Rhinosinusitis - Acute, Bacterial (Pediatric)

Definition

Acute bacterial rhinosinusitis (ABRS) in children is an infection of the paranasal sinuses caused by bacteria, usually following a viral upper respiratory infection, presenting with persistent nasal congestion, purulent nasal discharge, and sometimes fever.

Epidemiology

• Common in children aged 1–12 years
• Often follows viral upper respiratory infections
• Peak incidence during winter and early spring
• Estimated that 5–13% of children with viral rhinitis develop ABRS
• Recurrent infections more common in children with allergies, anatomical variations, or immunodeficiency

Etiology

• Bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
• Predisposing factors: viral URI, allergies, anatomical obstruction, immunodeficiency
• Environmental factors: exposure to smoke, daycare attendance
• Dental infections (upper teeth) may contribute in older children
• Less commonly, Staphylococcus aureus or anaerobic bacteria in complicated cases

Pathophysiology

• Viral infection leads to mucosal edema and impaired sinus drainage
• Stasis of mucus allows bacterial proliferation
• Inflammation of sinus mucosa causes pain, congestion, and purulent discharge
• Local immune response recruits neutrophils and inflammatory mediators
• Persistent infection may lead to complications such as orbital cellulitis or intracranial spread
• Recurrent infections may cause chronic sinus inflammation and mucosal thickening