion and headache which all started about a week ago. He mentions being in a healthy state before these symptoms started and has no significant past history except getting frequent upper respiratory infections which usually resolve on conservative management. He took acetaminophen but is still not getting better.

Case Discussion:

Introduction To Upper Respiratory Infections:

  • URIs are among the leading cause of lost of time from work and school.
  • It is difficult to distinguish URIs caused by virus or bacteria since the signs and symptoms are almost the same. 
  • Non specific URIs also known as "the common cold" have no prominent localizing features and usually present with nasal discharge, nasal congestion, cough and sore throat. In more severe cases patients may suffer from hoarseness, fever, malaise and body ache. 
  • The average duration of symptoms is about 1 week. 
Etiology of URIs: A wide variety of viruses e.g rhinoviruses, coronaviruses, parainfluenza, influenza virus and adenoviruses can cause non specific URIs. Secondary bacterial infections may complicate a few cases and may lead to prolonged course of disease with more severity of symptoms like purulent nasal and throat discharge. 

Treatment: Symptom based treatment like decongestants, antipyretics and anti inflammatory drugs are all that is required along with conservative measures like warm fluids, saline water gargles, etc.

Sinus Infections: Infection and inflammation of the sinuses known as Sinusitis is a common reason for visits to primary care physicians. it most commonly involves the maxillary sinus, followed by the ethmoid, frontal and sphenoidal sinus. 


Acute Sinusitis:

  •  Sinusitis is defined as Acute sinusitis if the duration of symptoms are less than 4 weeks.
  • Infectious  and non infectious causes lead to sinus ostial obstruction and retention of mucus.
  • Infectious causes include viruses ( rhinovirus, parainfluenza virus, influenza virus) and bacteria ( Strep.pnumoniae, Hemophillus influenzae, Moraxella catarrhalis). in immunocompromised patients fungal infections can also occur.
  • Non infectious causes include allergic rhinitis, barotrauma and exposure to chemical irritants.
  • Clinical signs and symptoms include nasal drainage and congestion, facial pain or pressure and headache.
  • Toothache and bad breath may be associated with bacterial sinus infection.
  • Advanced frontal sinusitis can present as " Pott's puffy tumor" : swelling and pitting edema over the frontal bone from a communicating sub periosteal abscess. 
                                           Pott's puffy tumor.
  • Life threatening complications include meningitis, epidural abscess and brain abscess. 
  • It is difficult to distinguish viral sinusitis from bacterial sinusitis but the viral cases outnumber the bacterial causes. 
  • If fungal sinusitis is a consideration the involved area should be biopsied.
  • Sinus Ct or radiography is not recommended for acute sinusitis except in nosocomial cases where it should be confirmed by sinus CT , with sinus aspirates sent for culture and susceptibility testing.
  • Most patients improve without antibiotic therapy. For patients with mild to moderate symptoms treatment should focus on symptom relief and facilitation of sinus drainage e.g using oral and topical decongestants, nasal saline lavage. 
  • Antibiotics should be given only to patients with severe disease at presentation or those who show no improvement after 10 days. 
  • Surgery is considered in patients with intracranial complications or invasive fungal sinusitis.
Guideline For Antibiotic Therapy In Acute Sinusitis:
Antibiotics should only be given in acute sinusitis when patient have moderate symptoms of purulent nasal congestion or cough for more than 10 days or patient presents with severe symptoms of any duration that includes focal facial swelling or tooth pain. 
 Treatment recommendations are summarized below:
  • Initial therapy: amoxicillin 500 mg PO tid or amoxicillin/clavulanate 500/125 mg PO tid. (Penicillin allergy : Doxycycline 100 mg PO bid or Clindamycin 300 mg PO tid )
Chronic Sinusitis: 
  • Sinusitis is defined as Chronic sinusitis iof duration of symptoms are more than 12 weeks. 
  •  It is commonly associated with bacterial or fungal infection. 
  • Impaired mucociliary clearance leads to repeated infections. 
  • Fungal infections usually seen in immunocompromised patients which may lead to bone erosion and serious complications. 

3 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
    Is the solution

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