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Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children

Marom, Tal MD*; Alvarez-Fernandez, Pedro E. MD*; Jennings, Kristofer PhD; Patel, Janak A. MD*; McCormick, David P. MD*; Chonmaitree, Tasnee MD*‡

Pediatric Infectious Disease Journal: August 2014 - Volume 33 - Issue 8 - p 803–808
doi: 10.1097/INF.0000000000000278
Original Studies

Background: Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory tract infections (URI). Clinical characteristics of URIs complicated by ABS in young children have not been well studied.

Methods: We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (6–35 months of age at enrollment), who were followed up for 1 year to capture all URI episodes and complications. At the initial URI visit seen by the study personnel (median day = 4 from symptoms onset), nasopharyngeal samples were obtained for bacterial cultures and viral studies.

Results: Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. Average age at ABS diagnosis was 18.8 ± 7.2 months; White children were more likely to have ABS episodes than Blacks (P = 0.01). Hispanic/Latino ethnicity (P < 0.0001) was negatively associated, and adequate 7-valent pneumococcal conjugate vaccine immunization status (P = 0.001) appeared to increase the risk of ABS. Girls had more ABS episodes than boys (0.5 ± 0.8 vs. 0.3 ± 0.6 episodes/yr, respectively, P = 0.03). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS risk (P = 0.01). Bacterial cultures were positive in 82/83 (99%) available samples obtained at the initial URI visit; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with the risk for ABS (P = 0.04 for both).

Conclusions: ABS complicates 8% of URI in young children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M. catarrhalis during URI are positively correlated with the risk for ABS complication.

From the *Department of Pediatrics; Department of Preventive Medicine and Community Health; and Department of Pathology, University of Texas Medical Branch, Galveston, TX.

Accepted for publication January 14, 2014.

This work was supported by the National Institutes of Health grants R01DC005841 and UL1TR000071. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Tasnee Chonmaitree, MD, Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77555-0371. E-mail: tchonmai@utmb.edu.

© 2014 by Lippincott Williams & Wilkins, Inc.