Chronic sinusitis: the disease of all ages

Article Abstract:

There is little information regarding the diagnosis and management of chronic sinusitis (infection or inflammation of the sinuses), a frequently overlooked disease of childhood. Sinusitis can occur in children of any age, including those under age five. Diagnosis is usually based on the history of symptoms, physical examination and X-rays. The main symptom is a cough, during both night and day, which may be accompanied by nasal obstruction, discharge, postnasal drip, and sore throat. It has been noted that up to 60 percent of children with sinusitis will also have middle-ear infection. Sinus X-rays are the most helpful tool, in addition to the physical examination, for diagnosing sinusitis. Little research has been done on the bacterial causes of sinusitis in children. Treatment of sinusitis should be directed toward the potential bacterial cause of the disease. An initial trial of antibiotics is recommended, and if no response is seen after a few weeks, a second trial of different antibiotics should be given. Usually within five days the cough and runny nose begin to resolve, and the patient feels better. If there is no response, then washing out the sinuses with antibiotic solution may be indicated. Surgery is not usually recommended, but if there is postnasal obstruction, removal of the adenoids will improve the flow of air. A child with allergic rhinitis (nasal inflammation) should be treated for the allergy, or the sinusitis will recur. In children who have middle-ear disease along with sinusitis, the ear problem may not improve until the sinusitis resolves. Also, patients who have asthma as well as sinusitis may have difficulty controlling their asthma until the underlying sinusitis improves. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Sinusitis, editorial

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Chronic neutropenia during childhood: a 13-year experience in a single institution

Article Abstract:

To learn more concerning the progression and outcome of chronic neutropenia (a deficiency of neutrophils, one class of white blood cell) in children, 50 patients with this condition were studied. Neutropenia was defined as a neutrophil count below a criterion level, and a chronic condition was one that existed more than eight weeks. The median age neutropenia began for the 45 patients whose disease was of unknown origin was 12 months. These patients suffered frequent but mild infections. Six of the 23 girls developed an abscess or infection of the labia majora at some point; other signs and symptoms that appeared in a few patients are described. In 28 of 31 patients who underwent bone marrow aspiration (removal of bone marrow for analysis), the marrow was normal or only neutropenic. The patients received antibiotic treatment when fevers developed. As they aged, the frequency of minor infections decreased. Twelve children required hospitalization, but many of these admissions were for diagnostic purposes. In 23 of the 37 children for whom follow-up information was available, the neutropenia resolved within 19 months. Thirteen remained neutropenic and one patient died. With the exception of two severely affected patients, 35 of the 37 were in good health. The results indicate that chronic neutropenia often has a benign course, with few patients suffering severe infections. It seems likely that neutropenia of undefined origin is an autoimmune disease (in which the immune system attacks components of the body's own cells), rather than a congenital absence of neutrophils. A review is presented of treatment options. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Development and progression, Pediatrics, Hematology, Neutropenia, Pediatric hematology

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Gonococcal conjunctivitis in prepubertal children

Article Abstract:

Four case histories of gonococcal conjunctivitis in children are presented. Gonococcal conjunctivitis is an infection of the conjunctiva (mucus membrane of the eye) caused by N. gonorrhoeae, and is seldom seen in children. The infection most frequently occurs in adults; it is also found among infants, where the infection has been acquired from the mother. Symptoms that were observed included discharge, eyelid swelling, and rash. If untreated, this condition can result in severe complications including loss of vision. All of the children had a fever and inflammation of the eye. The recommended treatment is antibiotics. Sexual abuse should be suspected in all cases of gonorrheal infections in children. Investigation of these four cases involved physical examination of the children, including cultures taken from the throat, genitals, and rectum, all of which proved negative. Other inquiries, including a detailed social evaluation, did not reveal evidence of sexual abuse in these cases. However, three of the four children shared a bed with a parent; two of these children had N. gonorrhoeae which matched strains isolated from the parent, which suggests a non-sexual mode of transmission. Close contact of a nonsexual nature may have caused the infections in these children. Asymptomatic adults who have close contact with children who are diagnosed with gonococcal conjunctivitis should be tested for N. gonorrhoeae. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Complications and side effects, Eye, Gonorrhea, Conjunctivitis

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